Yuanyuan Zhang1, Jonathan Schoenhals2, Alana Christie2, Osama Mohamad1, Chiachien Wang3, Isaac Bowman4, Nirmish Singla5, Hans Hammers4, Kevin Courtney4, Aditya Bagrodia5, Vitaly Margulis5, Neil Desai1, Aurelie Garant1, Hak Choy1, Robert Timmerman6, James Brugarolas7, Raquibul Hannan8. 1. Department of Radiation Oncology. 2. Kidney Cancer Program, Simmons Comprehensive Cancer Center. 3. Willis-Knighton Cancer Center, Shreveport, Louisiana. 4. Kidney Cancer Program, Simmons Comprehensive Cancer Center; Department of Internal Medicine, Hematology-Oncology Division, University of Texas Southwestern Medical Center, Dallas, Texas. 5. Kidney Cancer Program, Simmons Comprehensive Cancer Center; Department of Urology. 6. Department of Radiation Oncology; Kidney Cancer Program, Simmons Comprehensive Cancer Center. 7. Kidney Cancer Program, Simmons Comprehensive Cancer Center; Department of Internal Medicine, Hematology-Oncology Division, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: James.Brugarolas@utsouthwestern.edu. 8. Department of Radiation Oncology; Kidney Cancer Program, Simmons Comprehensive Cancer Center. Electronic address: Raquibul.Hannan@utsouthwestern.edu.
Abstract
PURPOSE: Stereotactic ablative radiotherapy (SAbR) is a promising alternative for selected patients with renal cell carcinoma (RCC) with oligometastasis. The objective of this study was to evaluate the potential of SAbR for longitudinal control in patients with persistently oligometastatic RCC. We report the impact of SAbR on tumor control rates as well as its tolerability in systemic therapy-naïve patients with oligometastatic disease (without brain metastases) and assess the effect of SAbR on subsequent first line systemic therapy by comparison to historical controls. METHODS AND MATERIALS: We reviewed patients with metastatic RCC treated with front-line SAbR with a curative intent from 2007 to 2017 at UT Southwestern Kidney Cancer Program. We analyzed local control rates (LCR), toxicity, freedom from systemic therapy (FST), type and duration of first-line systemic therapy, and overall survival (OS). Cox regression and Kaplan-Meier analyses were used. RESULTS: We identified 47 patients with oligometastatic RCC treated with SAbR to 88 metastases; 11 patients had more than 1 SAbR course. The local control rate was 91.5% at 2 years with no reported grade ≥3 toxicity. With a median follow-up of 30 months (interquartile range, 13.7-40.9), median FST from first SAbR was 15.2 months (95% confidence interval [CI], 8.8-40.1). The most common systemic therapies initiated after SAbR were pazopanib (60.7%) and sunitinib (14.3%). The duration of first line systemic therapy appeared unaffected by SAbR. Improved FST was observed in patients with metachronous disease (hazard ratio, 2.67; P = .02), solitary metastasis (HR, 2.26; P = .05), and non-bone metastasis (HR, 2.21; P = .04). One-year and 2-year OS after SAbR were 93.1% (95% CI, 80.1-97.7) and 84.8% (95% CI, 69.1-92.9), respectively. Median OS was not reached. CONCLUSIONS: SAbR is an effective and safe treatment for selected patients with oligometastatic RCC, can provide longitudinal disease control without systemic therapy for over a year, and does not appear to adversely affect the effectiveness of first-line systemic therapy once initiated. Prospective validation of these findings is being sought through a phase 2 trial.
PURPOSE: Stereotactic ablative radiotherapy (SAbR) is a promising alternative for selected patients with renal cell carcinoma (RCC) with oligometastasis. The objective of this study was to evaluate the potential of SAbR for longitudinal control in patients with persistently oligometastatic RCC. We report the impact of SAbR on tumor control rates as well as its tolerability in systemic therapy-naïve patients with oligometastatic disease (without brain metastases) and assess the effect of SAbR on subsequent first line systemic therapy by comparison to historical controls. METHODS AND MATERIALS: We reviewed patients with metastatic RCC treated with front-line SAbR with a curative intent from 2007 to 2017 at UT Southwestern Kidney Cancer Program. We analyzed local control rates (LCR), toxicity, freedom from systemic therapy (FST), type and duration of first-line systemic therapy, and overall survival (OS). Cox regression and Kaplan-Meier analyses were used. RESULTS: We identified 47 patients with oligometastatic RCC treated with SAbR to 88 metastases; 11 patients had more than 1 SAbR course. The local control rate was 91.5% at 2 years with no reported grade ≥3 toxicity. With a median follow-up of 30 months (interquartile range, 13.7-40.9), median FST from first SAbR was 15.2 months (95% confidence interval [CI], 8.8-40.1). The most common systemic therapies initiated after SAbR were pazopanib (60.7%) and sunitinib (14.3%). The duration of first line systemic therapy appeared unaffected by SAbR. Improved FST was observed in patients with metachronous disease (hazard ratio, 2.67; P = .02), solitary metastasis (HR, 2.26; P = .05), and non-bone metastasis (HR, 2.21; P = .04). One-year and 2-year OS after SAbR were 93.1% (95% CI, 80.1-97.7) and 84.8% (95% CI, 69.1-92.9), respectively. Median OS was not reached. CONCLUSIONS:SAbR is an effective and safe treatment for selected patients with oligometastatic RCC, can provide longitudinal disease control without systemic therapy for over a year, and does not appear to adversely affect the effectiveness of first-line systemic therapy once initiated. Prospective validation of these findings is being sought through a phase 2 trial.
Authors: G Marvaso; G Corrao; O Oneta; M Pepa; M Zaffaroni; F Corso; S Gandini; A Cecconi; D Zerini; G C Mazzola; M Augugliaro; M Cossu Rocca; E Verri; F Cattani; F La Fauci; L Bergamaschi; S Luzzago; A F Mistretta; G Musi; F Nolè; O De Cobelli; R Orecchia; B A Jereczek-Fossa Journal: Clin Transl Oncol Date: 2021-03-09 Impact factor: 3.405
Authors: Xuguang Chen; Hanbo Chen; Ian Poon; Darby Erler; Serena Badellino; Tithi Biswas; Roi Dagan; Matthew Foote; Alexander V Louie; Umberto Ricardi; Arjun Sahgal; Kristin J Redmond Journal: Cancer Med Date: 2021-08-25 Impact factor: 4.452
Authors: Jonathan E Schoenhals; Osama Mohamad; Alana Christie; Yuanyuan Zhang; Daniel Li; Nirmish Singla; Isaac Bowman; Waddah Arafat; Hans Hammers; Kevin Courtney; Suzanne Cole; Aditya Bagrodia; Vitaly Margulis; Neil Desai; Aurelie Garant; Hak Choy; Robert Timmerman; James Brugarolas; Raquibul Hannan Journal: Adv Radiat Oncol Date: 2021-05-26