Stereotactic body radiation therapy for inoperable localized kidney cancer
https://doi.org/10.21294/1814-4861-2023-22-2-120-128
Abstract
Purpose of the study: to evaluate the overall survival and local control in patients with inoperable kidney cancer treated with stereotactic body radiotherapy (SBRT).
Material and Methods. From 2011 to 2021, 42 patients with histologically verified kidney cancer underwent SBRT to a total dose ranging from 30 to 45 Gr in 3 fractions using the CyberKnife robotic radiosurgical system. SBRT was performed for inoperable patients, taking into account various factors (age, severity of concomitant pathology, ASA IV physical status level), patients’ refusal of surgical treatment, and tumor size of ≤5.0 cm in diameter. SBRT was not performed for patients with tumor size of ≥5.0 cm in diameter, impaired renal function, generalization of cancer and decompensation of concomitant pathology. The median age of the patients was 67.9 years. 93 % of patients had stage I kidney cancer. The primary tumor was diagnosed in 37 cases, recurrence after previous surgical treatment in 6, including 1 patient with recurrence of cancer of both kidneys. The average tumor volume was 28.1 cm3.
Results. The median overall survival (OS) was not reached due to the fact that the majority of patients (n=36) were alive at the time of the study. The 1-, 3- and 5-year OS rates were 94.1 %, 88.7 %, and 72.6 %, respectively. The 1-year local control rate was 93 %. At 3-6 months, 26.2 % of patients showed partial response, 66.8 % had stable disease and 7 % had disease progression (according to the RECIST 1.1 criteria). Renal toxicity occurred in 23.8 % of patients 3 months after radiation therapy; however, kidney function was restored in these patients within a year.
Conclusion. SBRT has demonstrated high efficacy with minimal toxicity in the treatment of inoperable patients with kidney cancer.
About the Authors
Zh. E. Sabelnikova
Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine
Russian Federation
Russian Federation
Zhanna E. Sabelnikova, MD, Radiotherapist,
42, Bluchera St., 454000, Chelyabinsk
M. M. Sarycheva
Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine;
South Ural State Medical University
Russian Federation
Russian Federation
Marina M. Sarycheva, MD, PhD, Radiotherapist, 42, Bluchera St., 454000, Chelyabinsk;
assistant of Department of Oncology, Radiation Diagnostics and Radiation Therapy, 64, Vorovskogo St., 454000, Chelyabinsk
E. Ya. Mozerova
Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine;
South Ural State Medical University
Russian Federation
Russian Federation
Ekaterina Ya. Mozerova, MD, PhD, Head of Radiotherapy Department № 1, 42, Bluchera St., 454000, Chelyabinsk;
Associate Professor of the Department of Oncology, Radiation Diagnostics and Radiation Therapy, 64, Vorovskogo St., 454000, Chelyabinsk
A. V. Vazhenin
South Ural State Medical University
Russian Federation
Russian Federation
Andrey V. Vazhenin, MD, Professor, Full Member of the Russian Academy of Sciences, Head of the Department of Oncology, Radiation Diagnostics and Radiation Therapy,
64, Vorovskogo St., 454000, Chelyabinsk
References
1. NCCN Guidelines Updates: Kidney Cancer. 2022; 20(1). https://doi.org/10.6004/jnccn.2022.201glup.
2. de la Pinta C., Latorre R.G., Fuentes R. SBRT in Localized Renal Carcinoma: A Review of the Literature. Anticancer Res. 2022; 42(2): 667–74. doi: 10.21873/anticanres.15525.
3. Chang J.H., Cheung P., Erler D., Sonier M., Korol R., Chu W. Stereotactic Ablative Body Radiotherapy for Primary Renal Cell Carcinoma in Non-surgical Candidates: Initial Clinical Experience. Clin Oncol (R Coll Radiol). 2016; 28(9): 109–14. doi: 10.1016/j.clon.2016.04.002.
4. Siva S., Chesson B., Bressel M., Pryor D., Higgs B., Reynolds H.M., Hardcastle N., Montgomery R., Vanneste B., Khoo V., Ruben J., Lau E., Hofman M.S., De Abreu Lourenco R., Sridharan S., Brook N.R., Martin J., Lawrentschuk N., Kron T., Foroudi F. TROG 15.03 phase II clinical trial of Focal Ablative STereotactic Radiosurgery for Cancers of the Kidney – FASTRACK II. BMC Cancer. 2018; 18(1): 1030. doi: 10.1186/s12885-018-4916-2.
5. Grant S.R., Lei X., Hess K.R., Smith G.L., Matin S.F., Wood C.G., Nguyen Q., Frank S.J., Anscher M.S., Smith B.D., Karam J.A., Tang C. Stereotactic Body Radiation Therapy for the Defnitive Treatment of Early Stage Kidney Cancer: A Survival Comparison With Surgery, Tumor Ablation, and Observation. Adv Radiat Oncol. 2020; 5(3): 495–502. doi: 10.1016/j.adro.2020.01.002.
6. Haque W., Verma V., Lewis G.D., Lo S.S., Butler E.B., Teh B.S. Utilization of radiotherapy and stereotactic body radiation therapy for renal cell cancer in the USA. Future Oncol. 2018; 14(9): 819–27. doi: 10.2217/fon-2017-0536.
