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. 2024 Nov 21:50:100891.
doi: 10.1016/j.ctro.2024.100891. eCollection 2025 Jan.

Stereotactic ablative radiotherapy for primary kidney cancer - An international patterns of practice survey

Katherine Taplin  1 , Raquibul Hannan  2 , Simon S Lo  3 , Scott C Morgan  4 , Muhammad Ali  5 , Samantha Sigurdson  6 , Matthias Guckenberger  7 , Anand Swaminath  6
Affiliations

Stereotactic ablative radiotherapy for primary kidney cancer - An international patterns of practice survey

Katherine Taplin et al. Clin Transl Radiat Oncol. .

Abstract

Purpose: To conduct an international survey of radiation oncologists treating primary renal cell carcinoma (RCC) with SABR to ascertain the general patterns of SABR use, common dose/treatment/follow-up details, and expected outcomes.

Materials and methods: A 51-question survey was created containing the following themes: prevalence and clinical scenarios in which RCC SABR is used, dose-fractionation schedules, treatment delivery details, follow-up/outcome assessments, and implementation barriers. The survey was distributed widely across multiple influential radiation oncology societies and social media, and ran from January to April 2023.

Results: A total of 255 respondents participated, mostly from academic centers within Europe/North America. Of these, 40 % (n = 102) currently offer SABR (50 % having begun within the last 3 years). Common barriers in non-users included lack of referrals by urologists and lack of supportive practice guidelines. Of respondents who do offer SABR, 77 % treat both small (4 cm or less) and large (>4 cm) renal masses. Dose-fractionation strategies varied from 27-52 Gy (3-5 fractions) for multifraction regimens, and 15-34 Gy for single fractions. Apart from treatment for medically inoperable disease, scenarios in which SABR was likely to be offered were for recurrence post surgery/thermal ablation and for oligometastatic kidney lesions. Uncommon scenarios included RCC with renal vein/inferior vena cava thrombosis, and as cytoreductive therapy in metastatic RCC. Expected local control outcomes were generally above 70 %, higher for small versus large renal masses.

Conclusions: SABR is a relatively newer indication for primary RCC, offered by less than 50% of respondents, with both consistent and variable practice patterns observed.

Keywords: Kidney cancer; Practice patterns; RCC; Stereotactic radiation; Survey.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Taplin: none, Hannan: none, Lo: Kuni Foundation – research funding; Radiosurgery Society – Member of Board of Directors; ACR – assistant councillor and chair of CARROS nomination committee, Morgan: none, Ali: none, Sigurdson: none, Guckenberger: none, Swaminath: Bristol-Myers Squibb – honoraria.

Figures

Fig. 1
Fig. 1
Patterns of Referral for RCC SABR.
Fig. 2
Fig. 2
SABR Utilization vs Alternative Therapies for Small (4 cm or less) Compared to Large (> 4 cm) Renal Masses in Medically Operable and Inoperable Patients (a-d).
Fig. 3
Fig. 3
Clinical Scenarios (a-l) Assessing SABR Utilization in RCC.
Fig. 4
Fig. 4
Commonly Utilized Dose Fractionations for RCC SABR.
Fig. 5
Fig. 5
Response Expectations (Local Control at 3-Years) Following RCC SABR.
See this image and copyright information in PMC

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