Results of stereotactic radiation therapy in treatment of patients with T1N0M0 kidney cancer

Background. Currently, the main treatment for T1N0M0 kidney cancer is surgery, mainly in the amount of kidney resection. However, not all patients can be operated on, and most often due to the severity of comorbidity, some patients refuse surgery. In such cases, it becomes necessary to search for an acceptable operation of an alternative method of treatment. Such requirements can be met by stereotactic radiotherapy (SBRT), being a non-invasive method of treating renal cell carcinoma.

Purpose. To determine overall survival (OS), local control, and renal toxicity after treatment of T1N0M0 renal cell carcinoma (RCC) with stereotactic radiotherapy.

Material and methods. Since 2011 to 2022 in the Chelyabinsk Regional Clinical Centre of Oncology and Nuclear Medicine, 50 patients with verified RCC underwent SBRT up to 30–45 Grey in three fractions using the CyberKnife. The mean age of the patients was 69.8 years. Primary tumor was diagnosed in 44 cases, recurrence after previous surgical treatment in 6 cases, including one patient with recurrence of cancer of both kidneys. The average tumor volume was 29.1 cm3 .

Results. Median overall survival was not reached as most patients were alive at the time of the study. Indicators of 1-, 3- and 5-year OS are 94.8%, 87.3% and 75.1%, respectively. In 74.5% of cases, according to the RECIST 1.1 criteria, stabilization of the process was recorded 6 months after STLT, in 21.6% of cases – a partial response, in 3.9% – progression of the process. One-year local control – 98%. Renal toxicity occurred in 26% of patients 6 months after radiation therapy, but within a year, kidney function was restored in these patients.

Conclusions. Stereotactic radiation therapy T1N0M0 of kidney cancer in SOD = 30–45 Grey allows to stabilize the tumor process with sufficiently high results of overall survival and local control with low renal toxicity, respectively, can be used in the treatment of inoperable patients with localized renal cell carcinoma.

1. Клинические рекомендации МЗ, 2021 г. Clinical guidelines of the Russian Ministry of Health 2021.

2. Hendrik an Poppel, Luigi Da Pozzo et al. A Prospective, Randomised EORTC Intergroup Phase 3 Study Comparing the Oncologic Outcome of Elective Nephron-Sparing Surgery and Radical Nephrectomy for Low-Stage Renal Cell Carcinoma. Eur Urol 2011; 59 (4): 543–52. DOI: 10.1016/j.eururo.2010.12.013.

3. Chang JH, 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. Clinical Oncology (R Coll Radiol) 2016; 28 (9): e109–e114. DOI: 10.1016/j.clon.2016.04.002.

4. Stephen R Grant, Xiudong Lei, Kenneth R Hess, Grace L Smith, Surena F Matin, Christopher G Wood, Quynh Nguyen, Steven J Frank, Mitchell S Anscher, Benjamin D Smith, Jose A Karam, Chad Tang. Stereotactic Body Radiation Therapy for the Definitive Treatment of Early-Stage Kidney Cancer: A Survival Comparison with Surgery, Tumor Ablation, and Observation. Ad Radiat Oncol. 2020 Jan 21; 5 (3): 495–502. DOI: 10.1016/j.adro.2020.01.002. eCollection 2020 May-Jun.

5. Haque W, Verma V, Lewis GD, Lo SS, Butler EB and Teh BS: Utilization of radiotherapy and stereotactic body radiation therapy for renal cell cancer in the USA. Future Oncol 14 (9): 819–827, 2018. PMID: 29527938. DOI: 10.2217/fon‑2017–0536.

6. Siva S, Jackson P, Kron T, Bressel M, Lau E, Hofman M. Impact of stereotactic radiotherapy on kidney function in primary renal cell carcinoma: Establishing a dose-response relationship. Radiother Oncol. 2016 Mar; 118 (3): 540–6. DOI: 10.1016/j.radonc.2016.01.027 Epub 2016 Feb 9.

7. Correa RJM, Louie A, Zaorsky NG, Lehrer EJ, Ellis R et al.: The emerging role of stereotactic ablative radiotherapy for primary renal cell carcinoma: A systematic review and meta-analysis. Eur Urol Focus 5 (6): 958–969, 2019. PMID: 31248849. DOI: 10.1016/j.euf. 2019.06.002.

8. Siva S, Louie A, Warner A, Muacevic A, Gandhidasan S, Ponsky L, Ellis R, Kaplan I, Mahadevan A, Chu W, Swaminath A, Onishi H, Teh B, Correa RJ, Lo SS and 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 124 (5): 934–942, 2018. PMID: 29266183. DOI: 10.1002/cncr.31156.

9. Siva S, Chesson B, Bressel M, Pryor D, Higgs B and all. TROG 15.03 phase II clinical trial of Focal Ablative Stereotactic Radiosurgery for Cancers of the Kidney – FASTRACK II/BMC Cancer. 2018 Oct 23; 18 (1): 1030. DOI: 10.1186/s12885–018–4916–2v.

10. Wegner RE, Abel S, Vemana G, Mao S and Fuhrer R: Utilization of stereotactic ablative body radiation therapy for intact renal cell carcinoma: Trends in treatment and predictors of outcome. Ad Radiat Oncol 5 (1): 85–91, 2019. PMID: 32051894. DOI: 10.1016/j.adro.2019.07.018v.

11. Siva S, Correa RJM, Warner A, Staehler M et al.: 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 108 (4): 941–949, 2020. PMID: 32562838. DOI: 10.1016/j.ijrobp.2020.06.014.

12. Ponsky L, Lo SS, Zhang Y, Schluchter M, Liu Y, Patel R et al.: Phase I dose-escalation study of stereotactic body radiotherapy (SBRT) for poor surgical candidates with localized renal cell carcinoma. Radiother Oncol 117 (1): 183–187, 2015. PMID: 26362723. DOI: 10.1016/j.radonc.2015.08.030.

13. Peddada A, Anderson D, Blasi OC, McCollough K, Jennings SB and Monroe AT: Nephron-sparing robotic radiosurgical therapy for primary renal cell carcinoma: Single-institution experience and review of the literature. Ad Radiat Oncol 5 (2): 204–211, 2019. PMID: 32280820. DOI: 10.1016/j.adro.2019.10.001.

14. Senger C, Conti A, Kluge A, Pasemann D et al.: Robotic stereotactic ablative radiotherapy for renal cell carcinoma in patients with impaired renal function. BMC Urol 19 (1): 96, 2019. PMID: 31638979. DOI: 10.1186/s12894–019–0531-z.

15. Carolina DE LA Pinta, Raquel García Latorre, Raquel Fuentes. SBRT in Localized Renal Carcinoma: A Review of the Literature. Anticancer Res. 2022 Feb; 42 (2): 667–674. DOI: 10.21873/anticanres.15525.