Abstract
Background: Local ablative treatments of extracranial metastases are increasingly used in renal cell carcinoma (RCC), but their impact on outcome and toxicity remains unclear. Objectives: To perform a systematic review on the efficacy and toxicity of stereotactic body radiotherapy (SBRT) and radiofrequency ablation (RFA) for the treatment of distant extracranial RCC-metastases. Methods: Search strategy: Pubmed, Embase and the national trial register were searched for the combination of metastatic RCC and SBRT or RFA. Eligible studies were original comparative studies with at least 10 patients per treatment arm, published since 2000 and reporting on at least one of: local control, overall or cancer specific survival, symptom control, toxicity. When possible, hazard ratios were calculated from survival curves. Results and limitations: No eligible studies on RFA were found. Eight studies on SBRT were included, all were non-randomized and seven were observational. Six included only bone metastases. Radiation regime, treatment site and measured outcomes were heterogeneous and intrinsic risks of bias were high. SBRT, especially single dose 24Gy in the spine, seemed more effective than lower dose SBRT or conventional radiotherapy in achieving local control and pain control. Local control rates were 80–90%. The risk of vertebral compression fracture after SBRT for spinal metastases might be as high as 10–25% or more, especially at higher doses. Other toxicities were mild. Conclusion: Due to the poor quality of the existing evidence, no definite recommendations on the use of SBRT in metastatic RCC can be made. SBRT, especially a single high dose, seems well tolerated and efficacious in achieving local control and pain relief, but the risk of vertebral compression fractures in spinal metastases is high. Randomized trials are needed to assess impact on local control, symptom control, survival and toxicity, to determine optimal dosing and assess potential synergistic efficacy or toxicity upon combination with systemic treatment.
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