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The Treatment of Primary and Metastatic Renal Cell Carcinoma (RCC) with Image-guided Stereotactic Body Radiation Therapy (SBRT)

Teh. B.S., and Bloch, C., and Galli-Guevara, M., and Doh, L., and Richardson, S., and Chiang, S., and Yeh, P., and Gonzalez, M., and Lunn, W., and Marco, R., and Jac, J., and Paulino, A.C., and Lu, H.H., and Butler, E.B., and Amato, R.J., (2007) The Treatment of Primary and Metastatic Renal Cell Carcinoma (RCC) with Image-guided Stereotactic Body Radiation Therapy (SBRT). Biomedical Imaging and Intervention Journal, 3 (1).

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Official URL: http://www.biij.org/2007/1/e6/e6.pdf

Affiliations

Methodist Hospital, Texas, USA. Dept. of Radiation Oncology
Methodist Hospital, Texas, USA. Dept. of Neurosurgery
Methodist Hospital, Texas, USA. Dept. of Pulmonary Medicine
Methodist Hospital, Texas, USA. Dept. of Orthopedic Surgery
Methodist Hospital, Texas, USA. Dept. of Genitourinary Oncology
Methodist Hospital, Texas, USA. Dept. of Radiology
Baylor College of Medicine, Texas, USA. Dept. of Radiology
Baylor College of Medicine, Texas, USA. Dept. of Pulmonary Medicine

Abstract

Purpose: Brain metastases from renal cell carcinoma (RCC) have been successfully treated with stereotactic radiosurgery (SRS). Metastases to extra-cranial sites may be treated with similar success using stereotactic body radiation therapy (SBRT), where image-guidance allows for the delivery of precise high-dose radiation in a few fractions. This paper reports the authors’ initial experience with image-guided SBRT in treating primary and metastatic RCC. Materials and methods: The image-guided Brainlab Novalis stereotactic system was used. Fourteen patients with 23 extra-cranial metastatic RCC lesions (orbits, head and neck, lung, mediastinum, sternum, clavicle, scapula, humerus, rib, spine and abdominal wall) and two patients with biopsy-proven primary RCC (not surgical candidates) were treated with SBRT (24-40 Gy in 3-6 fractions over 1-2 weeks). All patients were immobilised in body cast or head and neck mask. Image-guidance was used for all fractions. PET/CT images were fused with simulation CT images to assist in target delineation and dose determination. SMART (simultaneous modulated accelerated radiation therapy) boost approach was adopted. 4D-CT was utilised to assess tumour/organ motion and assist in determining planning target volume margins. Results: Median follow-up was nine months. Thirteen patients (93%) who received SBRT to extra-cranial metastases achieved symptomatic relief. Two patients had local progression, yielding a local control rate of 87%. In the two patients with primary RCC, tumour size remained unchanged but their pain improved, and their renal function was unchanged post SBRT. There were no significant treatment-related side effects. Conclusion: Image-guided SBRT provides excellent symptom palliation and local control without any significant toxicity. SBRT may represent a novel, non-invasive, nephron-sparing option for the treatment of primary RCC as well as extra-cranial metastatic RCC.

Item Type:Journal
Keywords:Renal cell carcinoma (RCC), primary and metastatic RCC, Image Guided Radiation Therapy (IGRT), Stereotactic Body Radiation Therapy (SBRT)
Subjects:R Medicine, Dentistry, Pharmacy, Nursing
ID Code:5065

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