Top

Published in:

01-12-2016 | Review Article

Stereotactic body radiotherapy for renal cell cancer and pancreatic cancer

Literature review and practice recommendations of the DEGRO Working Group on Stereotactic Radiotherapy

Authors: Dr.med. Cédric Panje, PD Dr. med. Nikolaus Andratschke, Prof. Dr. med. Thomas B. Brunner, PD Dr. med. Maximilian Niyazi, Prof. Dr. med. Matthias Guckenberger

Published in: Strahlentherapie und Onkologie | Issue 12/2016

Abstract

Purpose

This report of the Working Group on Stereotactic Radiotherapy of the German Society of Radiation Oncology (DEGRO) aims to provide a literature review and practice recommendations for stereotactic body radiotherapy (SBRT) of primary renal cell cancer and primary pancreatic cancer.

Methods

A literature search on SBRT for both renal cancer and pancreatic cancer was performed with focus on prospective trials and technical aspects for clinical implementation.

Results

Data on renal and pancreatic SBRT are limited, but show promising rates of local control for both treatment sites. For pancreatic cancer, fractionated SBRT should be preferred to single-dose treatment to reduce the risk of gastrointestinal toxicity. Motion-compensation strategies and image guidance are paramount for safe SBRT delivery in both tumor entities.

Conclusion

SBRT for renal cancer and pancreatic cancer have been successfully evaluated in phase I and phase II trials. Pancreatic SBRT should be practiced carefully and only within prospective protocols due to the risk of severe gastrointestinal toxicity. SBRT for primary renal cell cancer appears a viable option for medically inoperable patients but future research needs to better define patient selection criteria and the detailed practice of SBRT.

Timmerman RD, Herman J, Cho LC (2014) Emergence of stereotactic body radiation therapy and its impact on current and future clinical practice. J Clin Oncol 32:2847–2854. doi:10.1200/JCO.2014.55.4675 CrossRefPubMedPubMedCentral

Guckenberger M, Andratschke N, Alheit H et al (2014) Definition of stereotactic body radiotherapy: principles and practice for the treatment of stage I non-small cell lung cancer. Strahlenther Onkol 190:26–33. doi:10.1007/s00066-013-0450-y CrossRefPubMed

Sterzing F, Brunner TB, Ernst I et al (2014) Stereotactic body radiotherapy for liver tumors: principles and practical guidelines of the DEGRO Working Group on Stereotactic Radiotherapy. Strahlenther Onkol 190:872–881. doi:10.1007/s00066-014-0714-1 CrossRefPubMed

Stieb S, Lang S, Linsenmeier C et al (2015) Safety of high-dose-rate stereotactic body radiotherapy. Radiat Oncol 10:27. doi:10.1186/s13014-014-0317-0 CrossRefPubMedPubMedCentral

Hanson PW, Elaimy AL, Lamoreaux WT et al (2012) A concise review of the efficacy of stereotactic radiosurgery in the management of melanoma and renal cell carcinoma brain metastases. World J Surg Oncol 10:176. doi:10.1186/1477-7819-10-176 CrossRefPubMedPubMedCentral

Rini BI, Campbell SC, Escudier B (2009) Renal cell carcinoma. Lancet 373:1119–1132. doi:10.1016/S0140-6736(09)60229-4 CrossRefPubMed

Escudier B, Porta C, Schmidinger M et al (2014) Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 25(Suppl 3):iii49–iii56. doi:10.1093/annonc/mdu259 CrossRefPubMed

Flanigan RC, Mickisch G, Sylvester R et al (2004) Cytoreductive nephrectomy in patients with metastatic renal cancer: a combined analysis. J Urol 171:1071–1076. doi:10.1097/01.ju.0000110610.61545.ae CrossRefPubMed

Blanco AI, Teh BS, Amato RJ (2011) Role of radiation therapy in the management of renal cell cancer. Cancers (Basel) 3:4010–4023. doi:10.3390/cancers3044010 CrossRef

10.

