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Liu Y, Liu Z, Peng R, Xiao R, Wang J, Wang H, Ma L. Preoperative stereotactic body radiotherapy combined with surgical treatment for renal cell carcinoma and inferior vena cava tumour thrombus: study protocol for a single-arm cohort trial. BMJ Open 2022; 12:e055364. [PMID: 35105644 PMCID: PMC8804625 DOI: 10.1136/bmjopen-2021-055364] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Although surgery is currently the first choice for patients with renal cell carcinoma and vena cava tumour thrombus, the surgery is difficult, with many complications, and the prognosis of patients is not ideal. Renal cell carcinoma is not sensitive to traditional radiotherapy, but the development of stereotactic ablative body radiotherapy (SABR) technology with the characteristics of high precision, dose and conformity has made the radiotherapy of renal cell carcinoma reexamined. METHODS AND ANALYSIS STUDY DESIGN: This trial is a single-arm cohort study sponsored by Peking University Third Hospital. STUDY TREATMENT Preoperative stereotactic ablative radiotherapy combined with surgical treatment. PRIMARY ENDPOINTS: (1) Adverse reactions after 4-6 weeks of SABR. (2) Mayo staging of tumour thrombus. (3) The length of the tumour thrombus from the corresponding anatomical mark. (4) Invasion of the inferior vena cava wall. (5) Recurrent-free survival rate of the tumour. (6) Cancer-specific survival rate. (7) Overall survival rate. (8) Perioperative indicators including operation time, intraoperative bleeding volume and postoperative complications. SECONDARY ENDPOINTS: (1) The longest diameter of the tumour and (2) Lymph node condition. MAIN INCLUSION CRITERIA Patients with renal cell carcinoma and inferior vena cava tumour thrombus graded from Mayo II to IV and eligible for radical nephrectomy and inferior vena cava thrombectomy. MAIN EXCLUSION CRITERIA Patients with previous targeted therapy, chemotherapy or other interventions, or who cannot tolerate SABR or surgery. PLANNED SAMPLE SIZE 20 patients. ETHICS AND DISSEMINATION The trial protocol and the informed consent of the subjects were submitted and approved by the Peking University Biomedical Ethics Committee. TRIAL REGISTRATION NUMBER ChiCTR1800015118.
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Affiliation(s)
- Yunchong Liu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Zhuo Liu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Ran Peng
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Ruotao Xiao
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Junjie Wang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Hao Wang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, Beijing, China
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Tselis N, Chatzikonstantinou G. Treating the Chameleon: Radiotherapy in the management of Renal Cell Cancer. Clin Transl Radiat Oncol 2019; 16:7-14. [PMID: 30886912 PMCID: PMC6403071 DOI: 10.1016/j.ctro.2019.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 01/22/2019] [Accepted: 01/23/2019] [Indexed: 01/05/2023] Open
Abstract
PURPOSE To review the role of radiotherapy (RT) in the treatment of renal cell cancer (RCC) in the curative and palliative setting. CONTENT Details related to the clinical outcomes of primary, preoperative, postoperative and palliative RT are discussed, along with a presentation of the established role of surgery and systemic therapy. An overview of data derived from mono- and multi-institutional trials is provided. CONCLUSION Radiotherapy has been shown to provide good symptom palliation and local control in RCC depending on the dose that can be delivered. There is emerging data suggesting that with the use of high-precision RT methods the indication spectrum of RT can be exploited covering different clinical situations particularly for unresectable local recurrences and oligometastatic disease.
