Abstract
Simple SummaryIn metastatic renal cell carcinoma (mRCC), systemic treatment with checkpoint inhibitors or tyrosine kinase inhibitors is recommended in guidelines. However, the treatment of patients with oligometastatic disease or mixed responses remains challenging. We aimed to investigate the safety and efficacy of robotic radiosurgery in patients with mRCC. Sixty patients with visceral and lymph node metastases were selected for robotic radiosurgery. The median progression free survival of all patients was 17.4 months, local tumor control was achieved in 96.7% of patients, and only 8.3% of patients experienced adverse events. Robotic radiosurgery might be a powerful tool in addition to systemic treatment for patients with mRCC, but additive effects of both treatments require further investigation.Despite rapid advances of systemic therapy options in renal cell carcinoma (RCC), local tumor or metastases treatment remains important in selected patients. Here, we assess the safety and efficacy of robotic radiosurgery (RRS) as an ablative therapy for visceral and lymph node metastases of RCC. Patients with histologically confirmed RCC and radiologically confirmed progression of visceral or lymph node metastases underwent RRS and were retrospectively analyzed. Overall survival and progression free survival were calculated by the Kaplan–Meier method and log-rank test. Sixty patients underwent RRS and were included in the analysis. Patients presented for RRS treatment with a median age at RRS treatment of 64 years (range 42–83), clear cell histology (88.3%) and favorable international metastatic renal cell carcinoma database (IMDC) risk score (58.3%). Treatment parameters differed for the number of fractions (median visceral metastases: 1, range 1–5; median lymph node metastases: 1, range 0–5; p = 0.003) and prescription dose (median visceral metastases 24 Gy, range 8–26; median lymph node metastases 18 Gy, range 7–26, p < 0.001). The median overall survival was 65.7 months (range: 2.9–108.6), the median progression free survival was 17.4 months (range: 2.7–70.0) and local tumor control was achieved in 96.7% of patients. Adverse events were limited to 8.3% of patients, with one grade 4 toxicity within 6 weeks after RRS therapy. RRS is a safe and effective treatment option in selected patients with metastatic RCC in a multimodal approach. Further research is warranted to confirm our findings prospectively.
Highlights
Renal cell carcinoma (RCC) accounts for 4% of new cancer cases in the US and is responsible for 2% of cancer deaths [1]
Between December 2005 and September 2019, 60 patients with metastatic RCC undergoing robotic radiosurgery (RRS) were included in this study
44 patients presented with visceral metastasis (73.3%) and 16 with lymph node metastasis (26.7%)
Summary
Renal cell carcinoma (RCC) accounts for 4% of new cancer cases in the US and is responsible for 2% of cancer deaths [1]. As soon as RCC presents as a metastasized disease, systemic treatment is required [2]. The most frequent sites of metastases in RCC are the lungs and bones. Lymph nodes are the third most frequent site of metastases in 21.8% of all patients with metastatic renal cell carcinoma (mRCC). Systemic treatment options for mRCC have changed dramatically during the past few years, and with the approval of immunotherapy based regimes such as Nivolumab in second line settings [4] and, more recently, Nivolumab with Ipilimumab [5] and Pembrolizumab with Axitinib as first line therapies [6], a new standard of care has been gained
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