Stein M, Kuten A, Halpern J et al (1992) The value of postoperative irradiation in renal cell cancer. Radiother Oncol 24:41–44CrossRefPubMed

11.

Kao GD, Malkowicz SB, Whittington R et al (1994) Locally advanced renal cell carcinoma: low complication rate and efficacy of postnephrectomy radiation therapy planned with CT. Radiology 193:725–730. doi:10.1148/radiology.193.3.7972814 CrossRefPubMed

12.

Rades D, Heisterkamp C, Schild SE (2010) Do patients receiving whole-brain radiotherapy for brain metastases from renal cell carcinoma benefit from escalation of the radiation dose? Int J Radiat Oncol Biol Phys 78:398–403. doi:10.1016/j.ijrobp.2009.08.022 CrossRefPubMed

13.

Wilson D, Hiller L, Gray L et al (2003) The effect of biological effective dose on time to symptom progression in metastatic renal cell carcinoma. Clin Oncol (R Coll Radiol) 15:400–407CrossRef

14.

De Meerleer G, Khoo V, Escudier B et al (2014) Radiotherapy for renal-cell carcinoma. Lancet Oncol 15:e170–e177. doi:10.1016/S1470-2045(13)70569-2 CrossRefPubMed

15.

Kothari G, Foroudi F, Gill S et al (2015) Outcomes of stereotactic radiotherapy for cranial and extracranial metastatic renal cell carcinoma: A systematic review. Acta Oncol (Madr) 54:148–157. doi:10.3109/0284186X.2014.939298 CrossRef

16.

Onishi H, Kawasaki T, Zakoji H et al (2014) Renal cell carcinoma treated with stereotactic radiotherapy with histological change confirmed on autopsy: a case report. BMC Res Notes 7:270. doi:10.1186/1756-0500-7-270 CrossRefPubMedPubMedCentral

17.

Staehler M, Bader M, Schlenker B et al (2015) Single fraction radiosurgery for the treatment of renal tumors. J Urol 193:771–775. doi:10.1016/j.juro.2014.08.044 CrossRefPubMed

18.

Siva S, Pham D, Gill S et al (2012) A systematic review of stereotactic radiotherapy ablation for primary renal cell carcinoma. BJU Int 110:E737–E743. doi:10.1111/j.1464-410X.2012.11550.x CrossRefPubMed

19.

Kaplan ID, Redrosa I, Martin C et al (2010) Results of a phase I dose escalation study of stereotactic radiosurgery for primary renal tumors. Int J Radiat Oncol 78:S191. doi:10.1016/j.ijrobp.2010.07.464 CrossRef

20.

Pham D, Thompson A, Kron T et al (2014) Stereotactic ablative body radiation therapy for primary kidney cancer: a 3‑dimensional conformal technique associated with low rates of early toxicity. Int J Radiat Oncol Biol Phys 90:1061–1068. doi:10.1016/j.ijrobp.2014.07.043 CrossRefPubMed

21.

Siva S, Jackson P, Kron T et al (2016) Impact of stereotactic radiotherapy on kidney function in primary renal cell carcinoma: Establishing a dose-response relationship. Radiother Oncol 118:540–546. doi:10.1016/j.radonc.2016.01.027 CrossRefPubMed

22.

Ponsky L, Lo SS, Zhang Y et al (2015) Phase I dose-escalation study of stereotactic body radiotherapy (SBRT) for poor surgical candidates with localized renal cell carcinoma. Radiother Oncol 117:183–187. doi:10.1016/j.radonc.2015.08.030 CrossRefPubMed

23.

Svedman C, Sandström P, Pisa P et al (2006) A prospective Phase II trial of using extracranial stereotactic radiotherapy in primary and metastatic renal cell carcinoma. Acta Oncol 45:870–875. doi:10.1080/02841860600954875 CrossRefPubMed

24.

Beitler JJ, Makara D, Silverman P, Lederman G (2004) Definitive, high-dose-per-fraction, conformal, stereotactic external radiation for renal cell carcinoma. Am J Clin Oncol 27:646–648CrossRefPubMed

25.

