Journal article
Safety and Efficacy of Stereotactic Ablative Radiation Therapy for Renal Cell Carcinoma Extracranial Metastases
International journal of radiation oncology, biology, physics, Vol.98(1), pp.91-100
05/01/2017
DOI: 10.1016/j.ijrobp.2017.01.032
PMCID: PMC5555369
PMID: 28587057
Abstract
Renal cell carcinoma is refractory to conventional radiation therapy but responds to higher doses per fraction. However, the dosimetric data and clinical factors affecting local control (LC) are largely unknown. We aimed to evaluate the safety and efficacy of stereotactic ablative radiation therapy (SAbR) for extracranial renal cell carcinoma metastases. We reviewed 175 metastatic lesions from 84 patients treated with SAbR between 2005 and 2015. LC and toxicity after SAbR were assessed with Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 and Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. Predictors of local failure were analyzed with χ , Kaplan-Meier, and log-rank tests. In most cases (74%), SAbR was delivered with total doses of 40 to 60 Gy, 30 to 54 Gy, and 20 to 40 Gy in 5 fractions, 3 fractions, and a single fraction, respectively. The median biologically effective dose (BED) using the universal survival model was 134.5 Gy. The 1-year LC rate after SAbR was 91.2% (95% confidence interval, 84.9%-95.0%; median follow-up, 16.7 months). Local failures were associated with prior radiation therapy (hazard ratio [HR], 10.49; P<.0001), palliative-intent radiation therapy (HR, 4.63; P=.0189), spinal location (HR, 5.36; P=.0041), previous systemic therapy status (0-1 vs >1; HR, 3.52; P=.0217), and BED <115 Gy (HR, 3.45; P=.0254). Dose received by 99% of the target volume was the strongest dosimetric predictor for LC. Upon multivariate analysis, dose received by 99% of the target volume greater than BED of 98.7 Gy and systemic therapy status remained significant (HR, 0.12 and 3.64, with P=.0014 and P=.0472, respectively). Acute and late grade 3 toxicities attributed to SAbR were observed in 3 patients (1.7%) and 5 patients (2.9%), respectively. SAbR demonstrated excellent LC of metastatic renal cell carcinoma with a favorable safety profile when an adequate dose and coverage were applied. Multimodality treatment with surgery should be considered for reirradiation or vertebral metastasis. A higher radiation dose may be required in patients who received previous systemic therapies.
Details
- Title: Subtitle
- Safety and Efficacy of Stereotactic Ablative Radiation Therapy for Renal Cell Carcinoma Extracranial Metastases
- Creators
- Chiachien Jake Wang - The University of Texas Southwestern Medical CenterAlana Christie - Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TexasMu-Han Lin - Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TexasMatthew Jung - Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TexasDerek Weix - Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TexasLorel Huelsmann - Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TexasKristin Kuhn - Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TexasJeffrey Meyer - Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TexasNeil Desai - Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TexasD W Nathan Kim - Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TexasIvan Pedrosa - Department of Radiology, Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TexasVitaly Margulis - Department of Urology, University of Texas Southwestern Medical Center, Dallas, TexasJeffrey Cadeddu - Department of Urology, University of Texas Southwestern Medical Center, Dallas, TexasArthur Sagalowsky - Department of Urology, University of Texas Southwestern Medical Center, Dallas, TexasJeffrey Gahan - Department of Urology, University of Texas Southwestern Medical Center, Dallas, TexasAaron Laine - Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TexasXian-Jin Xie - Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TexasHak Choy - Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TexasJames Brugarolas - The University of Texas Southwestern Medical CenterRobert Timmerman - Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TexasRaquibul Hannan - The University of Texas Southwestern Medical Center
- Resource Type
- Journal article
- Publication Details
- International journal of radiation oncology, biology, physics, Vol.98(1), pp.91-100
- DOI
- 10.1016/j.ijrobp.2017.01.032
- PMID
- 28587057
- PMCID
- PMC5555369
- NLM abbreviation
- Int J Radiat Oncol Biol Phys
- ISSN
- 1879-355X
- eISSN
- 1879-355X
- Publisher
- United States
- Grant note
- P50 CA196516 / NCI NIH HHS
- Language
- English
- Date published
- 05/01/2017
- Academic Unit
- Preventive and Community Dentistry; Biostatistics; Dental Research
- Record Identifier
- 9983917766402771
Metrics
29 Record Views