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Stereotactic Body Radiotherapy for the Treatment of Oligometastatic Renal Cell Carcinoma

Ranck, Mark C. MD*; Golden, Daniel W. MD*; Corbin, Kimberly S. MD*; Hasselle, Michael D. MD*; Liauw, Stanley L. MD*,†; Stadler, Walter M. MD†,‡; Hahn, Olwen M. MD†,‡; Weichselbaum, Ralph R. MD*,†,§; Salama, Joseph Kamel MD

American Journal of Clinical Oncology: December 2013 - Volume 36 - Issue 6 - p 589–595
doi: 10.1097/COC.0b013e31825d52b2
Original Articles: Genitourinary

Objectives: Renal cell carcinoma (RCC) is considered radioresistant, but stereotactic radiosurgery can control intracranial metastases. Advances in radiotherapy, such as stereotactic body radiotherapy (SBRT), allow high-dose radiation delivery to extracranial sites. Herein, we report our experience treating oligometastatic RCC with SBRT.

Methods: Patients with RCC and limited metastases were treated on a 3-fraction dose-escalation protocol (8 to 14 Gy/fraction) or off protocol with 10 fractions (4 to 5 Gy/fraction). Disease control was evaluated with serial imaging, and the Kaplan-Meier method was used to estimate lesion control (LeC), distant control, and survival.

Results: Eighteen consecutively treated patients with 39 metastases were treated using SBRT; 12 underwent treatment for all metastatic sites. Median follow-up was 16.2 months. Treatment was well tolerated; the most common acute toxicity was fatigue (61.1%) and late toxicity was limited. At 2 years, LeC was 91.4% and overall survival was 85%. Those who underwent treatment for all metastatic sites had a 2-year LeC of 100% and distant control of 35.7%. A shorter interval from diagnosis to SBRT predicted for distant progression. Freedom from any post-SBRT therapy was 64.2% at 1 year.

Conclusions: In metastatic RCC, SBRT produces promising LeC with minimal toxicity. Further study should be expanded beyond that of managing intracranial disease. Its selected use may delay the requirement for systemic therapies.

*Department of Radiation and Cellular Oncology

Cancer Research Center

Section of Hematology/Oncology

§Ludwig Center for Metastasis Research, University of Chicago, Chicago, IL

Department of Radiation Oncology, Duke University Medical Center, Durham, NC

The authors declare no conflicts of interest.

Reprints: Joseph Kamel Salama, MD, Department of Radiation Oncology, Box 3085, Duke University Medical Center, Durham, NC 27710. E-mail: joseph.salama@duke.edu.

© 2013 by Lippincott Williams & Wilkins, Inc