Wersäll PJ, Blomgren H, Lax I et al (2005) Extracranial stereotactic radiotherapy for primary and metastatic renal cell carcinoma. Radiother Oncol 77:88–95. doi:10.1016/j.radonc.2005.03.022 CrossRefPubMed

26.

Gilson B, Lederman G, Qian G et al (2006) Hypo-Fractionated Stereotactic extra-cranial Radiosurgery(HFSR) for primary and metastatic renal cell carcinoma. Int J Radiat Oncol 66:S349. doi:10.1016/j.ijrobp.2006.07.656 CrossRef

27.

Svedman C, Karlsson K, Rutkowska E et al (2008) Stereotactic body radiotherapy of primary and metastatic renal lesions for patients with only one functioning kidney. Acta Oncol 47:1578–1583. doi:10.1080/02841860802123196 CrossRefPubMed

28.

Wang Y‑J, Han T‑T, Xue J‑X et al (2014) Stereotactic gamma-ray body radiation therapy for asynchronous bilateral renal cell carcinoma. Radiol Med 119:878–883. doi:10.1007/s11547-014-0402-3 CrossRefPubMed

29.

Sankineni S, Brown A, Cieciera M et al (2015) Imaging of renal cell carcinoma. Urol Oncol. doi:10.1016/j.urolonc.2015.05.020

30.

Siva S, Ellis RJ, Ponsky L et al (2016) Consensus statement from the International Radiosurgery Oncology Consortium for Kidney for primary renal cell carcinoma. Future Oncol 12:637–645. doi:10.2217/fon.16.2 CrossRefPubMed

31.

Lo SS, Fakiris AJ, Chang EL et al (2010) Stereotactic body radiation therapy: a novel treatment modality. Nat Rev Clin Oncol 7:44–54. doi:10.1038/nrclinonc.2009.188 CrossRefPubMed

32.

Siva S, Pham D, Gill S et al (2013) An analysis of respiratory induced kidney motion on four-dimensional computed tomography and its implications for stereotactic kidney radiotherapy. Radiat Oncol 8:248. doi:10.1186/1748-717X-8-248 CrossRefPubMedPubMedCentral

33.

Pham D, Kron T, Foroudi F, Siva S (2013) Effect of different breathing patterns in the same patient on stereotactic ablative body radiotherapy dosimetry for primary renal cell carcinoma: a case study. Med Dosim 38:304–308. doi:10.1016/j.meddos.2013.03.001 CrossRefPubMed

34.

Valakh V, Chan P, D’Adamo K, Micaily B (2013) Early-stage central lung cancer and volumetric modulated arc therapy: a dosimetric case study with literature review. Anticancer Res 33:4491–4495PubMed

35.

Ning S, Trisler K, Wessels BW, Knox SJ (1997) Radiobiologic studies of radioimmunotherapy and external beam radiotherapy in vitro and in vivo in human renal cell carcinoma xenografts. Cancer 80:2519–2528CrossRefPubMed

36.

Schanne DH, Nestle U, Allgäuer M et al (2015) Stereotactic body radiotherapy for centrally located stage I NSCLC: a multicenter analysis. Strahlenther Onkol 191:125–132. doi:10.1007/s00066-014-0739-5 CrossRefPubMed

37.

Motzer RJ, Escudier B, McDermott DF et al (2015) Nivolumab versus Everolimus in advanced renal-cell carcinoma. N Engl J Med. doi:10.1056/NEJMoa1510665 PubMedCentral

38.

Victor CT-S, Rech AJ, Maity A et al (2015) Radiation and dual checkpoint blockade activate non-redundant immune mechanisms in cancer. Nature 520:373–377. doi:10.1038/nature14292 CrossRefPubMedCentral

39.

Siegel RL, Miller KD, Jemal A (2015) Cancer statistics, 2015. CA Cancer J Clin 65:5–29. doi:10.3322/caac.21254 CrossRefPubMed

40.

Krejs GJ (2010) Pancreatic cancer: epidemiology and risk factors. Dig Dis 28:355–358. doi:10.1159/000319414 CrossRefPubMed

41.