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Affiliation(s)
- Nikolaos Tselis
- Department of Radiotherapy and Oncology, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
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Ulutin HC, Aksu G, Fayda M, Kuzhan O, Tahmaz L, Beyzadeoglu M. The Value of Postoperative Radiotherapy in Renal Cell Carcinoma: A Single-Institution Experience. TUMORI JOURNAL 2018; 92:202-6. [PMID: 16869236 DOI: 10.1177/030089160609200303] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim To evaluate the efficacy of postoperative irradiation in renal cell carcinoma. Patients and methods Forty patients with localized renal cell carcinoma admitted to our hospital between 1986 and 1999 were evaluated. All patients were initially treated with radical nephrectomy. Postoperative radiotherapy was given to 26 of 40 patients (65%). Fourteen patients (35%) received no adjuvant therapy. Median age was 55 years (range, 20–70 years). Twenty-four patients (60%) were men and 16 patients (40%) were women. Histopathological diagnosis was renal cell carcinoma in all of the patients. N+ disease was present in 3 patients (7%). Stage I and II disease was present in 25 patients (63%) and stage III and IV disease in 15 patients (37%). Two patients (5%) had T1a disease, 11 patients (27%) had T1b, 15 patients (38%) had T2, 11 patients (27%) had T3a and 1 (3%) patient had T3b. In the radiotherapy group, renal bed and regional lymphatic fields were irradiated with daily fractions of 180–200 cGy/fraction to a total dose of 46–50 Gy, using parallel opposing fields. Results The 5-year overall survival rates were 70% in the postoperative radiotherapy group and 20% in the no adjuvant treatment group, showing no significant difference (P = 0.1). The 5-year disease-free survival rates were 66% in the radiotherapy group and 16% in the no treatment group, with a significant difference in both univariate and multivariate analyses (P = 0.045 and P = 0.0007, respectively). Stage III and IV disease, tumor size ≥7 cm, presence of distant metastasis and lactate dehydrogenase level >450 U/L were found to be adverse prognostic factors for overall survival in both univariate and multivariate analyses. Analyzing the factors affecting disease-free survival, absence of postoperative radiotherapy and tumor size ≥7 cm were found to be adverse prognostic factors in univariate and multivariate analyses. Conclusion Multi-institutional prospective randomized trials using modern radiotherapy techniques such as conformal radiotherapy and intensity-modulated radiotherapy are necessary to evaluate the real role of radiotherapy and its effect on survival in renal cell carcinoma, especially in selected patients with a high risk of local or regional failure.
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Affiliation(s)
- H Cuneyt Ulutin
- Radiotherapy Department, Gulhane Military Faculty of Medicine, Ankara, Turkey.
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Tselis N, Chatzikonstantinou G. Radiation Therapy in Renal Cell Carcinoma. Radiat Oncol 2018. [DOI: 10.1007/978-3-319-52619-5_38-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Abstract
Background Renal cell carcinoma accounts for approximately 3% of adult malignancies and over 90% of primary renal tumors. Recurrence rates for patients with locally advanced renal cell carcinoma (LARCC) remain high. Methods The authors review literature regarding prognostic factors, potential biomarkers, surgical strategies, and adjuvant therapy trials for patients with LARCC. Results Molecular tumor markers may improve existing staging systems for predicting prognosis. Surgery is the best initial treatment for most patients with clinically localized renal tumors, although complete surgical resection can be challenging for patients with large tumors, bulky regional lymph node involvement, or inferior vena cava tumor thrombus. Significant recurrence rates for patients with LARCC undergoing nephrectomy indicate the presence of undetected micrometastases at the time of surgery. Adjuvant radiation, chemotherapy, and immunotherapy have been ineffective. Other trials of adjuvant therapy are ongoing. Conclusions Aggressive surgical resection alone for LARCC is not sufficient to prevent disease recurrence in a significant number of patients. Adjuvant therapies are needed to improve cancer-specific survival.
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Affiliation(s)
- Alejandro Rodriguez
- Genitourinary Oncology Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
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Role of Radiotherapy in the Treatment of Renal Cell Cancer: Updated and Critical Review. TUMORI JOURNAL 2017; 103:504-510. [DOI: 10.5301/tj.5000640] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2017] [Indexed: 12/22/2022]
Abstract
Purpose The growing incidence of renal cell carcinoma (RCC) raises many questions about the management of these patients. The late clinical presentation, the presence of locally advanced or metastatic disease at diagnosis, the difficulty of radical surgical excision, and radioresistance make it one of the more challenging tumors to treat. The primary objective of this article is to propose an updated and critical review of the role of radiotherapy (RT) in the treatment of RCC. Methods This literature review is based on data from meta-analyses and randomized, prospective, and retrospective studies. We collected reports from 1970 to the present about preoperative RT, postoperative RT, stereotactic body RT, radiosurgery, and intraoperative RT in locally advanced renal cancer and in metastatic diseases. Results We emphasize the progress made in RT technology that allowed the creation of a more personalized and focused treatment with a minimum rate of complications. Conclusions In the coming years, new studies will be published to confirm and increase the indications for use of RT.