7. Siva S., Jackson P., Kron T., Bressel M., Lau E., Hofman M., Shaw M., Chander S., Pham D., Lawrentschuk N., Wong L.M., Goad J., Foroudi F. Impact of stereotactic radiotherapy on kidney function in primary renal cell carcinoma: Establishing a dose-response relationship. Radiother Oncol. 2016; 118(3): 540–6. doi: 10.1016/j.radonc.2016.01.027.
8. Staehler M., Bader M., Schlenker B., Casuscelli J., Karl A., Roosen A., Stief C.G., Bex A., Wowra B., Muacevic A. Single fraction radiosurgery for the treatment of renal tumors. J Urol. 2015; 193(3): 771–5. doi: 10.1016/j.juro.2014.08.044.
9. Siva S., Louie A.V., Warner A., Muacevic A., Gandhidasan S., Ponsky L., Ellis R., Kaplan I., Mahadevan A., Chu W., Swaminath A., Onishi H., Teh B., Correa R.J., Lo S.S., Staehler M. Pooled analysis of stereotactic ablative radiotherapy for primary renal cell carcinoma: A report from the International Radiosurgery Oncology Consortium for Kidney (IROCK). Cancer. 2018; 124(5): 934–42. doi: 10.1002/cncr.31156.
10. Correa R.J.M., Louie A.V., Zaorsky N.G., Lehrer E.J., Ellis R., Ponsky L., Kaplan I., Mahadevan A., Chu W., Swaminath A., Hannan R., Onishi H., Teh B.S., Muacevic A., Lo S.S., Staehler M., Siva S. The Emerging Role of Stereotactic Ablative Radiotherapy for Primary Renal Cell Carcinoma: A Systematic Review and Meta-Analysis. Eur Urol Focus. 2019; 5(6): 958–69. doi: 10.1016/j.euf.2019.06.002.
11. Wegner R.E., Abel S., Vemana G., Mao S., Fuhrer R. Utilization of Stereotactic Ablative Body Radiation Therapy for Intact Renal Cell Carcinoma: Trends in Treatment and Predictors of Outcome. Adv Radiat Oncol. 2019; 5(1): 85–91. doi: 10.1016/j.adro.2019.07.018.
12. Siva S., Correa R.J.M., Warner A., Staehler M., Ellis R.J., Ponsky L., Kaplan I.D., Mahadevan A., Chu W., Gandhidasan S., Swa minath A., Onishi H., Teh B.S., Lo S.S., Muacevic A., Louie A.V. Stereotactic Ablative Radiotherapy for ≥T1b Primary Renal Cell Carcinoma: A Report From the International Radiosurgery Oncology Consortium for Kidney (IROCK). Int J Radiat Oncol Biol Phys. 2020; 108(4): 941–9. doi: 10.1016/j.ijrobp.2020.06.014.
13. Ponsky L., Lo S.S., Zhang Y., Schluchter M., Liu Y., Patel R., Abouassaly R., Welford S., Gulani V., Haaga J.R., Machtay M., Ellis R.J. Phase I dose-escalation study of stereotactic body radiotherapy (SBRT) for poor surgical candidates with localized renal cell carcinoma. Radiother Oncol. 2015; 117(1): 183–7. doi: 10.1016/j.radonc.2015.08.030.
14. Peddada A.V., Anderson D., Blasi O.C., McCollough K., Jennings S.B., Monroe A.T. Nephron-Sparing Robotic Radiosurgical Therapy for Primary Renal Cell Carcinoma: Single-Institution Experience and Review of the Literature. Adv Radiat Oncol. 2019; 5(2): 204–11. doi: 10.1016/j.adro.2019.10.001.
15. Senger C., Conti A., Kluge A., Pasemann D., Kufeld M., Acker G., Lukas M., Grün A., Kalinauskaite G., Budach V., Waiser J., Stromberger C. Robotic stereotactic ablative radiotherapy for renal cell carcinoma in patients with impaired renal function. BMC Urol. 2019; 19(1): 96. doi: 10.1186/s12894-019-0531-z.
16. Yamamoto T., Kadoya N., Takeda K., Matsushita H., Umezawa R., Sato K., Kubozono M., Ito K., Ishikawa Y., Kozumi M., Takahashi N., Katagiri Y., Onishi H., Jingu K. Renal atrophy after stereotactic body radiotherapy for renal cell carcinoma. Radiat Oncol. 2016; 11: 72. doi: 10.1186/s13014-016-0651-5.
17. Swaminath A., Cheung P., Glicksman R.M., Donovan E.K., Niglas M., Vesprini D., Kapoor A., Erler D., Chu W. Patient-reported Quality of Life following Stereotactic Body Radiation Therapy for Primary Kidney Cancer – Results from a Prospective Cohort Study. Clin Oncol (R Coll Radiol). 2021; 33(7): 468–75. doi: 10.1016/j.clon.2021.03.002.
Review
For citations:
Sabelnikova Zh.E., Sarycheva M.M., Mozerova E.Ya., Vazhenin A.V. Stereotactic body radiation therapy for inoperable localized kidney cancer. Siberian journal of oncology. 2023;22(2):120-128. (In Russ.) https://doi.org/10.21294/1814-4861-2023-22-2-120-128
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