Shankar Siva1, Price Jackson2, Tomas Kron3, Mathias Bressel4, Eddie Lau5, Michael Hofman3, Mark Shaw2, Sarat Chander2, Daniel Pham2, Nathan Lawrentschuk6, Lih-Ming Wong7, Jeremy Goad6, Farshad Foroudi2. 1. Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia. Electronic address: shankar.siva@petermac.org. 2. Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Australia. 3. Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia. 4. Department of Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Australia. 5. Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia; Department of Radiology, University of Melbourne, Australia. 6. Division of Cancer Surgery, Peter MacCallum Cancer Centre, Australia. 7. Department of Surgery, University of Melbourne, Australia.
Abstract
BACKGROUND AND PURPOSE: To evaluate renal dysfunction after stereotactic ablative body radiotherapy (SABR) for inoperable primary renal cell carcinoma (RCC) using nuclear medicine assessments. MATERIALS AND METHODS: In a prospective clinical trial, patients received single fraction renal SABR (26 Gy) for tumours <5 cm, or fractionated SABR (3 × 14 Gy) for tumours ⩾5 cm. Global and regional glomerular filtration rate (GFR) was calculated through (51)Cr-EDTA and (99m)Tc-DMSA SPECT/CT, respectively, at baseline and post-treatment (14, 90 days and at 1-year). Regional loss in function was correlated to the absolute and biologically effective doses (BED) delivered. RESULTS: In 21 patients the mean (range) tumour size was 48 mm (21-75 mm). The mean ± SD GFR at baseline was 52 ± 24 ml/min. Net change in mean GFR was +0.6 ± 11.3, +3.2 ± 14.5 and -8.7 ± 13.4 ml/min (p=0.03) at 2 weeks, 3 months and 1 year, respectively. For every 10 Gy of physical dose delivered, an exponential decline in affected kidney GFR was observed at 39% for 26 Gy/1 fraction and 25% for 42 Gy/3 fractions. When normalised to BED3Gy, the dose-response relationship for each treatment prescription was similar with a plateau beyond 100 Gy. The R50% conformity index correlated with GFR loss (p=0.04). No patient required dialysis. CONCLUSIONS: SABR results in clinically acceptable and dose-dependent renal dysfunction at 1-year. Sparing functional kidney from high-dose regions (>50% isodoses) may help reduce risk of functional loss.
BACKGROUND AND PURPOSE: To evaluate renal dysfunction after stereotactic ablative body radiotherapy (SABR) for inoperable primary renal cell carcinoma (RCC) using nuclear medicine assessments. MATERIALS AND METHODS: In a prospective clinical trial, patients received single fraction renal SABR (26 Gy) for tumours <5 cm, or fractionated SABR (3 × 14 Gy) for tumours ⩾5 cm. Global and regional glomerular filtration rate (GFR) was calculated through (51)Cr-EDTA and (99m)Tc-DMSA SPECT/CT, respectively, at baseline and post-treatment (14, 90 days and at 1-year). Regional loss in function was correlated to the absolute and biologically effective doses (BED) delivered. RESULTS: In 21 patients the mean (range) tumour size was 48 mm (21-75 mm). The mean ± SD GFR at baseline was 52 ± 24 ml/min. Net change in mean GFR was +0.6 ± 11.3, +3.2 ± 14.5 and -8.7 ± 13.4 ml/min (p=0.03) at 2 weeks, 3 months and 1 year, respectively. For every 10 Gy of physical dose delivered, an exponential decline in affected kidney GFR was observed at 39% for 26 Gy/1 fraction and 25% for 42 Gy/3 fractions. When normalised to BED3Gy, the dose-response relationship for each treatment prescription was similar with a plateau beyond 100 Gy. The R50% conformity index correlated with GFR loss (p=0.04). No patient required dialysis. CONCLUSIONS:SABR results in clinically acceptable and dose-dependent renal dysfunction at 1-year. Sparing functional kidney from high-dose regions (>50% isodoses) may help reduce risk of functional loss.
Authors: Shankar Siva; Gargi Kothari; Alexander Muacevic; Alexander V Louie; Ben J Slotman; Bin S Teh; Simon S Lo Journal: Nat Rev Urol Date: 2017-06-20 Impact factor: 14.432
Authors: Hayley M Reynolds; Bimal K Parameswaran; Mary E Finnegan; Diana Roettger; Eddie Lau; Tomas Kron; Mark Shaw; Sarat Chander; Shankar Siva Journal: PLoS One Date: 2018-08-16 Impact factor: 3.240