Single-fraction SABR for primary renal cell carcinoma: 5-year outcomes

Dr Philip Camilleri, Clinical Director for Uro-oncology and MRI Linear Accelerator (MRL) Specialist at GenesisCare

2 min read

Stereotactic ablative radiotherapy (SABR) is a non-invasive treatment option in the management of renal cell carcinoma (RCC). The use of SABR for treating RCC has increased steadily over the past 20 years and is recommended by guidelines, alongside percutaneous ablation, as an alternative to radical or partial nephrectomy for patients unsuitable for surgery. Now, for the first time, data has been published following patients for 5 years or more after SABR treatment, with encouraging results.

Study type¹:

Individual patient data meta-analysis

Location:

12 institutions from IROCK (International Radiosurgery Consortium of the Kidney) in 5 countries (Australia, Canada, Germany, Japan, USA)

Patients:

190 adults with non-metastatic RCC

73% male / 27% female

Median age - 73.6 years

Of 128 patients with available operability details, 75% deemed inoperable

Median tumour diameter - 4.0cm

Treatment:

Single- (43% of patients) or multi-fraction SABR (57% of patients)

No patients received adjuvant or concurrent systemic therapy

Follow-up:

Median 5.0 years (interquartile range, IQR 3.4-6.8)

• Single-fraction SABR had a local control rate of 94.5% at 5 years and a distant control rate of 87.3%
• No local failure was observed after 5 years in 86% of patients
• There were no grade 3 toxic effects or treatment-related deaths (grade 1-2 toxic effects were reported in 37% (70) patients)
• Single-fraction SABR showed fewer local failures than multi-fraction SABR

• The superiority of single-fraction SABR over multi-fraction needs to be confirmed in a randomised clinical trial
• SABR for primary RCC is safe and effective in the long term and a viable treatment option for patients who are inoperable or at high risk from surgery
• Comparative published outcome data on percutaneous ablation and partial nephrectomy are lacking compared with SABR in this indication

There are many patients with RCC where surgery is not an option. In those cases, these long-term outcome results reinforce SABR as an evidence-based treatment with strong efficacy data, a favourable safety profile and minimal inconvenience to the patient.

Read the full study here.

References

1.  Siva S. et al., 5-year outcomes after stereotactic ablative body radiotherapy for primary renal cell carcinoma: an individual patient data meta-analysis from IROCK (the International Radiosurgery Consortium of the Kidney). Lancet Oncol 16 Nov 2022