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Title: Safety and Efficacy of Stereotactic Ablative Radiation Therapy for Renal Cell Carcinoma Extracranial Metastases

Abstract

Purpose: Renal cell carcinoma is refractory to conventional radiation therapy but responds to higher doses per fraction. However, the dosimetric data and clinical factors affecting local control (LC) are largely unknown. We aimed to evaluate the safety and efficacy of stereotactic ablative radiation therapy (SAbR) for extracranial renal cell carcinoma metastases. Methods and Materials: We reviewed 175 metastatic lesions from 84 patients treated with SAbR between 2005 and 2015. LC and toxicity after SAbR were assessed with Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 and Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. Predictors of local failure were analyzed with χ{sup 2}, Kaplan-Meier, and log-rank tests. Results: In most cases (74%), SAbR was delivered with total doses of 40 to 60 Gy, 30 to 54 Gy, and 20 to 40 Gy in 5 fractions, 3 fractions, and a single fraction, respectively. The median biologically effective dose (BED) using the universal survival model was 134.5 Gy. The 1-year LC rate after SAbR was 91.2% (95% confidence interval, 84.9%-95.0%; median follow-up, 16.7 months). Local failures were associated with prior radiation therapy (hazard ratio [HR], 10.49; P<.0001), palliative-intent radiation therapy (HR, 4.63; P=.0189), spinal location (HR, 5.36; P=.0041), previous systemic therapy status (0-1 vs >1; HR, 3.52;more » P=.0217), and BED <115 Gy (HR, 3.45; P=.0254). Dose received by 99% of the target volume was the strongest dosimetric predictor for LC. Upon multivariate analysis, dose received by 99% of the target volume greater than BED of 98.7 Gy and systemic therapy status remained significant (HR, 0.12 and 3.64, with P=.0014 and P=.0472, respectively). Acute and late grade 3 toxicities attributed to SAbR were observed in 3 patients (1.7%) and 5 patients (2.9%), respectively. Conclusions: SAbR demonstrated excellent LC of metastatic renal cell carcinoma with a favorable safety profile when an adequate dose and coverage were applied. Multimodality treatment with surgery should be considered for reirradiation or vertebral metastasis. A higher radiation dose may be required in patients who received previous systemic therapies.« less

Authors:
 [1];  [2];  [1]; ; ; ; ; ; ; ;  [3];  [4]; ; ; ;  [5];  [3];  [1];  [3];  [1] more »;  [2];  [3]; « less
  1. Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas (United States)
  2. (United States)
  3. Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas (United States)
  4. Department of Radiology, Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas (United States)
  5. Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas (United States)
Publication Date:
OSTI Identifier:
22649911
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 98; Journal Issue: 1; Other Information: Copyright (c) 2017 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CARCINOMAS; DOSIMETRY; GY RANGE 100-1000; GY RANGE 10-100; KIDNEYS; MULTIVARIATE ANALYSIS; PATIENTS; RADIATION DOSES; RADIOTHERAPY

