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J Urol. 2019 Jun;201(6):1097-1104. doi: 10.1097/JU.0000000000000111.

Stereotactic Radiotherapy as a Treatment Option for Renal Tumors in the Solitary Kidney: A Multicenter Analysis from the IROCK.

Author information

1
Departments of Radiation Oncology, London Regional Cancer Program , London , Ontario , Canada.
2
University of Munich Hospitals , Munich , Germany.
3
Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre and University of Melbourne , Melbourne , Australia.
4
University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center , Cleveland , Ohio.
5
Beth Israel Deaconess Medical Center , Boston , Massachusetts.
6
Geisinger Health , Danville , Pennsylvania.
7
Sunnybrook Health Sciences Centre and University of Toronto , Toronto , Ontario , Canada.
8
Division of Radiation Oncology, Juravinski Cancer Centre, McMaster University , Hamilton , Ontario , Canada.
9
Department of Radiology, University of Yamanashi , Yamanashi , Japan.
10
Department of Radiation Oncology, Houston Methodist Hospital, Cancer Center and Research Institute , Houston , Texas.
11
Department of Radiation Oncology, University of Washington School of Medicine , Seattle , Washington.
#
Contributed equally

Abstract

PURPOSE:

Stereotactic ablative radiotherapy is an emerging treatment for renal cell carcinoma. Our study objective was to evaluate this therapy in patients with a solitary kidney, focusing on oncologic and renal function outcomes.

MATERIALS AND METHODS:

We pooled individual patient data from 9 IROCK (International Radiosurgery Oncology Consortium for Kidney) institutions in Germany, Australia, the United States of America, Canada and Japan. Median followup was 2.6 years. Baseline characteristics and outcomes were compared between the solitary and bilateral kidney cohorts. Predictors of renal function after stereotactic ablative radiotherapy were assessed by logistic regression modeling.

RESULTS:

A total of 81 patients with a solitary kidney underwent stereotactic ablative radiotherapy. Mean age was 67.3 years and 97.5% of patients had good performance status, including ECOG (Eastern Cooperative Oncology Group) 0-1 or KPS (Karnofsky Performance Status) 70% or greater. Median tumor diameter was 3.7 cm (IQR 2.5-4.3) and 37% of tumors were 4 cm or greater. The 138 patients in the bilateral cohort harbored larger tumors and were older (p <0.001) with a lower baseline estimated glomerular filtration rate (p = 0.024). After stereotactic ablative radiotherapy in the solitary kidney cohort the mean ± SD estimated glomerular filtration rate decrease was -5.8 ± 10.8 ml per minute (-9%). No patient with a solitary kidney required dialysis. After stereotactic ablative radiotherapy a tumor size of 4 cm or greater was associated with an estimated glomerular filtration rate decrease of 15 ml per minute or greater (OR 4.2, p = 0.029). At 2 years the rates of local control, and progression-free, cancer specific and overall survival in the solitary cohort were 98.0%, 77.5%, 98.2% and 81.5%, respectively. There was no significant difference in renal function or oncologic outcomes between the cohorts (p >0.05).

CONCLUSIONS:

In this analysis of the IROCK database stereotactic ablative radiotherapy in patients with a solitary kidney had an acceptable impact on renal function and achieved excellent oncologic outcomes, similar to those in patients with bilateral kidneys. Thus, stereotactic ablative radiotherapy represents a viable treatment option in patients with renal cell carcinoma in a solitary kidney.

KEYWORDS:

carcinoma; radiofrequency ablation; radiosurgery; renal cell; solitary kidney; stereotaxic techniques

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PMID:
30741849
DOI:
10.1097/JU.0000000000000111
[Indexed for MEDLINE]

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