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Jhavar S, Swanson G, Pruszynski J. Risk factors for locoregional relapse after radical nephrectomy. Asia Pac J Clin Oncol 2017; 14:192-197. [PMID: 28488392 DOI: 10.1111/ajco.12684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 02/17/2017] [Indexed: 11/30/2022]
Abstract
AIM To identify risk factors for locoregional relapse after radical nephrectomy for renal cell carcinoma. METHODS We retrospectively reviewed the charts of 259 patients who underwent radical nephrectomy for sporadic clinically localized unilateral renal cell carcinoma between 1998 and 2012. Relapse patterns (locoregional and/or distant) were identified. Relapse-free survival was calculated using Kaplan-Meier method. Factors associated with decreased relapse-free survival were identified using univariate and multivariate Cox proportional hazards regression model analysis. Locoregional relapse estimates were calculated for individual factors and combination of factors. RESULTS At a median follow-up of 68 months (interquartile range: 75 months), 24% patients relapsed. Of these, 54% had locoregional relapse. High-grade, positive margin, large tumor size and stage III/IV were associated with worse relapse-free survival on multivariate analysis. Locoregional relapse occurred among patients with tumor size >7-</ = 10 cm (22%), >10 cm (35%), stage III/IV (31%), grade III/IV (26%), renal vein invasion (22%), perinephric fat invasion (30%), </ = 7 cm plus grade III/IV (15%), >7 cm plus grade I/II (21%), >7 cm plus grade III/IV (48%), stage III/IV plus grade I/II (24%) and stage III/IV plus grade III/IV (45%). CONCLUSION We were able to discern risk factors (individual or in combination) associated with increased risk of locoregional relapse after radical nephrectomy for renal cell carcinoma. This could help distinguish patients who may benefit from adjuvant locoregionally directed therapy.
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Affiliation(s)
- Sameer Jhavar
- Department of Radiation Oncology, Scott and White Medical Center, Temple, Texas, USA
| | - Gregory Swanson
- Department of Radiation Oncology, Scott and White Medical Center, Temple, Texas, USA
| | - Jessica Pruszynski
- Department of Biostatistics, Scott and White Medical Center, Temple, Texas, USA
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The Role of Radiation Therapy in Renal Cell Carcinoma. KIDNEY CANCER 2015. [DOI: 10.1007/978-3-319-17903-2_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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9
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The Role of Radiation Therapy in Renal Cell Carcinoma. KIDNEY CANCER 2012. [DOI: 10.1007/978-3-642-21858-3_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Abstract
There has been a recent expansion of therapeutic options in metastatic renal cell carcinoma (RCC) targeted at the vascular endothelial growth factor and mammalian target of rapamycin pathways, which are fundamental to the biology of RCC. These treatment options have similarities in antitumor effect but also important differences in regards to clinical effects, toxicity and patient populations in which they have been investigated. Further, issues regarding the role of debulking nephrectomy, timing of therapy, and appropriate sequencing of agents have emerged as clinically relevant. There are thus potentially many different treatment approaches to each metastatic RCC patient. This review discusses how to integrate the available data regarding targeted therapy in metastatic RCC into personalized cancer care.
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Affiliation(s)
- Brian I. Rini
- From the Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Institute, Glickman Urological and Kidney Institute, Cleveland, OH
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11
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Abstract
Considerable progress has been made in the treatment of patients with renal cell carcinoma, with innovative surgical and systemic strategies revolutionising the management of this disease. In localised disease, partial nephrectomy for small tumours and radical nephrectomy for large tumours continue to be the gold-standard treatments, with emphasis on approaches that have reduced invasiveness and preserve renal function. Additionally, cytoreductive nephrectomy is often indicated before the start of systemic treatment in patients with metastatic disease as part of integrated management strategy. The effectiveness of immunotherapy, although previously widely used for treatment of metastatic renal cell carcinoma, is still controversial, and is mainly reserved for patients with good prognostic factors. Development of treatments that have specific targets in relevant biological pathways has been the main advance in treatment. Targeted drugs, including inhibitors of the vascular endothelial growth factor and mammalian target of rapamycin pathways, have shown robust effectiveness and offer new therapeutic options for the patients with metastatic disease.
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Affiliation(s)
- Brian I Rini
- Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
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Troiano M, Corsa P, Raguso A, Cossa S, Piombino M, Guglielmi G, Parisi S. Radiation therapy in urinary cancer: state of the art and perspective. Radiol Med 2008; 114:70-82. [PMID: 19082788 DOI: 10.1007/s11547-008-0347-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Accepted: 04/10/2008] [Indexed: 12/19/2022]
Abstract
Invasive urinary tumours are relatively rare, and their treatment may cause important changes in urinary, sexual and social functions. A systematic review of external radiation therapy studies in urinary cancers was performed. This synthesis of the literature is based on data from meta-analyses, randomised and prospective trials and retrospective studies. There are few controlled clinical trials using adjuvant or radical radiotherapy with or without chemotherapy in cancer of the kidney, ureter and urethra. There are several reports on multimodality treatment in invasive bladder cancer: intravesical surgery and neoadjuvant chemotherapy to radiotherapy or concomitant radiochemotherapy with organ preservation. The conclusions reached for renal cancer are controversial, and data on cancers of the urethra and ureter are few and inconclusive. Sufficient data now exist in the literature to demonstrate that conservative management with organ preservation is a valuable alternative to radical cystectomy, the traditional gold standard, in invasive bladder cancer.
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Affiliation(s)
- M Troiano
- Department of Radiation Oncology, Scientific Institute Hospital Casa Sollievo della Sofferenza, and University of Foggia, Department of Radiology, San Giovanni Rotondo, 71013, Foggia, Italy
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Kidney and Ureter Cancers. Radiat Oncol 2008. [DOI: 10.1007/978-3-540-77385-6_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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14
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Lam JS, Bergman J, Breda A, Schulam PG. Importance of surgical margins in the management of renal cell carcinoma. ACTA ACUST UNITED AC 2008; 5:308-17. [DOI: 10.1038/ncpuro1121] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Accepted: 03/20/2008] [Indexed: 02/02/2023]
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15
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Renal Cell Cancer. Oncology 2007. [DOI: 10.1007/0-387-31056-8_46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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16
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Parisi S, Troiano M, Corsa P, Raguso A, Cossa S, Piazzolla EE, Munafò T, Sanpaolo G, Natuno A, Maiello E. Role of external radiation therapy in urinary cancers. Ann Oncol 2007; 18 Suppl 6:vi157-61. [PMID: 17591812 DOI: 10.1093/annonc/mdm247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Invasive urinary tumors are relatively rare and their treatment may cause important changes in urinary, sexual, and social functions. A systematic review of external radiation therapy studies in urinary cancers has been carried out. This synthesis of the literature is based on data from meta-analysis, randomized and prospective trials, and retrospective studies. There are few controlled clinical trials using adjuvant or radical radiotherapy +/- chemotherapy in kidney, ureter, and urethra cancers; there are several reports of muscle-invasive bladder cancer using multimodality treatment: intravesical surgery and neo-adjuvant chemotherapy to radiotherapy or concomitant radiochemotherapy with organ preservation. The conclusions reached for renal cancer are controversial; urethra and ureter cancers data are few and inconclusive; sufficient data now exist in literature to demonstrate that conservative management with organ preservation, for muscle-invasive bladder cancer, is a valid alternative to radical cystectomy, viewed as the gold standard.
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Affiliation(s)
- S Parisi
- Department of Radiation Oncology, Istituti di ricovero e cura a carattere scientifico Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
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Abstract
Metastatic renal cell carcinoma (RCC) has a highly variable natural history and carries a dismal prognosis. Unlike many other tumors, RCC is generally unresponsive to cytotoxic, hormonal, and radiation adjuvant therapies after cytoreductive surgery. Different modalities of treatment have been tried and tested with modest success. Until recently, only immunotherapies such as interleukin-2 and interferon-alpha have been shown to provide a response, albeit in a minority of patients and often with severe treatment-associated toxicities. Other adjuvant therapies, such as active specific immunotherapy with Bacillus Calmette-Guerin and autologous renal tumor cell vaccines, have not provided alternative solutions. Recent approaches include heat-shock protein peptide complex 96 vaccine and cG250 monoclonal antibody therapy. Novel targeted therapies have been developed using our knowledge of the molecular genetics that belie RCC. This culminated in sorafenib and sunitinib, the first Food and Drug Administration-approved drugs for RCC in more than a decade in the United States. The future will see further trials being carried out in the development of targeted therapies with emphasis placed on patient selection. Staging systems will need to be updated to integrate molecular biomarkers, which could potentially act not just as diagnostic and prognostic predictors, but also as tools for appropriate patient selection for treatment. In the future, this could potentially lead us to our ultimate goal of personalized medicine.
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Affiliation(s)
- Timothy A Yap
- Department of Medicine, Royal Marsden Hospital, London, UK
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Anderson DA, Woltman ML, Kovach G, Konety BR. Long-term treatment of metastatic renal-cell carcinoma with fluorouracil. Lancet Oncol 2004; 5:690-2. [PMID: 15522657 DOI: 10.1016/s1470-2045(04)01611-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- David A Anderson
- Department of Urology, University of Iowa, Iowa City 52242-1089, USA
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