Vincent A, Herman J, Schulick R et al (2011) Pancreatic cancer. Lancet 378:607–620. doi:10.1016/S0140-6736(10)62307-0 CrossRefPubMedPubMedCentral

42.

Huguet F, Mukherjee S, Javle M (2014) Locally advanced pancreatic cancer: the role of definitive chemoradiotherapy. Clin Oncol (R Coll Radiol) 26:560–568. doi:10.1016/j.clon.2014.06.002 CrossRef

43.

Iacobuzio-Donahue CA, Fu B, Yachida S et al (2009) DPC4 gene status of the primary carcinoma correlates with patterns of failure in patients with pancreatic cancer. J Clin Oncol 27:1806–1813. doi:10.1200/JCO.2008.17.7188 CrossRefPubMedPubMedCentral

44.

Huguet F, André T, Hammel P et al (2007) Impact of chemoradiotherapy after disease control with chemotherapy in locally advanced pancreatic adenocarcinoma in GERCOR phase II and III studies. J Clin Oncol 25:326–331. doi:10.1200/JCO.2006.07.5663 CrossRefPubMed

45.

Ben-Josef E, Schipper M, Francis IR et al (2012) A phase I/II trial of intensity modulated radiation (IMRT) dose escalation with concurrent fixed-dose rate gemcitabine (FDR-G) in patients with unresectable pancreatic cancer. Int J Radiat Oncol Biol Phys 84:1166–1171. doi:10.1016/j.ijrobp.2012.02.051 CrossRefPubMedPubMedCentral

46.

Murphy JD, Adusumilli S, Griffith KA et al (2007) Full-dose gemcitabine and concurrent radiotherapy for unresectable pancreatic cancer. Int J Radiat Oncol Biol Phys 68:801–808. doi:10.1016/j.ijrobp.2006.12.053 CrossRefPubMed

47.

Hammel P, Huguet F, van Laethem J‑L et al (2016) Effect of chemoradiotherapy vs chemotherapy on survival in patients with locally advanced pancreatic cancer controlled after 4 months of Gemcitabine with or without Erlotinib: the LAP07 randomized clinical trial. JAMA 315:1844–1853. doi:10.1001/jama.2016.4324 CrossRefPubMed

48.

Wei Q, Yu W, Rosati LM, Herman JM (2015) Advances of stereotactic body radiotherapy in pancreatic cancer. Chin J Cancer Res 27:349–357. doi:10.3978/j.issn.1000-9604.2015.04.12 PubMedPubMedCentral

49.

Wild AT, Herman JM, Dholakia AS et al (2016) Lymphocyte-sparing effect of stereotactic body radiation therapy in patients with unresectable pancreatic cancer. Int J Radiat Oncol Biol Phys 94:571–579. doi:10.1016/j.ijrobp.2015.11.026 CrossRefPubMed

50.

Koong AC, Le QT, Ho A et al (2004) Phase I study of stereotactic radiosurgery in patients with locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 58:1017–1021. doi:10.1016/j.ijrobp.2003.11.004 CrossRefPubMed

51.

Koong AC, Christofferson E, Le Q‑T et al (2005) Phase II study to assess the efficacy of conventionally fractionated radiotherapy followed by a stereotactic radiosurgery boost in patients with locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 63:320–323. doi:10.1016/j.ijrobp.2005.07.002 CrossRefPubMed

52.

Schellenberg D, Goodman KA, Lee F et al (2008) Gemcitabine chemotherapy and single-fraction stereotactic body radiotherapy for locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 72:678–686. doi:10.1016/j.ijrobp.2008.01.051 CrossRefPubMed

53.

Schellenberg D, Kim J, Christman-Skieller C et al (2011) Single-fraction stereotactic body radiation therapy and sequential gemcitabine for the treatment of locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 81:181–188. doi:10.1016/j.ijrobp.2010.05.006 CrossRefPubMed

54.

