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Stereotactic ablative radiotherapy for renal cell carcinoma has produced comparable results in patients with solitary and bilateral kidneys, according to the findings presented at the annual meeting of the American Society of Radiation Oncology.
"Stereotactic ablative radiotherapy is actually an emerging treatment for renal cell carcinoma", Rohann J.M. Correa, MD, PhD, A resident in radiation oncology at the London Health Sciences Center in London, Canada, said at a press conference. "Renal renal cell carcinoma is a unique situation and a difficult management scenario. Patients present a high risk of renal dysfunction due to anterior nephrectomy. There is a lack of renal function reserve. "
Correa and colleagues sought to compare oncologic findings and renal function in patients with solitary and bilateral kidneys who underwent stereotactic ablative radiotherapy.
Management options for patients with solitary renal cell carcinoma tend to be invasive and limited, according to Correa. "Ablative stereotactic radiotherapy, on the other hand, is a noninvasive and ambulatory strategy," he said.
Mark A. Hallman, MD, PhD, Assistant Professor at the Department of Radiation Oncology at the Fox Chase Cancer Center and another investigator of the study, added that any option for this patient population carries a risk. "Surgical resection and stereotactic ablative radiotherapy pose a potential risk of complications, especially kidney failure requiring dialysis," Hallman said. HemOnc today.
The cohort included 223 patients from nine centers in Australia, Germany, Japan and North America. Among them were 81 patients (mean age, 62.5 years; 69% men) with solitary kidneys having undergone ablative stereotactic renal radiotherapy.
Baseline data showed that 97.5% of patients had ECOG status of 0 to 1 and 14.8% (n = 12) had metastatic disease.
Pathological confirmation was obtained in 91.4% of the cohort, revealing a median tumor diameter of 3.7 cm (interquartile range, 2.5 to 4.3) in patients with solitary kidneys and 4.3 cm (IQR, 3-5,5) at patients with bilateral kidneys (P <0.001).
Patients received a median dose of radiotherapy of 25 Gy (14 to 70) in a median fraction of 1 (1 to 10).
Total dose and number of fractions were significantly lower in patients with solitary tumors (P .001). However, there was no median difference in biologically effective dose between the two groups, with solitary group patients receiving 87.5 Gy (range 33.6-125) and those in the bilateral group receiving 87.5 Gy. (extremes 37.5-125; P = 0.103).
Mean baseline GFR was higher in the solitary kidney group (64.6 ± 21.7 mL / min) than in the bilateral group (57.2 ± 21.6 mL / min; P = 0.016). Mean decreases in GFR following stereotaxic radiotherapy by ablation were similar in the solitary (-5.8 mL / min) and bilateral (-5.3 mL / min) groups; P = 0.984).
Follow-up data over a 2.57-year period indicated a local control rate of 98%, a PHS rate of 77.5%, a cancer-specific survival rate of 98.2%, and an two years of 81.5%. There was a local failure in the group of solitary kidneys and two local failures in the bilateral group.
"These results are comparable to similar series of partial nephrectomy," said Hamilton.
Univariate badysis results from the solitary kidney group revealed an badociation between moderate chronic renal failure – defined as a TFGe of no greater than 60 mL / min – and a lower PFS (HR = 2.66, P = 0.043).
No solitary dialysis required dialysis, compared to six (4.2%) in the bilateral cohort.
"These data make ablative stereotactic radiotherapy an effective and relatively safe way to treat early-stage renal cell carcinoma in an isolated kidney, particularly in inoperable patients," Hamilton said.
"We conclude that ablative stereotactic radiotherapy can provide excellent local control with an acceptable impact on renal function in patients with isolated renal cell carcinoma," Correa said. "We suggest that a reference for stereotactic ablative radiotherapy of the kidney is worthy of consideration in this population." – by Rob Volansky
Reference:
Correa RJM, et al. Abstract 222. Presented at the annual meeting of the American Society for Radiation Oncology; October 21-24, 2018; San Antonio.
Disclosures: Correa does not report any relevant financial information. Hallman reports consultations for New Century Health.
