Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

ACC 2024 Congress

Catch up on all the top stories and latest evidence in cardiology research with our ACC 2024 Congress hub page.
ADVANCED SEARCH
Log in
Top
Radiation Oncology
Published in: Radiation Oncology 1/2018

Open Access 01-12-2018 | Research

A prospective phase I dose-escalation trial of stereotactic ablative radiotherapy (SABR) as an alternative to cytoreductive nephrectomy for inoperable patients with metastatic renal cell carcinoma

Authors: Rohann J. M. Correa, Belal Ahmad, Andrew Warner, Craig Johnson, Mary J. MacKenzie, Stephen E. Pautler, Glenn S. Bauman, George B. Rodrigues, Alexander V. Louie

Published in: Radiation Oncology | Issue 1/2018

Login to get access

Abstract

Background

Cytoreductive nephrectomy is thought to improve survival in metastatic renal cell carcinoma (mRCC). As many patients are ineligible for major surgery, we hypothesized that SABR could be a safe alternative.

Methods

In this dose-escalation trial, inoperable mRCC patients underwent SABR targeting the entire affected kidney. Toxicity (CTCAE v3.0), quality of life (QoL), renal function, and tumour response (RECIST v1.0) were assessed.

Results

Twelve patients of mostly intermediate (67%) or poor (25%) International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) prognostic class, median KPS of 70%, and median tumour size of 8.7 cm (range: 4.8–13.8) were enrolled in successive dose cohorts of 25 (n = 3), 30 (n = 6), and 35 Gy (n = 3) in 5 fractions. SABR was well tolerated with 3 grade 3 events: fatigue (2) and bone pain (1). QoL decreased for physical well-being (p = 0.016), but remained unchanged in other domains. SABR achieved a median tumour size reduction of − 17.3% (range: + 5.3 to − 54.4) at 5.3 months. All patients progressed systemically and median OS was 6.7 months. Crude median follow-up was 5.8 months.

Conclusions

In non-operable mRCC patients, renal-ablative SABR to 35 Gy in 5 fractions yielded acceptable toxicity, renal function preservation, and stable QoL. SABR merits further prospective investigation as an alternative to cytoreductive nephrectomy.

