Focal therapy for oligometastatic and oligoprogressive renal cell carcinoma: a narrative review

August C Anderson^{1

2}, Joel Ho³, Evan T Hall^{4

5}, Raquibul Hannan^{6

7}, Jay J Liao^{1

2}, Alexander V Louie⁸, Ting Martin Ma^{1

2}, Sarah P Psutka^{5

9}, Ramesh Rengan^{1

2}, Shankar Siva^{10

11}, Anand Swaminath^{12

13}, Lisa Tachiki^{4

5}, Chad Tang^{14

15

16}, Bin Sing Teh¹⁷, Joseph Tsai^{1

2}, Scott S Tykodi^{4

5}, Emily Weg^{1

2}, Nicholas G Zaorsky¹⁸, Simon S Lo^{1

2}

Affiliations

¹ University of Washington, Department of Radiation Oncology, Seattle, WA 98195, USA.
² Fred Hutchinson Cancer Center, Radiation Oncology Division, Seattle, WA 98195, USA.
³ Pfizer Inc., Bothell, WA 98011, USA.
⁴ University of Washington, Division of Hematology & Oncology, Seattle, WA 98195,USA.
⁵ Fred Hutchinson Cancer Center, Clinical Research Division, Seattle, WA 98195, USA.
⁶ The University of Texas Southwestern Medical Center, Radiation Oncology, Dallas, TX 75235, USA.
⁷ Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Kidney Cancer Program, Dallas, TX 75235, USA.
⁸ Sunnybrook Health Sciences Centre, Department of Radiation Oncology, Toronto, ON, M4N 3M5, Canada.
⁹ University of Washington, Department of Urology, Seattle, WA 98195, USA.
¹⁰ Peter MacCallum Cancer Centre, Division of Radiation Oncology & Cancer Imaging, Melbourne, VIC, 3052, Australia.
¹¹ The University of Melbourne, Sir Peter MacCallum Department of Oncology, Melbourne, VIC, 3052, Australia.
¹² Juravinski Cancer Centre, Radiation Therapy, Hamilton, ON, L8V 5C2, Canada.
¹³ McMaster University, Division of Radiation Oncology, Hamilton, ON, L8S 4L8,Canada.
¹⁴ The University of Texas MD Anderson Cancer Center, Genitourinary Radiation Oncology, Houston, TX 77030, USA.
¹⁵ The University of Texas MD Anderson Cancer Center, Investigational Cancer Therapeutics, Houston, TX 77030, USA.
¹⁶ The University of Texas MD Anderson Cancer Center, Translational Molecular Pathology, Houston, TX 77030, USA.
¹⁷ Houston Methodist Hospital, Radiation Oncology, Houston, TX 77030, USA.
¹⁸ University Hospitals Seidman Cancer Center, Case Western Reserve University, Department of Radiation Oncology, Cleveland, OH 44106, USA.

PMID: 39258792
PMCID: PMC11534104
DOI: 10.1080/14796694.2024.2389769

Review

Focal therapy for oligometastatic and oligoprogressive renal cell carcinoma: a narrative review

August C Anderson et al. Future Oncol. 2024.

. 2024;20(33):2573-2588.

doi: 10.1080/14796694.2024.2389769. Epub 2024 Sep 11.

Authors

Affiliations

¹ University of Washington, Department of Radiation Oncology, Seattle, WA 98195, USA.
² Fred Hutchinson Cancer Center, Radiation Oncology Division, Seattle, WA 98195, USA.
³ Pfizer Inc., Bothell, WA 98011, USA.
⁴ University of Washington, Division of Hematology & Oncology, Seattle, WA 98195,USA.
⁵ Fred Hutchinson Cancer Center, Clinical Research Division, Seattle, WA 98195, USA.
⁶ The University of Texas Southwestern Medical Center, Radiation Oncology, Dallas, TX 75235, USA.
⁷ Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Kidney Cancer Program, Dallas, TX 75235, USA.
⁸ Sunnybrook Health Sciences Centre, Department of Radiation Oncology, Toronto, ON, M4N 3M5, Canada.
⁹ University of Washington, Department of Urology, Seattle, WA 98195, USA.
¹⁰ Peter MacCallum Cancer Centre, Division of Radiation Oncology & Cancer Imaging, Melbourne, VIC, 3052, Australia.
¹¹ The University of Melbourne, Sir Peter MacCallum Department of Oncology, Melbourne, VIC, 3052, Australia.
¹² Juravinski Cancer Centre, Radiation Therapy, Hamilton, ON, L8V 5C2, Canada.
¹³ McMaster University, Division of Radiation Oncology, Hamilton, ON, L8S 4L8,Canada.
¹⁴ The University of Texas MD Anderson Cancer Center, Genitourinary Radiation Oncology, Houston, TX 77030, USA.
¹⁵ The University of Texas MD Anderson Cancer Center, Investigational Cancer Therapeutics, Houston, TX 77030, USA.
¹⁶ The University of Texas MD Anderson Cancer Center, Translational Molecular Pathology, Houston, TX 77030, USA.
¹⁷ Houston Methodist Hospital, Radiation Oncology, Houston, TX 77030, USA.
¹⁸ University Hospitals Seidman Cancer Center, Case Western Reserve University, Department of Radiation Oncology, Cleveland, OH 44106, USA.

PMID: 39258792
PMCID: PMC11534104
DOI: 10.1080/14796694.2024.2389769

Abstract

Metastatic renal cell carcinoma (RCC) can present with oligometastatic disease and/or develop oligoprogression following systemic therapy. Cytoreductive and focal metastasis-directed therapy options include resection, stereotactic ablative radiation and thermal ablation. Aggressive focal therapy may allow delay in initiation of or modification to systemic therapy and improve clinical outcomes. In this narrative review we synthesize current practice guidelines and prospective data on focal therapy management options and highlight future research. Patient selection and the choice of focal treatment techniques are controversial due to limited and heterogeneous data and patients may benefit from multidisciplinary evaluation. Prospective comparative trials with clearly defined inclusion criteria and relevant end points are needed to clarify the risks and benefits of different approaches.

Keywords: RCC; SABR; SBRT; cytoreduction; immunotherapy; metastasis-directed therapy; oligometastatic; oligoprogressive; renal cell carcinoma.

Plain language summary

[Box: see text].

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Conflict of interest statement

SS Lo reports travel funds from JASTRO; leadership roles at the Radiosurgery Society and American College of Radiology. SP Psutka is on the editorial boards of European Urology and Bladder Cancer, is a member of the guidelines committee for the American Urological Association: Upper Tract Urothelial Carcinoma Guidelines 2023 and holds advisory/consultancy roles with Janssen (SunRise-4 Global Co-PI), Immunity Bio, Merck and CG Oncology. R Rengan reports honoraria, travel and lodging funds from Siemens and Ion Beam Applications, and was on the Siemens advisory board. The authors have no other competing interests or relevant affiliations with any organization or entity with the subject matter or materials discussed in the manuscript apart from those disclosed.

Figures

**Figure 1.**
Potential selection factors for focal therapy (— Surgery/SABR; - - - SABR; ⋅ ⋅ ⋅ Multidisciplinary discussion).

See this image and copyright information in PMC

References

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Focal therapy for oligometastatic and oligoprogressive renal cell carcinoma: a narrative review

Affiliations

Focal therapy for oligometastatic and oligoprogressive renal cell carcinoma: a narrative review

Authors

Affiliations

Abstract

Plain language summary

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical