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Tan VS, Correa RJM, Warner A, Ali M, Muacevic A, Ponsky L, Ellis RJ, Lo SS, Onishi H, Swaminath A, Kwon YS, Morgan SC, Cury F, Teh BS, Mahadevan A, Kaplan ID, Chu W, Hannan R, Staehler M, Grubb W, Louie AV, Siva S. 5-Year Renal Function Outcomes after SABR for Primary Renal Cell Carcinoma: A Report from the International Radiosurgery Oncology Consortium of the Kidney (IROCK). Int J Radiat Oncol Biol Phys 2023; 117:S84. [PMID: 37784588 DOI: 10.1016/j.ijrobp.2023.06.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Renal cell carcinoma (RCC) presents uncommonly in patients with a congenital solitary kidney or prior contralateral nephrectomy. The objective of this study was to compare renal function outcomes of stereotactic ablative body radiotherapy (SABR) in patients with solitary vs. bilateral kidneys. MATERIALS/METHODS Patients with primary RCC with ≥2 years of follow-up at 12 participating International Radiosurgery Consortium for Kidney (IROCK) institutions were included. Patients with upper tract urothelial carcinoma or metastatic disease were excluded. Renal function was measured by estimated glomerular filtration rate (eGFR). For patients where eGFR was not recorded, Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation was used to estimate eGFR based on known creatinine. Baseline characteristics and renal function outcomes were compared between solitary vs. bilateral kidneys. Multivariable logistic regression was used to identify factors predictive of eGFR decline ≥ 15 mL/min and any eGFR increase evaluated at 1-year post-SABR. RESULTS One hundred and ninety patients with solitary (n = 56) or bilateral kidneys (n = 134) underwent SABR and were followed for a median of 5.0 years (IQR: 3.4-6.8). Pre-SABR eGFR (mean ± SD) was similar in patients with solitary (61.1 ± 23.2 mL/min) vs. bilateral kidneys (58.0 ± 22.3 mL/min, p = 0.324). Mean tumor size was 3.70 ± 1.40 cm in solitary and 4.35 ± 2.50 cm in bilateral kidneys (p = 0.026). After SABR, an initial compensatory increase in eGFR was observed in both cohorts (22.7% solitary and 17.7% bilateral at 1 year). This compensatory increase persisted in patients with bilateral but not a solitary kidney (10.3% vs. 0% at 3-years and 21.1% vs. 0% at 5-years, respectively). At 5-years post-SABR, eGFR decreased by -14.5 ± 7.6 in solitary and -13.3 ± 15.9 mL/min in bilateral kidneys (p = 0.665). At all timepoints assessed, there were no significant differences in eGFR decline between solitary vs. bilateral cohorts (all p > 0.05). There were also no significant differences in post-SABR end-stage renal disease (7.1% vs. 6.7%) or dialysis (3.6% vs. 3.7%) in solitary vs. bilateral, respectively. Multivariable analysis demonstrated that increasing tumor size (OR per 1 cm: 1.57; 95% CI: 1.14-2.16, p = 0.006) and baseline eGFR (OR per 10 mL/min: 1.30; 95% CI: 1.02-1.66, p = 0.034) was more likely to be associated with eGFR decline ≥ 15 mL/min. There was no significant association between solitary vs. bilateral kidney and eGFR decline (OR: 1.22; 95% CI: 0.45-3.34, p = 0.693). CONCLUSION There was no observed difference between renal function outcomes in patients with a solitary vs. bilateral kidneys. While larger tumor size may increase the risk of eGFR decline post-SABR, treatment of a solitary kidney does not appear to increase the risk of renal dysfunction long-term.
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Affiliation(s)
- V S Tan
- London Regional Cancer Program, London, ON, Canada
| | - R J M Correa
- London Regional Cancer Program, London, ON, Canada
| | - A Warner
- London Regional Cancer Program, London, ON, Canada
| | - M Ali
- Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - A Muacevic
- University of Munich Hospitals, Munich, Germany
| | - L Ponsky
- University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | | | - S S Lo
- University of Washington School of Medicine, Seattle, WA
| | - H Onishi
- University of Yamanashi, Chuo, Japan
| | - A Swaminath
- Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - Y S Kwon
- University of Texas Southwestern Medical Center, Dallas, TX
| | - S C Morgan
- The Ottawa Hospital Cancer Center, Ottawa, ON, Canada
| | - F Cury
- McGill University Health Centre, Montreal, QC, Canada
| | - B S Teh
- Houston Methodist Hospital, Houston, TX
| | - A Mahadevan
- NYU Langone Health Laura and Isaac Perlmutter Cancer Center, New York, NY
| | - I D Kaplan
- Beth Israel Deaconess Medical Center, Boston, MA
| | - W Chu
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - R Hannan
- University of Texas Southwestern Medical Center, Dallas, TX
| | - M Staehler
- University of Munich Hospitals, Munich, Germany
| | - W Grubb
- Augusta University, Augusta, GA
| | - A V Louie
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - S Siva
- Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
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Correa RJM. Found in translation: a medical student's reflection on the emotional realities of translational cancer research. Curr Oncol 2015; 22:e412-3. [PMID: 26628890 DOI: 10.3747/co.22.2561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The packed snow yielded its familiar crunch with every step I took. Behind me, the winter daylight faded as darkness crept through the cloudless sky. With each step forward, the brick walls of the cancer centre loomed larger ahead. This was my destination for the evening. Despite my fatigue after a day of classes and clinical sessions, I believed these hours—and many more like them—were justified, for they were spent in pursuit of worthwhile scientific goals and were ultimately in service to patients [...]
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Affiliation(s)
- R J M Correa
- Schulich School of Medicine and Dentistry, Western University, London, ON
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