1.The treatment of primary and metastatic renal cell carcinoma (RCC) with image-guided stereotactic body radiation therapy (SBRT)
BS Teh ; C Bloch ; M Galli-Guevara ; L Doh ; S Richardson ; S Chiang ; P Yeh ; M Gonzalez ; W Lunn ; R Marco ; J Jac ; AC Paulino ; HH Lu ; EB Butler ; RJ Amato
Biomedical Imaging and Intervention Journal 2007;3(1):1-9
Purpose: Brain metastases from renal cell carcinoma (RCC) have been successfully treated with stereotactic
radiosurgery (SRS). Metastases to extra-cranial sites may be treated with similar success using stereotactic body
radiation therapy (SBRT), where image-guidance allows for the delivery of precise high-dose radiation in a few fractions.
This paper reports the authors’ initial experience with image-guided SBRT in treating primary and metastatic RCC.
Materials and methods: The image-guided Brainlab Novalis stereotactic system was used. Fourteen patients with
23 extra-cranial metastatic RCC lesions (orbits, head and neck, lung, mediastinum, sternum, clavicle, scapula, humerus,
rib, spine and abdominal wall) and two patients with biopsy-proven primary RCC (not surgical candidates) were treated
with SBRT (24-40 Gy in 3-6 fractions over 1-2 weeks). All patients were immobilised in body cast or head and neck
mask. Image-guidance was used for all fractions. PET/CT images were fused with simulation CT images to assist in
target delineation and dose determination. SMART (simultaneous modulated accelerated radiation therapy) boost
approach was adopted. 4D-CT was utilised to assess tumour/organ motion and assist in determining planning target
volume margins.
Results: Median follow-up was nine months. Thirteen patients (93%) who received SBRT to extra-cranial
metastases achieved symptomatic relief. Two patients had local progression, yielding a local control rate of 87%. In the two patients with primary RCC, tumour size remained unchanged but their pain improved, and their renal function was
unchanged post SBRT. There were no significant treatment-related side effects.
Conclusion: Image-guided SBRT provides excellent symptom palliation and local control without any significant
toxicity. SBRT may represent a novel, non-invasive, nephron-sparing option for the treatment of primary RCC as well as extra-cranial metastatic RCC.
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