Hoyer M, Roed H, Sengelov L et al (2005) Phase-II study on stereotactic radiotherapy of locally advanced pancreatic carcinoma. Radiother Oncol 76:48–53. doi:10.1016/j.radonc.2004.12.022 CrossRefPubMed

55.

Herman JM, Chang DT, Goodman KA et al (2015) Phase 2 multi-institutional trial evaluating gemcitabine and stereotactic body radiotherapy for patients with locally advanced unresectable pancreatic adenocarcinoma. Cancer 121:1128–1137. doi:10.1002/cncr.29161 CrossRefPubMed

56.

Comito T, Cozzi L, Clerici E et al (2016) Can stereotactic body radiation therapy be a viable and efficient therapeutic option for unresectable locally advanced pancreatic adenocarcinoma? Results of a phase 2 study. Technol Cancer Res Treat. doi:10.1177/1533034616650778 PubMed

57.

Rwigema J‑CM, Parikh SD, Heron DE et al (2011) Stereotactic body radiotherapy in the treatment of advanced adenocarcinoma of the pancreas. Am J Clin Oncol 34:63–69. doi:10.1097/COC.0b013e3181d270b4 CrossRefPubMed

58.

Chang DT, Schellenberg D, Shen J et al (2009) Stereotactic radiotherapy for unresectable adenocarcinoma of the pancreas. Cancer 115:665–672. doi:10.1002/cncr.24059 CrossRefPubMed

59.

Mahadevan A, Miksad R, Goldstein M et al (2011) Induction gemcitabine and stereotactic body radiotherapy for locally advanced nonmetastatic pancreas cancer. Int J Radiat Oncol Biol Phys 81:e615–e622. doi:10.1016/j.ijrobp.2011.04.045 CrossRefPubMed

60.

Moningi S, Dholakia AS, Raman SP et al (2015) The role of stereotactic body radiation therapy for pancreatic cancer: A single-institution experience. Ann Surg Oncol 22:2352–2358. doi:10.1245/s10434-014-4274-5 CrossRefPubMedPubMedCentral

61.

Pollom EL, Alagappan M, von Eyben R et al (2014) Single- versus multifraction stereotactic body radiation therapy for pancreatic adenocarcinoma: outcomes and toxicity. Int J Radiat Oncol Biol Phys 90:918–925. doi:10.1016/j.ijrobp.2014.06.066 CrossRefPubMed

62.

Chuong MD, Springett GM, Freilich JM et al (2013) Stereotactic body radiation therapy for locally advanced and borderline resectable pancreatic cancer is effective and well tolerated. Int J Radiat Oncol Biol Phys 86:516–522. doi:10.1016/j.ijrobp.2013.02.022 CrossRefPubMed

63.

Rajagopalan MS, Heron DE, Wegner RE et al (2013) Pathologic response with neoadjuvant chemotherapy and stereotactic body radiotherapy for borderline resectable and locally-advanced pancreatic cancer. Radiat Oncol 8:254. doi:10.1186/1748-717X-8-254 CrossRefPubMedPubMedCentral

64.

Rwigema J‑CM, Heron DE, Parikh SD et al (2012) Adjuvant stereotactic body radiotherapy for resected pancreatic adenocarcinoma with close or positive margins. J Gastrointest Cancer 43:70–76. doi:10.1007/s12029-010-9203-7 CrossRefPubMed

65.

Wild AT, Hiniker SM, Chang DT et al (2013) Re-irradiation with stereotactic body radiation therapy as a novel treatment option for isolated local recurrence of pancreatic cancer after multimodality therapy: experience from two institutions. J Gastrointest Oncol 4:343–351. doi:10.3978/j.issn.2078-6891.2013.044 PubMedPubMedCentral

66.

Gurka MK, Collins SP, Slack R et al (2013) Stereotactic body radiation therapy with concurrent full-dose gemcitabine for locally advanced pancreatic cancer: a pilot trial demonstrating safety. Radiat Oncol 8:44. doi:10.1186/1748-717X-8-44 CrossRefPubMedPubMedCentral

67.

