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Anderson AC, Ho J, Hall ET, Hannan R, Liao JJ, Louie AV, Ma TM, Psutka SP, Rengan R, Siva S, Swaminath A, Tachiki L, Tang C, Teh BS, Tsai J, Tykodi SS, Weg E, Zaorsky NG, Lo SS. Focal therapy for oligometastatic and oligoprogressive renal cell carcinoma: a narrative review. Future Oncol 2024; 20:2573-2588. [PMID: 39258792 PMCID: PMC11534104 DOI: 10.1080/14796694.2024.2389769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 08/05/2024] [Indexed: 09/12/2024] Open
Abstract
Metastatic renal cell carcinoma (RCC) can present with oligometastatic disease and/or develop oligoprogression following systemic therapy. Cytoreductive and focal metastasis-directed therapy options include resection, stereotactic ablative radiation and thermal ablation. Aggressive focal therapy may allow delay in initiation of or modification to systemic therapy and improve clinical outcomes. In this narrative review we synthesize current practice guidelines and prospective data on focal therapy management options and highlight future research. Patient selection and the choice of focal treatment techniques are controversial due to limited and heterogeneous data and patients may benefit from multidisciplinary evaluation. Prospective comparative trials with clearly defined inclusion criteria and relevant end points are needed to clarify the risks and benefits of different approaches.
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Affiliation(s)
- August C Anderson
- University of Washington, Department of Radiation Oncology, Seattle, WA 98195, USA
- Fred Hutchinson Cancer Center, Radiation Oncology Division, Seattle, WA 98195, USA
| | - Joel Ho
- Pfizer Inc., Bothell, WA 98011, USA
| | - Evan T Hall
- University of Washington, Division of Hematology & Oncology, Seattle, WA 98195,USA
- Fred Hutchinson Cancer Center, Clinical Research Division, Seattle, WA 98195, USA
| | - Raquibul Hannan
- The University of Texas Southwestern Medical Center, Radiation Oncology, Dallas, TX 75235, USA
- Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Kidney Cancer Program, Dallas, TX75235, USA
| | - Jay J Liao
- University of Washington, Department of Radiation Oncology, Seattle, WA 98195, USA
- Fred Hutchinson Cancer Center, Radiation Oncology Division, Seattle, WA 98195, USA
| | - Alexander V Louie
- Sunnybrook Health Sciences Centre, Department of Radiation Oncology, Toronto, ON, M4N 3M5, Canada
| | - Ting Martin Ma
- University of Washington, Department of Radiation Oncology, Seattle, WA 98195, USA
- Fred Hutchinson Cancer Center, Radiation Oncology Division, Seattle, WA 98195, USA
| | - Sarah P Psutka
- Fred Hutchinson Cancer Center, Clinical Research Division, Seattle, WA 98195, USA
- University of Washington, Department of Urology, Seattle, WA 98195, USA
| | - Ramesh Rengan
- University of Washington, Department of Radiation Oncology, Seattle, WA 98195, USA
- Fred Hutchinson Cancer Center, Radiation Oncology Division, Seattle, WA 98195, USA
| | - Shankar Siva
- Peter MacCallum Cancer Centre, Division of Radiation Oncology & Cancer Imaging, Melbourne, VIC, 3052, Australia
- The University of Melbourne, Sir Peter MacCallum Department of Oncology, Melbourne, VIC, 3052, Australia
| | - Anand Swaminath
- Juravinski Cancer Centre, Radiation Therapy, Hamilton, ON, L8V 5C2, Canada
- McMaster University, Division of Radiation Oncology, Hamilton, ON,L8S 4L8,Canada
| | - Lisa Tachiki
- University of Washington, Division of Hematology & Oncology, Seattle, WA 98195,USA
- Fred Hutchinson Cancer Center, Clinical Research Division, Seattle, WA 98195, USA
| | - Chad Tang
- The University of Texas MD Anderson Cancer Center, Genitourinary Radiation Oncology, Houston, TX 77030, USA
- The University of Texas MD Anderson Cancer Center, Investigational Cancer Therapeutics, Houston, TX 77030, USA
- The University of Texas MD Anderson Cancer Center, Translational Molecular Pathology, Houston, TX 77030, USA
| | - Bin Sing Teh
- Houston Methodist Hospital, Radiation Oncology, Houston, TX 77030, USA
| | - Joseph Tsai
