Propensity Score-Matched Analysis of Single Fraction Robotic Radiosurgery Versus Open Partial Nephrectomy in Renal Cell Carcinoma: Oncological Outcomes.

Michael Staehler,Tina Schuler,Severin Rodler,Christoph Fürweger,Alexander Muacevic,Alexander Tamalunas,Annabel Spek

doi:10.7759/cureus.21623

Abstract

IntroductionHigh-dose local stereotactic robotic radiosurgery (RRS) is a non-invasive alternative to surgery in renal masses and selected patients. We have, so far, limited its use to the elderly and patients at high risk from surgery. In this study, we matched patients with renal tumors who were treated with single fraction RRS to patients who underwent open partial nephrectomy (OPN).MethodsBetween January 2009 and December 2017, we included 571 consecutive patients undergoing OPN and 99 patients who underwent RRS in this retrospective analysis. Patients had to have a follow-up of at least six months and we were able to match 35 with a propensity score. Matching criteria were Eastern Cooperative Oncology Group (ECOG) status, age, clinical tumor, nodes, and metastases (TNM), and tumor diameter. Tumor response, renal function, survival, and adverse events were evaluated every three months until progression or death.ResultsMedian age was 65 years for RRS (range 58-75) and 71 (range 56-76) for OPN (p=0.131). Median diameter of renal tumors was 2.8 cm (range 2.4-3.9) for RRS and 3.5 cm (2.8-4.5) for OPN, p=0.104. Median follow-up was 28.1 months (range 6.0-78.3 months). Local tumor control nine months after RRS and OPN was 98% (95% CI: 89-99%). Renal function remained stable with a median creatinine clearance (Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)) at baseline of 76.8mlmin/1.73m2 (range 25.3-126.3) and 70.3ml/min/1.73m2 (range 18.6-127.3) at follow-up (p=0.89). Median overall survival was not reached. No difference in overall survival (OS) was seen in RRS compared to OPN (p=0.459).ConclusionsSingle fraction RRS is an alternative to OPN in patients unfit for surgery. Oncological and functional results are comparable to those of OPN. Further studies are needed to determine long-term results and limits of RRS in this setting and in younger patients.

Highlights

MethodsBetween January 2009 and December 2017, we included 571 consecutive patients undergoing open partial nephrectomy (OPN) and 99 patients who underwent robotic radiosurgery (RRS) in this retrospective analysis
High-dose local stereotactic robotic radiosurgery (RRS) is a non-invasive alternative to surgery in renal masses and selected patients
Local tumor control nine months after RRS and open partial nephrectomy (OPN) was 98%

Summary

Methods

Between January 2009 and December 2017, we included 571 consecutive patients undergoing OPN and 99 patients who underwent RRS in this retrospective analysis. Patients had to have a follow-up of at least six months and we were able to match 35 with a propensity score. Renal function, survival, and adverse events were evaluated every three months until progression or death. Out of 571 consecutive patients undergoing OPN and 99 patients who underwent RRS, we could match 35 with a propensity score between January 2009 and December 2017. The indication for RRS was determined by the oncological tumor board with the patients’ oncological status and their treatment preference being the most important factors. Renal function, survival, and adverse events were estimated every three months with a follow-up of at least six months

Results

Discussion

Conclusion