Brunner TB, Nestle U, Grosu A‑L, Partridge M (2015) SBRT in pancreatic cancer: what is the therapeutic window? Radiother Oncol 114:109–116. doi:10.1016/j.radonc.2014.10.015 CrossRefPubMed

68.

Minn AY, Schellenberg D, Maxim P et al (2009) Pancreatic tumor motion on a single planning 4D-CT does not correlate with intrafraction tumor motion during treatment. Am J Clin Oncol 32:364–368. doi:10.1097/COC.0b013e31818da9e0 CrossRefPubMed

69.

Ge J, Santanam L, Noel C, Parikh PJ (2013) Planning 4‑Dimensional Computed Tomography (4DCT) Ccnnot adequately represent daily intrafractional motion of abdominal tumors. Int J Radiat Oncol 85:999–1005. doi:10.1016/j.ijrobp.2012.09.014 CrossRef

70.

Heerkens HD, van Vulpen M, van den Berg CAT et al (2014) MRI-based tumor motion characterization and gating schemes for radiation therapy of pancreatic cancer. Radiother Oncol 111:252–257. doi:10.1016/j.radonc.2014.03.002 CrossRefPubMed

71.

Dalah E, Moraru I, Paulson E et al (2014) Variability of target and normal structure delineation using multimodality imaging for radiation therapy of pancreatic cancer. Int J Radiat Oncol Biol Phys 89:633–640. doi:10.1016/j.ijrobp.2014.02.035 CrossRefPubMed

72.

Hall WA, Mikell JL, Mittal P et al (2013) Tumor size on abdominal MRI versus pathologic specimen in resected pancreatic adenocarcinoma: implications for radiation treatment planning. Int J Radiat Oncol Biol Phys 86:102–107. doi:10.1016/j.ijrobp.2012.11.019 CrossRefPubMed

73.

Mellon EA, Hoffe SE, Springett GM et al (2015) Long-term outcomes of induction chemotherapy and neoadjuvant stereotactic body radiotherapy for borderline resectable and locally advanced pancreatic adenocarcinoma. Acta Oncol 54:979–985. doi:10.3109/0284186X.2015.1004367 CrossRefPubMed

74.

Dholakia AS, Kumar R, Raman SP et al (2013) Mapping patterns of local recurrence after pancreaticoduodenectomy for pancreatic adenocarcinoma: a new approach to adjuvant radiation field design. Int J Radiat Oncol Biol Phys 87:1007–1015. doi:10.1016/j.ijrobp.2013.09.005 CrossRefPubMedPubMedCentral

75.

Conroy T, Desseigne F, Ychou M et al (2011) FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 364:1817–1825. doi:10.1056/NEJMoa1011923 CrossRefPubMed

Title: Stereotactic body radiotherapy for renal cell cancer and pancreatic cancer
Literature review and practice recommendations of the DEGRO Working Group on Stereotactic Radiotherapy
Authors: Dr.med. Cédric Panje
PD Dr. med. Nikolaus Andratschke
Prof. Dr. med. Thomas B. Brunner
PD Dr. med. Maximilian Niyazi
Prof. Dr. med. Matthias Guckenberger
Publication date: 01-12-2016
Publisher: Springer Berlin Heidelberg
Published in: Strahlentherapie und Onkologie / Issue 12/2016
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-016-1053-1

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Stereotactic body radiotherapy for renal cell cancer and pancreatic cancer

Literature review and practice recommendations of the DEGRO Working Group on Stereotactic Radiotherapy

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 12/2016

Beziehung zwischen HPV-Infektion, p16-Status und Effektivität der Strahlentherapie mit oder ohne Cetuximab beim lokoregional fortgeschrittenen Plattenepithelkarzinom des Oropharynx

Thank you to all Reviewers of “Strahlentherapie und Onkologie” 2016

Die LAP07-Studienergebnisse sollten nicht als Aus der Radiochemotherapie für das Pankreaskarzinom missverstanden werden

Simultaneous integrated protection

Prophylactic cranial irradiation could improve overall survival in patients with extensive small cell lung cancer

Nasopharyngeal carcinoma in a low incidence European area