Here is an interesting article:
Hypo-fractionated Stereotactic Extra-Cranial Radiosurgery(HFSR) for Primary and Metastatic Renal Cell Carcinoma
B. Gilson, G. Lederman, G. Qian, M. Fastaia, L. Cangiane Cabrini Medical Center, New York, NY
Purpose/Objective(s): HFSR is precisely delivered radiation using an external stereotactic frame and hypo-fractionated high dose radiation in an attempt to control extra-cranial sites of kidney cancer.
Materials/Methods: 92 patients (pts) with 204 renal cell cancers completed treatment between June 1997 and May 2005 and were radiographically evaluated. Included were 171 extra-cranial metastases and 33 primary kidney cancers. For the primary renal cell cancers, 14 pts, age ranged from 31 to 85 years (mean 62), had 33 cancers treated with a volume ranging from 2.4 to 1366cc (mean 356cc).
For the extra-cranial metastases of kidney cancer, 78 pts age ranged from 31 to 84 years (mean 61) had 171 metastatic sites treated with volume 0.06 to 3166cc (mean 165cc). Patients were treated with 1200 - 6000cGy(median 4000) in 2–10 (median 5) fractions. All cancers were radiographically evaluated after treatment using contrast-enhanced scanning and reviewed by a multi-disciplinary panel. Control rate of the treated site is defined as cessation of growth, shrinkage or disappearance of cancer.
Results: The overall control rate for the 204 renal cell cancers was 87%. The control rate for the primary kidney cancers was 94% with follow-up ranging from 2 to 73 months (mean 17 months).
For primary kidney cancers, the control rate was 88% for 16 cancers with volume 196.48cc.
For the extra-cranial, extra-renal sites of disease, the control rate was 87% with follow-up ranging from 1 to 73 months (mean 10 months). For metastatic renal cell cancers, the control rate was 86% for 101 cancers with volume 37.3cc vs. 89% for cancers with volume 37.3cc. Dose and volume of treated area were not statistically significant in multivariate analysis.
Conclusions: HFSR is an option for those who are unable or unwilling to undergo surgical resection of their primary site or in whom the primary site is symptomatic in the face of metastatic cancer. Body radiosurgery offers high control rates in patients with extra-renal sites of disease whose disease has not been controlled by systemic therapy or other means. HFSR offers an appealing method of treatment that at this time shows high control rates while avoiding systemic effects associated with other methods of treatment.
Author Disclosure: B. Gilson, None; G. Lederman, None; G. Qian, None; M. Fastaia, None; L. Cangiane, None.
The Treatment of Primary and Metastatic Renal Cell Carcinoma (RCC) With Stereotactic Body Radiation Therapy (SBRT) and Stereotactic Radiosurgery (SRS)
L. Doh1, C. Bloch1, A. C. Paulino1,2, M. Galli Guevara2, S. Chiang2, S. Shen2, D. Baskin2, E. B. Butler2, R. Amato2, B. S. Teh1,2 1Baylor College of Medicine, Houston, TX, 2Methodist Hospital, Houston, TX
Purpose/Objective(s): RCC is often regarded as a radioresistant tumor. However, brain metastases from RCC have been successfully treated with SRS. Therefore, metastases to extra-cranial sites may be treated with similar success using stereotactic body radiation therapy (SBRT), where image-guidance allows for the delivery of precise high dose radiation in few fractions. We report our experience with SRS/SBRT in the management of primary and metastatic RCC.
Materials/Methods: The image-guided Novalis radiation therapy system was used. Thirty patients with brain metastases were treated with SRS (16–22 Gy in a single fraction). Five of these patients underwent resection of their metastatic lesions after SRS and their pathology was reviewed. Twenty patients with extra-cranial metastatic lesions (orbits, head and neck, lung, mediatinum, sternum, clavicle, scapula, humerus, rib, spine, abdomen) and 2 patients with biopsy proven primary RCC (not surgical candidates), were treated with SBRT (24–32 Gy in 3–4 fractions over 1–2 weeks). Immobilization using a body cast and image-guidance was used for all patients with treated with SBRT. 4D-CT was utilized in the treatment planning to assess tumor motion.
Results: Overall local control rate was 96%. Of the 30 patients who received SRS to brain, follow-up MR images showed decreasing or stable lesion size in 25 patients. 5 patients had an “increase in size” in their treated lesions, and underwent resection of the lesions. Pathology revealed necrotic specimen without any viable RCC in each case. Of the 20 patients with extra-cranial metastatic lesions, 18 patients achieved symptom relief after treatment; 2 patients had local progression. In the 2 patients with primary RCC, tumor size remained unchanged but their pain improved, and their renal function was unchanged post SBRT. There was no significant treatment related side-effect.
Conclusions: Precise high dose radiation can cause significant tumor cell death in “radio-resistant” metastases from RCC. It also offers excellent local control and symptom palliation, without significant toxicity. Therefore, SBRT may represent a novel non-invasive, nephron-sparing option for the treatment of primary RCC as well as extra-cranial metastatic RCC. A prospective clinical trial using SBRT for primary and metastatic RCC is ongoing. Author Disclosure: L. Doh, None; C. Bloch, None; A.C. Paulino, None; M. Galli Guevara, None; S. Chiang, None; S. Shen, None; D. Baskin, None; E.B. Butler, None; R. Amato, None; B.S. Teh, None.