Trial Registration

ClinicalTrials.​gov NCT02264548. Registered July 22 2014 – Retrospectively registered: https://​clinicaltrials.​gov/​ct2/​show/​NCT02264548
Appendix
Available only for authorised users
Literature
1.
Flanigan RC, Mickisch G, Sylvester R, Tangen C, Van Poppel H, Crawford ED. Cytoreductive nephrectomy in patients with metastatic renal cancer: a combined analysis. J Urol. 2004;171:1071–6.CrossRefPubMed
2.
Hanna N, Sun M, Meyer CP, et al. Survival Analyses of Patients With Metastatic Renal Cancer Treated With Targeted Therapy With or Without Cytoreductive Nephrectomy: A National Cancer Data Base Study. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2016;34:3267–75.CrossRef
3.
Petrelli F, Coinu A, Vavassori I, et al. Cytoreductive Nephrectomy in Metastatic Renal Cell Carcinoma Treated With Targeted Therapies: A Systematic Review With a Meta-Analysis. Clin Genitourin Cancer. 2016;14:465–72.CrossRefPubMed
4.
Choueiri TK, Xie W, Kollmannsberger C, et al. The impact of cytoreductive nephrectomy on survival of patients with metastatic renal cell carcinoma receiving vascular endothelial growth factor targeted therapy. J Urol. 2011;185:60–6.CrossRefPubMed
5.
Bex A. Immediate versus deferred cytoreductive nephrectomy (CN) in patients with synchronous metastatic renal cell carcinoma (mRCC) receiving sunitinib (EORTC 30073 SURTIME). Madrid: ESMO 2017 Congress; 2017.
6.
7.
Conti SL, Thomas IC, Hagedorn JC, et al. Utilization of cytoreductive nephrectomy and patient survival in the targeted therapy era. International journal of cancer Journal international du cancer. 2014;134:2245–52.CrossRefPubMedPubMedCentral
8.
Abdollah F, Sun M, Thuret R, et al. Mortality and morbidity after cytoreductive nephrectomy for metastatic renal cell carcinoma: a population-based study. Ann Surg Oncol. 2011;18:2988–96.CrossRefPubMed
9.
Ning S, Trisler K, Wessels BW, Knox SJ. Radiobiologic studies of radioimmunotherapy and external beam radiotherapy in vitro and in vivo in human renal cell carcinoma xenografts. Cancer. 1997;80:2519–28.CrossRefPubMed
10.
Ponsky LE, Crownover RL, Rosen MJ, et al. Initial evaluation of Cyberknife technology for extracorporeal renal tissue ablation. Urology. 2003;61:498–501.CrossRefPubMed
11.
Walsh L, Stanfield JL, Cho LC, et al. Efficacy of ablative high-dose-per-fraction radiation for implanted human renal cell cancer in a nude mouse model. Eur Urol. 2006;50:795–800. discussion.CrossRefPubMed
12.
Kothari G, Foroudi F, Gill S, Corcoran NM, Siva S. Outcomes of stereotactic radiotherapy for cranial and extracranial metastatic renal cell carcinoma: a systematic review. Acta Oncol. 2015;54:148–57.CrossRefPubMed
13.
Alongi F, Arcangeli S, Triggiani L, et al. Stereotactic ablative radiation therapy in renal cell carcinoma: From oligometastatic to localized disease. Crit Rev Oncol Hematol. 2017;117:48–56.CrossRefPubMed
14.
Siva S, Pham D, Gill S, Corcoran NM, Foroudi F. A systematic review of stereotactic radiotherapy ablation for primary renal cell carcinoma. BJU Int. 2012;110:E737–43.CrossRefPubMed
15.
Siva S, Kothari G, Muacevic A, et al. Radiotherapy for renal cell carcinoma: renaissance of an overlooked approach. Nature reviews. Urology. 2017;14:549-563.
16.
Siva S, Muacevic A, Staehler M, et al. Individual Patient Data Meta-analysis of SBRT Kidney: A Report From the International Radiosurgery Oncology Consortium for Kidney (IROCK). International Journal of Radiation Oncology*Biology*Physics. 2017;99:S153–S4.CrossRef
17.
Shin BJ, Chick JF, Stavropoulos SW. Contemporary Status of Percutaneous Ablation for the Small Renal Mass. Curr Urol Rep. 2016;17:23.CrossRefPubMed
18.
Kurup AN. Percutaneous ablation for small renal masses-complications. Semin Interv Radiol. 2014;31:42–9.CrossRef
19.
Demaria S, Ng B, Devitt ML, et al. Ionizing radiation inhibition of distant untreated tumors (abscopal effect) is immune mediated. Int J Radiat Oncol Biol Phys. 2004;58:862–70.CrossRefPubMed
20.
21.
Brooks ED, Schoenhals JE, Tang C, et al. Stereotactic Ablative Radiation Therapy Combined With Immunotherapy for Solid Tumors. Cancer J. 2016;22:257–66.CrossRefPubMedPubMedCentral
22.
Correa RJ, Rodrigues GB, Chen H, Warner A, Ahmad B, Louie AV. Stereotactic Ablative Radiotherapy (SABR) for Large Renal Tumors: A Retrospective Case Series Evaluating Clinical Outcomes, Toxicity, and Technical Considerations. Am J Clin Oncol. 2016. Epub ahead of print.