Stereotactic ablative radiotherapy for renal cell carcinoma has produced comparable results in patients with solitary and bilateral kidneys, according to the findings presented at the annual meeting of the American Society of Radiation Oncology.
"Stereotactic ablative radiotherapy is actually an emerging treatment for renal cell carcinoma", Rohann J.M. Correa, MD, PhD, A resident in radiation oncology at the London Health Sciences Center in London, Canada, said at a press conference. "Renal renal cell carcinoma is a unique situation and a difficult management scenario. Patients present a high risk of renal dysfunction due to anterior nephrectomy. There is a lack of renal function reserve. "
Correa and colleagues sought to compare oncologic findings and renal function in patients with solitary and bilateral kidneys who underwent stereotactic ablative radiotherapy.
Management options for patients with solitary renal cell carcinoma tend to be invasive and limited, according to Correa. "Ablative stereotactic radiotherapy, on the other hand, is a noninvasive and ambulatory strategy," he said.
Mark A. Hallman, MD, PhD, Assistant Professor at the Department of Radiation Oncology at the Fox Chase Cancer Center and another investigator of the study, added that any option for this patient population carries a risk. "Surgical resection and stereotactic ablative radiotherapy pose a potential risk of complications, especially kidney failure requiring dialysis," Hallman said. HemOnc today.
The cohort included 223 patients from nine centers in Australia, Germany, Japan and North America. Among them were 81 patients (mean age, 62.5 years; 69% men) with solitary kidneys having undergone ablative stereotactic renal radiotherapy.
Baseline data showed that 97.5% of patients had ECOG status of 0 to 1 and 14.8% (n = 12) had metastatic disease.
Pathological confirmation was obtained in 91.4% of the cohort, revealing a median tumor diameter of 3.7 cm (interquartile range, 2.5 to 4.3) in patients with solitary kidneys and 4.3 cm (IQR, 3-5,5) at patients with bilateral kidneys (P <0.001).
Patients received a median dose of radiotherapy of 25 Gy (14 to 70) in a median fraction of 1 (1 to 10).
Total dose and number of fractions were significantly lower in patients with solitary tumors (P .001). However, there was no median difference in biologically effective dose between the two groups, with solitary group patients receiving 87.5 Gy (range 33.6-125) and those in the bilateral group receiving 87.5 Gy. (extremes 37.5-125; P = 0.103).
Mean baseline GFR was higher in the solitary kidney group (64.6 ± 21.7 mL / min) than in the bilateral group (57.2 ± 21.6 mL / min; P = 0.016). Mean decreases in GFR following stereotaxic radiotherapy by ablation were similar in the solitary (-5.8 mL / min) and bilateral (-5.3 mL / min) groups; P = 0.984).
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Follow-up data over a 2.57-year period indicated a local control rate of 98%, a PHS rate of 77.5%, a cancer-specific survival rate of 98.2%, and an two years of 81.5%. There was a local failure in the group of solitary kidneys and two local failures in the bilateral group.
"These results are comparable to similar series of partial nephrectomy," said Hamilton.
Univariate badysis results from the solitary kidney group revealed an badociation between moderate chronic renal failure – defined as a TFGe of no greater than 60 mL / min – and a lower PFS (HR = 2.66, P = 0.043).
No solitary dialysis required dialysis, compared to six (4.2%) in the bilateral cohort.
"These data make ablative stereotactic radiotherapy an effective and relatively safe way to treat early-stage renal cell carcinoma in an isolated kidney, particularly in inoperable patients," Hamilton said.
"We conclude that ablative stereotactic radiotherapy can provide excellent local control with an acceptable impact on renal function in patients with isolated renal cell carcinoma," Correa said. "We suggest that a reference for stereotactic ablative radiotherapy of the kidney is worthy of consideration in this population." – by Rob Volansky
Reference:
Correa RJM, et al. Abstract 222. Presented at the annual meeting of the American Society for Radiation Oncology; October 21-24, 2018; San Antonio.
Disclosures: Correa does not report any relevant financial information. Hallman reports consultations for New Century Health.
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