- University of Washington, Department of Radiation Oncology, Seattle, WA 98195, USA
- Fred Hutchinson Cancer Center, Radiation Oncology Division, Seattle, WA 98195, USA
| | - Scott S Tykodi
- University of Washington, Division of Hematology & Oncology, Seattle, WA 98195,USA
- Fred Hutchinson Cancer Center, Clinical Research Division, Seattle, WA 98195, USA
| | - Emily Weg
- University of Washington, Department of Radiation Oncology, Seattle, WA 98195, USA
- Fred Hutchinson Cancer Center, Radiation Oncology Division, Seattle, WA 98195, USA
| | - Nicholas G Zaorsky
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Department of Radiation Oncology, Cleveland, OH 44106, USA
| | - Simon S Lo
- University of Washington, Department of Radiation Oncology, Seattle, WA 98195, USA
- Fred Hutchinson Cancer Center, Radiation Oncology Division, Seattle, WA 98195, USA
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David C, Muhammad A, Cristian U, Ben T, Arun A, Lewis A, Lavinia S, Marlon P, Shankar S. SABR for oligometastatic renal cell carcinoma. Clin Transl Radiat Oncol 2024; 45:100739. [PMID: 38380117 PMCID: PMC10877104 DOI: 10.1016/j.ctro.2024.100739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/25/2024] [Accepted: 01/27/2024] [Indexed: 02/22/2024] Open
Abstract
Stereotactic ablative body radiotherapy (SABR) aims to accurately deliver a higher than conventional dose of radiotherapy to a well-defined target tumour incorporating advanced immobilisation and imaging techniques. SABR is an emerging treatment option for primary kidney cancer especially when surgery is contraindicated. Increasingly, SABR is being incorporated into the management of low-volume stage IV kidney cancers to delay the need for systemic therapy or to prolong the duration of ongoing systemic treatment. This review will evaluate the evidence and limitations of SABR for oligometastatic renal cell carcinoma.
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Affiliation(s)
- Chang David
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ali Muhammad
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Udovicich Cristian
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Tran Ben
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Azad Arun
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Au Lewis
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Spain Lavinia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Perera Marlon
- Division of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Siva Shankar
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
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Antoni D, Mesny E, El Kabbaj O, Josset S, Noël G, Biau J, Feuvret L, Latorzeff I. Role of radiotherapy in the management of brain oligometastases. Cancer Radiother 2024; 28:103-110. [PMID: 37802747 DOI: 10.1016/j.canrad.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/27/2023] [Accepted: 03/29/2023] [Indexed: 10/08/2023]
Abstract
The management of patients with brain oligometastases is complex and relies on specific reasoning compared to extracranial oligometastases. The levels of evidence are still low because patients with brain oligometastases are frequently excluded from randomized clinical trials. Stereotactic radiotherapy should be preferred in this indication over whole brain irradiation, both for patients with metastases in place and for those who have undergone surgery. The decision of local treatment and its timing must be a multidisciplinary reflection taking into account the histological and molecular characteristics of the tumor as well as the intracranial efficacy of the prescribed systemic treatments. Great caution must be observed when using stereotactic radiotherapy and concomitant systemic treatments because interactions are still poorly documented. We present the recommendations of the French society of radiation oncology on the management of brain oligometastatic patients with radiotherapy.
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Affiliation(s)
- D Antoni
- Radiation Therapy Department, Institut de cancérologie Strasbourg Europe, 67033 Strasbourg, France.
