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. 2022 Dec;5(6):695-703.
doi: 10.1016/j.euo.2022.06.008. Epub 2022 Aug 16.

Stereotactic Ablative Radiation for Systemic Therapy-naïve Oligometastatic Kidney Cancer

Raquibul Hannan  1 , Michael Christensen  2 , Alana Christie  3 , Aurelie Garant  4 , Ivan Pedrosa  5 , Liliana Robles  2 , Samantha Mannala  2 , Chiachien Wang  2 , Hans Hammers  6 , Waddah Arafat  6 , Kevin Courtney  6 , Isaac A Bowman  6 , David Sher  2 , Chul Ahn  3 , Suzanne Cole  6 , Hak Choy  2 , Robert Timmerman  7 , James Brugarolas  8
Affiliations

Stereotactic Ablative Radiation for Systemic Therapy-naïve Oligometastatic Kidney Cancer

Raquibul Hannan et al. Eur Urol Oncol. 2022 Dec.

Abstract

Background: Evidence-based guidelines for the management of systemic therapy-naïve oligometastatic renal cell carcinoma (RCC) are lacking.

Objective: To evaluate the potential of stereotactic ablative radiotherapy (SAbR) to provide longitudinal disease control while preserving quality of life (QOL) in patients with systemic therapy-naïve oligometastatic RCC.

Design, setting, and participants: RCC patients with three or fewer extracranial metastases were eligible. SAbR was administered longitudinally to all upfront and, as applicable, subsequent metastases.

Outcome measurements and statistical analysis: This prospective phase II single-arm trial was powered to achieve a primary objective of freedom from systemic therapy for >1 yr in >60% of patients (using the Clopper and Pearson methodology). Secondary endpoints included progression-free survival (PFS), defined as the time from first SAbR to progression not amenable to SAbR (local failure at SAbR-treated sites, new metastases not amenable to SAbR, more than three new metastases, or brain metastases); patient-reported QOL metrics; local control (LC) rates; toxicity; cancer-specific survival (CSS); and overall survival (OS).

Results and limitations: Twenty-three patients received SAbR to 33 initial and 57 total sites. The median follow-up was 21.7 mo (interquartile range 16.3-30.3). Exceeding the prespecified 60% benchmark, freedom from systemic therapy at 1 yr was 91.3% (95% confidence interval [CI]: 69.5, 97.8). One-year PFS was 82.6% (95% CI: 60.1, 93.1). QOL was largely unaffected. LC was 100%. There were no grade 3/4 toxicities, but there was one death due to immune-related colitis 3 mo after SAbR while on subsequent checkpoint inhibitor therapy, where a SAbR contribution could not be excluded. One-year OS was 95.7% (95% CI: 72.9, 99.4); one-year CSS was 100%.

Conclusions: SAbR for oligometastatic RCC was associated with meaningful longitudinal disease control while preserving QOL. These data support further evaluation of SAbR for systemic therapy-naïve oligometastatic RCC.

Patient summary: Sequential stereotactic radiation therapy can safely and effectively control metastatic kidney cancer with limited spread for over a year without compromising patients' quality of life.

Keywords: Oligometastasis; Renal cell carcinoma; Stereotactic ablative radiotherapy; Stereotactic body radiation therapy; Stereotactic radiation.

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Conflict of interest statement

Conflicts of Interest: None

Figures

Figure 1.
Figure 1.
Swimmer plot and Kaplan-Meier analyses of freedom from systemic therapy, progression-free survival (PFS), and overall survival (OS). A. Swimmer plot representation from onset of SAbR. Dark blue bars indicate time after SAbR without progression and systemic treatment; light blue bars show time after progression prior to start of systemic therapy with associated interventions. Diamonds indicate SAbR with numbers representing number of sites, and colors referring to location. Black squares indicate the start of systemic therapy. Asterisks indicate ongoing follow-up. Plus sign (+) indicates patients who died. GK refers to Gamma Knife radiosurgery. B. Kaplan-Meier estimate of freedom from systemic therapy. C. Kaplan-Meier estimate of PFS. D. Kaplan-Meier estimate of OS. *PFS defined as time from first SAbR to progression not amenable to SAbR, local failure at SAbR-treated sites, >3 new metastases, or brain metastases.
Figure 1.
Figure 1.
Swimmer plot and Kaplan-Meier analyses of freedom from systemic therapy, progression-free survival (PFS), and overall survival (OS). A. Swimmer plot representation from onset of SAbR. Dark blue bars indicate time after SAbR without progression and systemic treatment; light blue bars show time after progression prior to start of systemic therapy with associated interventions. Diamonds indicate SAbR with numbers representing number of sites, and colors referring to location. Black squares indicate the start of systemic therapy. Asterisks indicate ongoing follow-up. Plus sign (+) indicates patients who died. GK refers to Gamma Knife radiosurgery. B. Kaplan-Meier estimate of freedom from systemic therapy. C. Kaplan-Meier estimate of PFS. D. Kaplan-Meier estimate of OS. *PFS defined as time from first SAbR to progression not amenable to SAbR, local failure at SAbR-treated sites, >3 new metastases, or brain metastases.
Figure 1.
Figure 1.
Swimmer plot and Kaplan-Meier analyses of freedom from systemic therapy, progression-free survival (PFS), and overall survival (OS). A. Swimmer plot representation from onset of SAbR. Dark blue bars indicate time after SAbR without progression and systemic treatment; light blue bars show time after progression prior to start of systemic therapy with associated interventions. Diamonds indicate SAbR with numbers representing number of sites, and colors referring to location. Black squares indicate the start of systemic therapy. Asterisks indicate ongoing follow-up. Plus sign (+) indicates patients who died. GK refers to Gamma Knife radiosurgery. B. Kaplan-Meier estimate of freedom from systemic therapy. C. Kaplan-Meier estimate of PFS. D. Kaplan-Meier estimate of OS. *PFS defined as time from first SAbR to progression not amenable to SAbR, local failure at SAbR-treated sites, >3 new metastases, or brain metastases.
Figure 1.
Figure 1.
Swimmer plot and Kaplan-Meier analyses of freedom from systemic therapy, progression-free survival (PFS), and overall survival (OS). A. Swimmer plot representation from onset of SAbR. Dark blue bars indicate time after SAbR without progression and systemic treatment; light blue bars show time after progression prior to start of systemic therapy with associated interventions. Diamonds indicate SAbR with numbers representing number of sites, and colors referring to location. Black squares indicate the start of systemic therapy. Asterisks indicate ongoing follow-up. Plus sign (+) indicates patients who died. GK refers to Gamma Knife radiosurgery. B. Kaplan-Meier estimate of freedom from systemic therapy. C. Kaplan-Meier estimate of PFS. D. Kaplan-Meier estimate of OS. *PFS defined as time from first SAbR to progression not amenable to SAbR, local failure at SAbR-treated sites, >3 new metastases, or brain metastases.
See this image and copyright information in PMC

Comment in

  • Radiation Therapy for Renal Cell Carcinoma.
    Zaorsky NG, Louie AV, Siva S. Zaorsky NG, et al. Int J Radiat Oncol Biol Phys. 2023 Nov 1;117(3):523-525. doi: 10.1016/j.ijrobp.2023.03.073. Int J Radiat Oncol Biol Phys. 2023. PMID: 37739599 No abstract available.

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