Guidelines Provide Recommendations for SBRT in Primary RCC

Researchers have released new guidelines for stereotactic body radiotherapy (SBRT) in patients with primary renal cell carcinoma (RCC), based on results of a systematic review. The review and guidelines were published in The Lancet Oncology.

The systematic review included 36 studies of SBRT for primary RCC. The 23 retrospective studies and 13 prospective studies included a total of 822 patients.

Pooled data revealed a local control rate of 94.1%, a 5-year progression-free survival rate of 80.5%, and a 5-year overall survival rate of 77.2%.

Based on the results of this review, the researchers created practice guidelines on behalf of the International Stereotactic Radiosurgery Society. The guidelines address 4 clinical questions.

The first question was the optimal dose regimen for SBRT in patients with primary RCC. The guidelines state that the optimal dose is 26 Gy in 1 fraction if the tumor is 4-5 cm or smaller, 42-48 Gy in 3 fractions if the tumor is larger than 4-5 cm, or 40 Gy in 5 fractions if the dose constraints for organs at risk cannot be met for 3 fractions.

The second question was the role of kidney biopsy in patients who receive SBRT for primary RCC. The guidelines state that routine post-SBRT biopsy should not be used to evaluate response. It is only recommended in patients with imaging findings that suggest potential disease progression.

Next, the researchers explored the role of SBRT in patients with a solitary kidney. The guidelines state that SBRT for primary RCC in a solitary kidney is safe and effective, except in patients with stage 4-5 kidney disease. “Technical approaches to reduce the volume of irradiated kidney, particularly in the intermediate dose-wash region, is recommended,” the guidelines note.

Finally, the researchers addressed the optimal follow-up schedule after SBRT. The guidelines recommend that this follow-up include cross-axial imaging of the abdomen, including both kidneys and adrenals, every 6 months and surveillance scans including chest imaging at a minimum.

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

This article originally appeared on Cancer Therapy Advisor