| | - E Mesny
- Radiation Therapy Department, Hospices civils de Lyon, 69000 Lyon, France
| | - O El Kabbaj
- Radiation Therapy Department, hôpital privé Océane, 56000 Vannes, France
| | - S Josset
- Medical Physics, Institut de cancérologie de l'Ouest, 44800 Saint-Herblain, France
| | - G Noël
- Radiation Therapy Department, Institut de cancérologie Strasbourg Europe, 67033 Strasbourg, France
| | - J Biau
- Radiation Therapy Department, centre Jean-Perrin, 63011 Clermont-Ferrand, France
| | - L Feuvret
- Radiation Therapy Department, Hospices civils de Lyon, 69000 Lyon, France
| | - I Latorzeff
- Radiation Therapy Department, clinique Pasteur, 31300 Toulouse, France
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Bekku K, Kawada T, Sekito T, Yoshinaga K, Maruyama Y, Yamanoi T, Tominaga Y, Sadahira T, Katayama S, Iwata T, Nishimura S, Edamura K, Kobayashi T, Kobayashi Y, Araki M, Niibe Y. The Diagnosis and Treatment Approach for Oligo-Recurrent and Oligo-Progressive Renal Cell Carcinoma. Cancers (Basel) 2023; 15:5873. [PMID: 38136417 PMCID: PMC10741872 DOI: 10.3390/cancers15245873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023] Open
Abstract
One-third of renal cell carcinomas (RCCs) without metastases develop metastatic disease after extirpative surgery for the primary tumors. The majority of metastatic RCC cases, along with treated primary lesions, involve limited lesions termed "oligo-recurrent" disease. The role of metastasis-directed therapy (MDT), including stereotactic body radiation therapy (SBRT) and metastasectomy, in the treatment of oligo-recurrent RCC has evolved. Although the surgical resection of all lesions alone can have a curative intent, SBRT is a valuable treatment option, especially for patients concurrently receiving systemic therapy. Contemporary immune checkpoint inhibitor (ICI) combination therapies remain central to the management of metastatic RCC. However, one objective of MDT is to delay the initiation of systemic therapies, thereby sparing patients from potentially unnecessary burdens. Undertaking MDT for cases showing progression under systemic therapies, known as "oligo-progression", can be complex in considering the treatment approach. Its efficacy may be diminished compared to patients with stable disease. SBRT combined with ICI can be a promising treatment for these cases because radiation therapy has been shown to affect the tumor microenvironment and areas beyond the irradiated sites. This may enhance the efficacy of ICIs, although their efficacy has only been demonstrated in clinical trials.
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Affiliation(s)
- Kensuke Bekku
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan; (T.K.); (T.S.); (K.Y.); (Y.M.); (T.Y.); (Y.T.); (T.S.); (S.K.); (T.I.); (S.N.); (K.E.); (T.K.); (Y.K.); (M.A.)
| | - Tatsushi Kawada
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan; (T.K.); (T.S.); (K.Y.); (Y.M.); (T.Y.); (Y.T.); (T.S.); (S.K.); (T.I.); (S.N.); (K.E.); (T.K.); (Y.K.); (M.A.)
| | - Takanori Sekito
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan; (T.K.); (T.S.); (K.Y.); (Y.M.); (T.Y.); (Y.T.); (T.S.); (S.K.); (T.I.); (S.N.); (K.E.); (T.K.); (Y.K.); (M.A.)
| | - Kasumi Yoshinaga
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan; (T.K.); (T.S.); (K.Y.); (Y.M.); (T.Y.); (Y.T.); (T.S.); (S.K.); (T.I.); (S.N.); (K.E.); (T.K.); (Y.K.); (M.A.)
| | - Yuki Maruyama
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan; (T.K.); (T.S.); (K.Y.); (Y.M.); (T.Y.); (Y.T.); (T.S.); (S.K.); (T.I.); (S.N.); (K.E.); (T.K.); (Y.K.); (M.A.)
| | - Tomoaki Yamanoi
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan; (T.K.); (T.S.); (K.Y.); (Y.M.); (T.Y.); (Y.T.); (T.S.); (S.K.); (T.I.); (S.N.); (K.E.); (T.K.); (Y.K.); (M.A.)
| | - Yusuke Tominaga
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan; (T.K.); (T.S.); (K.Y.); (Y.M.); (T.Y.); (Y.T.); (T.S.); (S.K.); (T.I.); (S.N.); (K.E.); (T.K.); (Y.K.); (M.A.)
| | - Takuya Sadahira
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan; (T.K.); (T.S.); (K.Y.); (Y.M.); (T.Y.); (Y.T.); (T.S.); (S.K.); (T.I.); (S.N.); (K.E.); (T.K.); (Y.K.); (M.A.)
| | - Satoshi Katayama
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan; (T.K.); (T.S.); (K.Y.); (Y.M.); (T.Y.); (Y.T.); (T.S.); (S.K.); (T.I.); (S.N.); (K.E.); (T.K.); (Y.K.); (M.A.)
| | - Takehiro Iwata
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan; (T.K.); (T.S.); (K.Y.); (Y.M.); (T.Y.); (Y.T.); (T.S.); (S.K.); (T.I.); (S.N.); (K.E.); (T.K.); (Y.K.); (M.A.)