Citation Formats

Wang, Chiachien Jake, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, Christie, Alana, Lin, Mu-Han, Jung, Matthew, Weix, Derek, Huelsmann, Lorel, Kuhn, Kristin, Meyer, Jeffrey, Desai, Neil, Kim, D. W. Nathan, Pedrosa, Ivan, Margulis, Vitaly, Cadeddu, Jeffrey, Sagalowsky, Arthur, Gahan, Jeffrey, Laine, Aaron, Xie, Xian-Jin, Choy, Hak, Brugarolas, James, Division of Hematology/Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, Timmerman, Robert, and and others. Safety and Efficacy of Stereotactic Ablative Radiation Therapy for Renal Cell Carcinoma Extracranial Metastases. United States: N. p., 2017. Web. doi:10.1016/J.IJROBP.2017.01.032.
Wang, Chiachien Jake, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, Christie, Alana, Lin, Mu-Han, Jung, Matthew, Weix, Derek, Huelsmann, Lorel, Kuhn, Kristin, Meyer, Jeffrey, Desai, Neil, Kim, D. W. Nathan, Pedrosa, Ivan, Margulis, Vitaly, Cadeddu, Jeffrey, Sagalowsky, Arthur, Gahan, Jeffrey, Laine, Aaron, Xie, Xian-Jin, Choy, Hak, Brugarolas, James, Division of Hematology/Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, Timmerman, Robert, & and others. Safety and Efficacy of Stereotactic Ablative Radiation Therapy for Renal Cell Carcinoma Extracranial Metastases. United States. doi:10.1016/J.IJROBP.2017.01.032.
Wang, Chiachien Jake, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, Christie, Alana, Lin, Mu-Han, Jung, Matthew, Weix, Derek, Huelsmann, Lorel, Kuhn, Kristin, Meyer, Jeffrey, Desai, Neil, Kim, D. W. Nathan, Pedrosa, Ivan, Margulis, Vitaly, Cadeddu, Jeffrey, Sagalowsky, Arthur, Gahan, Jeffrey, Laine, Aaron, Xie, Xian-Jin, Choy, Hak, Brugarolas, James, Division of Hematology/Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, Timmerman, Robert, and and others. Mon . "Safety and Efficacy of Stereotactic Ablative Radiation Therapy for Renal Cell Carcinoma Extracranial Metastases". United States. doi:10.1016/J.IJROBP.2017.01.032.
@article{osti_22649911,
title = {Safety and Efficacy of Stereotactic Ablative Radiation Therapy for Renal Cell Carcinoma Extracranial Metastases},
author = {Wang, Chiachien Jake and Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas and Christie, Alana and Lin, Mu-Han and Jung, Matthew and Weix, Derek and Huelsmann, Lorel and Kuhn, Kristin and Meyer, Jeffrey and Desai, Neil and Kim, D. W. Nathan and Pedrosa, Ivan and Margulis, Vitaly and Cadeddu, Jeffrey and Sagalowsky, Arthur and Gahan, Jeffrey and Laine, Aaron and Xie, Xian-Jin and Choy, Hak and Brugarolas, James and Division of Hematology/Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas and Timmerman, Robert and and others},
abstractNote = {Purpose: Renal cell carcinoma is refractory to conventional radiation therapy but responds to higher doses per fraction. However, the dosimetric data and clinical factors affecting local control (LC) are largely unknown. We aimed to evaluate the safety and efficacy of stereotactic ablative radiation therapy (SAbR) for extracranial renal cell carcinoma metastases. Methods and Materials: We reviewed 175 metastatic lesions from 84 patients treated with SAbR between 2005 and 2015. LC and toxicity after SAbR were assessed with Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 and Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. Predictors of local failure were analyzed with χ{sup 2}, Kaplan-Meier, and log-rank tests. Results: In most cases (74%), SAbR was delivered with total doses of 40 to 60 Gy, 30 to 54 Gy, and 20 to 40 Gy in 5 fractions, 3 fractions, and a single fraction, respectively. The median biologically effective dose (BED) using the universal survival model was 134.5 Gy. The 1-year LC rate after SAbR was 91.2% (95% confidence interval, 84.9%-95.0%; median follow-up, 16.7 months). Local failures were associated with prior radiation therapy (hazard ratio [HR], 10.49; P<.0001), palliative-intent radiation therapy (HR, 4.63; P=.0189), spinal location (HR, 5.36; P=.0041), previous systemic therapy status (0-1 vs >1; HR, 3.52; P=.0217), and BED <115 Gy (HR, 3.45; P=.0254). Dose received by 99% of the target volume was the strongest dosimetric predictor for LC. Upon multivariate analysis, dose received by 99% of the target volume greater than BED of 98.7 Gy and systemic therapy status remained significant (HR, 0.12 and 3.64, with P=.0014 and P=.0472, respectively). Acute and late grade 3 toxicities attributed to SAbR were observed in 3 patients (1.7%) and 5 patients (2.9%), respectively. Conclusions: SAbR demonstrated excellent LC of metastatic renal cell carcinoma with a favorable safety profile when an adequate dose and coverage were applied. Multimodality treatment with surgery should be considered for reirradiation or vertebral metastasis. A higher radiation dose may be required in patients who received previous systemic therapies.},
doi = {10.1016/J.IJROBP.2017.01.032},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 1,
volume = 98,
place = {United States},
year = {Mon May 01 00:00:00 EDT 2017},
month = {Mon May 01 00:00:00 EDT 2017}
}