Dr Hannan on the Advantages of Stereotactic Radiation in Primary and Locally Advanced RCC

Raquibul Hannan, MD, PhD, adiation oncologist, professor, chief, Genitourinary Radiation Oncology Service, Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, discusses the advantages of stereotactic radiation in primary or locally advanced renal cell carcinoma (RCC).

There are several advantages associated with utilizing stereotactic radiation therapy in primary RCC, Hannan begins. As stereotactic radiation therapy is completely non-invasive, patients with high-risk features and/or individuals who are ineligible for surgery may receive this modality instead, Hanna says. Unlike ablation, stereotactic radiation is not as limited by location or tumor size, making it an ideal treatment approach for patients with large tumors, he adds.

Several studies have shown benefit with stereotactic radiation therapy as a noninvasive treatment option in RCC, including a prospective phase 2 study in patients with biopsy-proven, radiographically progressive primary RCC, Hannah introduces. The study's end point was local control, which was defined as a reduction in tumor growth rate and pathologic evidence of tumor response at 1 year. Results showed that stereotactic radiation therapy was safe and effective, producing local control rates of 94% with pathologic evidence of response at 1 year, Hannan reports. These findings support the consideration of this approach as a potential option in primary RCC, as well as its continued investigation in a phase 3 trial. 

Stereotactic radiation therapy may also be considered for patients with locally advanced RCC with intravascular tumor thrombus, Hannan continues. Patients with this disease often require extensive surgery and have high comorbidities, he states. The application of this modality for patients who are not candidates for surgery has shown promising efficacy. A multi-institutional case report assessing this approach showed that over half of these patients responded to stereotactic radiation, Hannan details. Moreover, stereotactic radiation provided palliative benefit to the majority of patients by alleviating venous congestion due to Budd-Chiari syndrome, Hannan concludes.