| | - Shingo Nishimura
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan; (T.K.); (T.S.); (K.Y.); (Y.M.); (T.Y.); (Y.T.); (T.S.); (S.K.); (T.I.); (S.N.); (K.E.); (T.K.); (Y.K.); (M.A.)
| | - Kohei Edamura
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan; (T.K.); (T.S.); (K.Y.); (Y.M.); (T.Y.); (Y.T.); (T.S.); (S.K.); (T.I.); (S.N.); (K.E.); (T.K.); (Y.K.); (M.A.)
| | - Tomoko Kobayashi
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan; (T.K.); (T.S.); (K.Y.); (Y.M.); (T.Y.); (Y.T.); (T.S.); (S.K.); (T.I.); (S.N.); (K.E.); (T.K.); (Y.K.); (M.A.)
| | - Yasuyuki Kobayashi
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan; (T.K.); (T.S.); (K.Y.); (Y.M.); (T.Y.); (Y.T.); (T.S.); (S.K.); (T.I.); (S.N.); (K.E.); (T.K.); (Y.K.); (M.A.)
| | - Motoo Araki
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan; (T.K.); (T.S.); (K.Y.); (Y.M.); (T.Y.); (Y.T.); (T.S.); (S.K.); (T.I.); (S.N.); (K.E.); (T.K.); (Y.K.); (M.A.)
| | - Yuzuru Niibe
- Department of Public Health, School of Medicine, Kurume University, Fukuoka 830-0011, Japan;
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Franzese C, Marini B, Baldaccini D, Badalamenti M, Navarria P, Bellu L, Franceschini D, Comito T, Clerici E, Teriaca MA, Massaro M, Di Cristina L, Lo Faro L, Tomatis S, Scorsetti M. The impact of stereotactic ablative radiotherapy on oligoprogressive metastases from renal cell carcinoma. J Cancer Res Clin Oncol 2023; 149:4411-4417. [PMID: 36109401 DOI: 10.1007/s00432-022-04352-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/07/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Renal cell carcinoma (RCC) represents 80-90% of all kidney tumors and about 15-25% of patients will develop distant metastases. Systemic therapy represents the standard of care for metastatic patients, but stereotactic ablative radiotherapy (SABR) may play a relevant role in the oligoprogressive setting, defined as the progression of few metastases during an ongoing systemic therapy on a background of otherwise stable disease. Aim of the present study was to analyze the outcome of RCC patients treated with SABR on oligoprogressive metastases. MATERIALS AND METHODS In this monocenter study, we analyzed patients affected by RCC treated with SABR on a maximum of 5 cranial or extracranial oligoprogressive sites of disease. Endpoints were overall survival (OS), progression-free survival (PFS), and toxicity. RESULTS We included 74 oligoprogressions (26 intracranial and 48 extracranial) and 57 SABR treatments in 44 patients. Most common concomitant treatments were sunitinib (28, 49.1%), pazopanib (12, 21.0%) and nivolumab (11, 19.3%). Median follow-up was 19.0 months, and 1- and 2-year OS rates were 79.2% and 57.3%, respectively. Repeated SABR was a positive predictive factor for OS (p = 0.034). Median PFS was 9.8 months, with 1- and 2-year rates of 43.2% and 25.8%. At multivariable analysis, disease-free interval (p = 0.022) and number of treated metastases (p = 0.007) were significant for PFS. About 80% of patients continued the ongoing systemic therapy 1- and 2-years after SABR with no grade 3 or 4 toxicities. CONCLUSIONS we confirmed the efficacy and safety of SABR for oligoprogression from RCC, with the potential to ablate resistant metastases and to prolong the ongoing systemic therapy.
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Affiliation(s)
- Ciro Franzese
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy.
