There Is Excitement and Advances in SBRT Treatment For RCC

James B. Yu, MD, MHS, FASTRO, professor in the Department of Radiation Oncology and Applied Sciences, leader of the Genitourinary Radiation Oncology Program at Dartmouth-Hitchcock Medical Center, and radiation oncology editorial advisory board member of the Journal ONCOLOGY®, has been more enthusiastic about the use of stereotactic body radiation therapy (SBRT) in renal cell carcinoma (RCC).

A recent study published in European Urology Oncology found that SBRT demonstrated positive renal function preservation, as well as strong local control in patients with RCC: at 1 and 5 years, the probability of local control was 98% (95% CI, 94%-99%) and 96% (95% CI, 92%-99%), respectively.

More specifically concerning radiation as a RCC treatment, Yu told CancerNetwork® that intrafraction motion management is extremely important as the kidney moves when a patient breathes.

He did, however, also speak to a need for bigger tools as critics point out that, occasionally, radiation oncologists treat tumors that were benign or may not have needed any treatment at all.

Transcript:

I’ve been much more enthusiastic [about SBRT as a treatment for RCC], recently. Previously, when I did radiosurgery for RCC it was largely palliative or a treatment of non-operative candidates. We’re also learning that renal tumors and the kidney move quite a bit during breathing, and so intrafraction motion management is critical, so [whether] you have an MRI-linac [guided linear accelerator], place fiducial markers, or do old-school abdominal compressions to keep the kidney from moving—with those innovations—I’ve been more enthusiastic about doing more focused RCC radiosurgery.

Some criticisms I heard from neurologists are that radiation oncologists are treating tumors that would never have needed treatment anyway, like small renal masses that would have been indolent. We do need better tools to assess which tumors have malignant potential. As the population ages, we’ll be called on more to treat these tumors. As some of the big prospective clinical trials on renal tumor radiation start to mature or report out, we’ll see more and more of that. It is going to be a decent chunk of future practice for most radiation oncologists; right now, it’s a tiny piece. Of all the areas, renal and bladder [cancers] are probably changing the most and are probably the biggest areas for growth for radiation oncologists.

Reference

Pasquier D, Abancourt L, Ali M, et al. Results of stereotactic body radiation therapy for primary renal cell carcinoma in a large multicenter series. Eur Urol Oncol. Available online February 7, 2025. doi:10.1016/j.euo.2025.01.001