Oligometastatic renal cell carcinoma: radiotherapy as a new standard of care?

Abstract

The prognosis of metastatic renal cell carcinoma is poor, with a median 5-year survival of 9·5%. 1 Vallard A Trone JC Langrand-Escure J et al. The world of targeted therapies in kidney cancers: pitfalls, tips and tricks. Onco Targets Ther. 2017; 10: 1375-1380 Crossref PubMed Scopus (3) Google Scholar In patients with localised renal tumours, surgery remains the reference treatment, whereas radiotherapy plays a key role in the palliative care of patients with metastatic disease. However, during the past 20 years, a better understanding of biology has allowed targeted molecular therapies 1 Vallard A Trone JC Langrand-Escure J et al. The world of targeted therapies in kidney cancers: pitfalls, tips and tricks. Onco Targets Ther. 2017; 10: 1375-1380 Crossref PubMed Scopus (3) Google Scholar to emerge as a new standard of care in the metastatic setting. Regarding the role of radiotherapy in this setting, the sparing of surrounding healthy tissues has improved substantially thanks to the increasing use of stereotactic body radiotherapy (SBRT). A higher and more accurate dose per fraction is delivered with SBRT than with standard radiotherapy, which results in a large dose gradient around the target volume. In addition, new sophisticated imaging modalities have made identifying patients with oligometastatic renal cell carcinoma—namely patients with five or fewer metastatic lesions—possible. But, in oligometastatic disease, the role of radiotherapy and systemic treatment in the therapeutic arsenal has not yet been established. Definitive radiotherapy in lieu of systemic therapy for oligometastatic renal cell carcinoma: a single-arm, single-centre, feasibility, phase 2 trialSequential radiotherapy might facilitate deferral of systemic therapy initiation and could allow sustained systemic therapy breaks for select patients with oligometastatic renal cell carcinoma. Full-Text PDF