- Deparment of Radiotherapy and Radiosurgery, Humanitas Research Hospital IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
| | - Beatrice Marini
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy
- Deparment of Radiotherapy and Radiosurgery, Humanitas Research Hospital IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Davide Baldaccini
- Deparment of Radiotherapy and Radiosurgery, Humanitas Research Hospital IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Marco Badalamenti
- Deparment of Radiotherapy and Radiosurgery, Humanitas Research Hospital IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Pierina Navarria
- Deparment of Radiotherapy and Radiosurgery, Humanitas Research Hospital IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Luisa Bellu
- Deparment of Radiotherapy and Radiosurgery, Humanitas Research Hospital IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Davide Franceschini
- Deparment of Radiotherapy and Radiosurgery, Humanitas Research Hospital IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Tiziana Comito
- Deparment of Radiotherapy and Radiosurgery, Humanitas Research Hospital IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Elena Clerici
- Deparment of Radiotherapy and Radiosurgery, Humanitas Research Hospital IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Maria Ausilia Teriaca
- Deparment of Radiotherapy and Radiosurgery, Humanitas Research Hospital IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Maria Massaro
- Deparment of Radiotherapy and Radiosurgery, Humanitas Research Hospital IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Luciana Di Cristina
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy
- Deparment of Radiotherapy and Radiosurgery, Humanitas Research Hospital IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Lorenzo Lo Faro
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy
- Deparment of Radiotherapy and Radiosurgery, Humanitas Research Hospital IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Stefano Tomatis
- Deparment of Radiotherapy and Radiosurgery, Humanitas Research Hospital IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Marta Scorsetti
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy
- Deparment of Radiotherapy and Radiosurgery, Humanitas Research Hospital IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
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Le Guevelou J, Sargos P, Siva S, Ploussard G, Ost P, Gillessen S, Zilli T. The Emerging Role of Extracranial Stereotactic Ablative Radiotherapy for Metastatic Renal Cell Carcinoma: A Systematic Review. Eur Urol Focus 2023; 9:114-124. [PMID: 36151031 DOI: 10.1016/j.euf.2022.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/12/2022] [Accepted: 08/30/2022] [Indexed: 11/28/2022]
Abstract
CONTEXT Although the management of metastatic renal cell carcinoma (mRCC) has been revolutionized by the advent of new systemic agents, still few patients experience a long-term durable response. Stereotactic ablative radiotherapy (SABR) is nowadays commonly used as metastasis-directed therapy (MDT), but limited data exist on how best to implement this strategy as part of a multimodal approach. OBJECTIVE To evaluate the potential role of extracranial SABR in mRCC and to identify future therapeutic developments of SABR in different disease settings. EVIDENCE ACQUISITION A systematic review was conducted in May 2022 according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement on the PubMed database. Thirty-four studies were selected for inclusion in this systematic review. EVIDENCE SYNTHESIS SABR has been used with four main goals: (1) eradication of the whole metastatic burden in synchronous and metachronous oligometastatic patients, resulting in a long-term local control (LC) rate of >90% and median progression-free survival (PFS) ranging between 8 and 15 mo; (2) eradication of oligoprogressive lesions, enabling an extension of the duration of the systemic therapy by approximately 9 mo; (3) improvement of the response to systemic therapy in polymetastatic patients, resulting in an overall response rate ranging from 17% to 56%; and (4) cytoreduction in polymetastatic mRCC patients, with LC rates ranging between 71% and 100%, and preservation of the renal function, but unclear PFS and overall survival impact. Overall, the combination of SABR and systemic agents has been associated with overall good tolerance, with grade ≥3 toxicity ranging from 0% to 13%. CONCLUSIONS Current data highlight the role of SABR as an emerging MDT treatment option in both oligometastatic and oligoprogressive extracranial mRCC, able to ensure long-term disease control and delay the use of next-line systemic therapies. The use of SABR for cytoreduction in the de novo metastatic disease and as an immunological booster in the polymetastatic setting remains investigational and warrants further investigations. PATIENT SUMMARY Radiotherapy delivered with ablative doses (>6 Gy per fraction) is a promising treatment strategy for patients diagnosed with metastatic renal cell carcinoma. Excellent outcome results have been observed in patients with a limited number of metastases, improving metastasis-free survival by several months. For patients with a few metastases progressing under systemic therapy, radiotherapy allows an extension of the duration of the ongoing therapy by several months.
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Affiliation(s)
- Jennifer Le Guevelou
- Department of Radiation Oncology, Faculty of Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Paul Sargos
- Department of Radiation Oncology, Institut Bergonié, Bordeaux, France
| | - Shankar Siva
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia; Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Guillaume Ploussard
- Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France; Institut Universitaire du Cancer Oncopole, Toulouse, France
| | - Piet Ost
- Iridium Network, Radiation Oncology, Antwerp, Belgium; Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Silke Gillessen
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland; Università della Svizzera Italiana, Lugano, Switzerland
| | - Thomas Zilli
- Department of Radiation Oncology, Faculty of Medicine, Geneva University Hospital, Geneva, Switzerland; Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland; Università della Svizzera Italiana, Lugano, Switzerland.
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