2486 - The Changing Dogma in Oligometastatic Renal Cell Carcinoma - SBRT
Presenter(s)
P. S. Sridhar1, P. Anuradha1, D. Priyasha2, K. Kallur2, M. Gupta2, A. Jerrin1, G. W. Kiarie3, S. Patil2, G. Vineet4, and M. Govindarajan1; 1Apollo Cancer Centre, Bengaluru, India, 2HealthCare Global Enterprises Ltd, Bengaluru, India, 3Nairobi Hospital, Nairobi, Kenya, 4Sakra World Hospital, Bengaluru, India
Purpose/Objective(s): Renal cell carcinoma (RCC) constitutes a broad spectrum of aggressiveness with variable outcomes depending on existing risk factors. 20% patients present with de novo metastasis and almost 30% progress distantly after the treatment of primary. Management options of metastatic RCC include Active surveillance, Surgery (Cytoreductive nephrectomy/ metastasectomy), Local ablative therapy (SBRT) and systemic therapy. Recently SBRT has emerged as promising therapy for metastatic RCC with favorable local control and toxicity rates. However, SBRT to primary lesion in metastatic setting is quite unexplored. In our study, we analyzed 43 patients diagnosed with metastatic RCC, treated with SBRT including primary tumor with respect to disease control, survival outcomes and toxicity analysis.
Materials/Methods: 43 patients diagnosed with biopsy proven metastatic RCC with ECOG Performance status </= 2, treated from 2009 to 2024 were prospectively analyzed. FDG PET and MRI based SBRT with a frameless robotic radiosurgery system was delivered to metastatic +/- primary lesions using real time tracking method to a dose of 30 to 40 Gy in 3 to 5 fractions. Treatment sites included kidney(primary), Brain, Adrenal, Lung, Bone, Liver, and Lymphnodes. Systemic therapy was administered as and when indicated. All patients underwent clinico- radiological evaluation (PETC/MRI) during followup visits. Local control and survival outcomes were analyzed.
Results: 43 patients (M:F - 31:12) with a median age of 45 years (Age range- 35 to 80 years) were included in the study. SBRT was delivered to a total of 85 sites which include the primary tumor(40%), Brain (37.5%), Adrenal (12.5%), Lung (22.5%), Bone (40%), Liver (17.5%), Lymph node (10%). All patients tolerated well with minimal side effects. Median Overall Survival was observed to be 24 months and median Progression Free Survival was 18 months (range- 3 - 176 months).None of the patients experienced acute or late toxicities.
Conclusion: SBRT is well tolerated in patients with metastatic RCC with maximal local control and best quality of life translating to better survival outcomes. In the era of high precision oncology, SBRT should be considered as an integral component for the treatment of Metastatic RCC including primary tumor. Larger samples are required to validate these results.