23.
Siva S, Ellis RJ, Ponsky L, et al. Consensus statement from the International Radiosurgery Oncology Consortium for Kidney for primary renal cell carcinoma. Future Oncol. 2016;12:637–45.CrossRefPubMed
24.
Timmerman RD. An overview of hypofractionation and introduction to this issue of seminars in radiation oncology. Semin Radiat Oncol. 2008;18:215–22.CrossRefPubMed
25.
Heng DY, Xie W, Regan MM, et al. Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor-targeted agents: results from a large, multicenter study. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2009;27:5794–9.CrossRef
26.
Patel HD, Pierorazio PM, Johnson MH, et al. Renal Functional Outcomes after Surgery, Ablation, and Active Surveillance of Localized Renal Tumors: A Systematic Review and Meta-Analysis. Clin J Am Soc Nephrol. 2017;12:1057-1069.
27.
De Wolf K, Rottey S, Vermaelen K, et al. Combined high dose radiation and tyrosine kinase inhibitors in renal cell carcinoma: a phase I trial. ESTRO Annual Meeting. Vienna, Austria. Radiother Oncol. 2017;12:157.
28.
29.
30.
Lugade AA, Moran JP, Gerber SA, Rose RC, Frelinger JG, Lord EM. Local radiation therapy of B16 melanoma tumors increases the generation of tumor antigen-specific effector cells that traffic to the tumor. J Immunol. 2005;174:7516–23.CrossRefPubMed
31.
Kim MS, Kim W, Park IH, et al. Radiobiological mechanisms of stereotactic body radiation therapy and stereotactic radiation surgery. Radiation oncology journal. 2015;33:265–75.CrossRefPubMedPubMedCentral
32.
Wersall PJ, Blomgren H, Pisa P, Lax I, Kalkner KM, Svedman C. Regression of non-irradiated metastases after extracranial stereotactic radiotherapy in metastatic renal cell carcinoma. Acta Oncol. 2006;45:493–7.CrossRefPubMed
33.
Siva S, MacManus MP, Martin RF, Martin OA. Abscopal effects of radiation therapy: a clinical review for the radiobiologist. Cancer Lett. 2015;356:82–90.CrossRefPubMed
34.
Golden EB, Demaria S, Schiff PB, Chachoua A, Formenti SC. An abscopal response to radiation and ipilimumab in a patient with metastatic non-small cell lung cancer. Cancer immunology research. 2013;1:365–72.CrossRefPubMedPubMedCentral
35.
Hiniker SM, Chen DS, Reddy S, et al. A systemic complete response of metastatic melanoma to local radiation and immunotherapy. Transl Oncol. 2012;5:404–7.CrossRefPubMedPubMedCentral
36.
37.
Reynders K, Illidge T, Siva S, Chang JY, De Ruysscher D. The abscopal effect of local radiotherapy: using immunotherapy to make a rare event clinically relevant. Cancer Treat Rev. 2015;41:503–10.CrossRefPubMedPubMedCentral
38.
Singh AK, Winslow TB, Kermany MH, et al. A Pilot Study of Stereotactic Body Radiation Therapy Combined with Cytoreductive Nephrectomy for Metastatic Renal Cell Carcinoma. Clin Cancer Res. 2017;23:5055-5065.
Metadata
Title
A prospective phase I dose-escalation trial of stereotactic ablative radiotherapy (SABR) as an alternative to cytoreductive nephrectomy for inoperable patients with metastatic renal cell carcinoma
Authors
Rohann J. M. Correa
Belal Ahmad
Andrew Warner
Craig Johnson
Mary J. MacKenzie
Stephen E. Pautler
Glenn S. Bauman
George B. Rodrigues
Alexander V. Louie
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2018
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/s13014-018-0992-3

Other articles of this Issue 1/2018

Radiation Oncology 1/2018 Go to the issue

Research

Effect of one comprehensive education course to lower anxiety and depression among Chinese breast cancer patients during the postoperative radiotherapy period - one randomized clinical trial

Research

Bone density and pain response following intensity-modulated radiotherapy versus three-dimensional conformal radiotherapy for vertebral metastases - secondary results of a randomized trial

Research

Radiation oncology resident training in patient safety and quality improvement: a national survey of residency program directors

Research

Clinical evaluation for the difference of absorbed doses calculated to medium and calculated to water by Monte Carlo method

Research

Light and shadows of a new technique: is photon total-skin irradiation using helical IMRT feasible, less complex and as toxic as the electrons one?

Research

Treatment outcomes of proton or carbon ion therapy for skull base chordoma: a retrospective study