Stereotactic body radiotherapy for the treatment of medically inoperable primary renal cell carcinoma: Current evidence and future directions

Authors

  • Anand Swaminath McMaster University
  • William Chu University of Toronto

DOI:

https://doi.org/10.5489/cuaj.2900

Keywords:

kidney cancer, renal cell carcinoma, radiation, radiotherapy, stereotactic, ablative, outcomes

Abstract

The incidence of renal cell carcinoma (RCC) is steadily rising due to an aging population and more frequent imaging of the abdomen for other medical conditions. While surgery remains the standard of care treatment for localized disease, many patients are unfit due to their advanced age and medical comorbidities. In these patients, an active surveillance strategy or ablative therapies, including radiofrequency/ microwave ablation or cryotherapy, can be offered. Such options have limitations particularly with fast growing, or larger tumors. A promising ablative therapy option to consider is stereotactic body radiotherapy (SBRT). SBRT refers to high dose, focally ablative radiation delivered in a short time (3–5 fractions), and is safe and effective in many other cancer sites, including lung, liver and spine. SBRT offers potential advantages in the primary kidney cancer setting due to its ablative dosing (overcoming the notion of “radio-resistance”), short treatment duration (important in an elderly population), low toxicity profile (enabling SBRT to treat larger RCCs than other ablative modalities), and non-invasiveness. To date, there is limited long-term prospective data on the outcomes of SBRT in primary RCC. However, early evidence is intriguing with respect to excellent local control and low toxicity; however, most studies vary in terms of technique and radiation dosing used. Welldesigned prospective cohort studies with clearly defined and standardized techniques, dosing, follow-up, and integration of quality of life outcomes will be essential to further establish the role of SBRT in management of inoperable, localized RCC.

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Author Biographies

Anand Swaminath, McMaster University

MD FRCPC

Assistant Professor

Department of Oncology

McMaster University

Radiation Oncologist

Juravinski Cancer Centre

699 Concession Street

Hamilton, Ontario

L8V 5C2

Phone: 905-387-9495 x64706

Fax: 905-575-6326

William Chu, University of Toronto

Assistant ProfessorDepartment of Radiation OncologyOdette Cancer CentreSunnybrook Health Sciences CentreUniversity of Toronto2075 Bayview Ave.Toronto, Ontario, CanadaM4N 3M5Phone: 416-480-6100Fax: 416-480-6002

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Published

2015-08-10

How to Cite

Swaminath, A., & Chu, W. (2015). Stereotactic body radiotherapy for the treatment of medically inoperable primary renal cell carcinoma: Current evidence and future directions. Canadian Urological Association Journal, 9(7-8), 275–80. https://doi.org/10.5489/cuaj.2900