Vienna, Austria

ESTRO 2023

Session Item

Tuesday
May 16
11:00 - 12:15
Lehar 1-3
ESTRO-RANZCR: Role of radiotherapy in renal cell carcinoma: From the primary to the metastatic setting
Gerry Adams, Australia;
Thomas Zilli, Switzerland
4160
Joint Symposium
Clinical
11:25 - 11:50
Oligometastatic renal cell carcinoma
Ciro Franzese, Italy
SP-1034

Abstract

Oligometastatic renal cell carcinoma
Authors:

Ciro Franzese1

1Humanitas University, Humanitas Research Hospital IRCSS, Radiotherapy and Radiosurgery department, Milano, Italy

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Abstract Text

Kidney represents a common site of primary malignant tumor, with renal cell carcinoma (RCC) accounting for 80-90% of all cases. The incidence rate of kidney cancer has been increasing in the last years, and 30% of patients undergoing surgical resection of the primary tumor will develop distant metastases during follow-up, most commonly into lung, liver, or bone. Survival of metastatic kidney cancer patients is still today unsatisfactory with an overall 5-year survival rate ranging between 20 and 40%. Systemic therapies, including tyrosine kinase inhibitors (TKIs), targeting vascular endothelial growth factor receptor (VEGFR), and immune checkpoint inhibitors (ICIs), represents nowadays the standard of care for metastatic kidney cancer. However, the use of metastases-directed surgery or local ablative treatments, including radiation therapy, have been investigated in the last years. A meta-analysis showed that metastatic patients benefit from metastasectomy in terms of overall survival compared to non-operated patients. Related to radiotherapy, kidney cancer has been considered historically as a radioresistant tumor, nevertheless the use of high dose per fraction typical of stereotactic radiation therapy is able to overcome this old concept of radioresistance. Several published studies showed high rates of tumor control after stereotactic radiation therapy both in the kidney primary and metastatic settings. Stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) are able to ablate intracranial and extracranial oligometastases from kidney cancer with local control rate higher than 90%. The encouraging efficacy data together with a mild pattern of toxicity, makes stereotactic radiation therapy as a valid alternative to more invasive treatment. SRS and SBRT can potentially be used for oligorecurrent disease in order to control the whole visible burden of disease, or in the oligoprogressive setting to control few isolated metastatic foci progressing on a background of metastatic disease responsive to an on-going systemic therapy. This talk will discuss the most recent advancements and evidences about the role of stereotactic radiation therapy in the management of oligometastatic kidney cancer.