{"id":46294,"date":"2023-10-24T12:00:00","date_gmt":"2023-10-24T12:00:00","guid":{"rendered":"https:\/\/www.cancer.gov\/news-events\/cancer-currents-blog\/2023\/kidney-cancer-localized-sbrt-radiation"},"modified":"2024-11-03T15:12:21","modified_gmt":"2024-11-03T15:12:21","slug":"sbrt-emerging-as-an-important-treatment-for-early-stage-kidney-cancer","status":"publish","type":"post","link":"https:\/\/ogkologos.com\/en\/sbrt-emerging-as-an-important-treatment-for-early-stage-kidney-cancer\/","title":{"rendered":"SBRT Emerging as an Important Treatment for Early-Stage Kidney Cancer"},"content":{"rendered":"

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In stereotactic body radiotherapy (SBRT) for localized kidney cancer, imaging is used to precisely map the tumor, which radiation oncologists then use to create a treatment plan for directly targeting it with multiple radiation beams.<\/p>\n

Credit: National Cancer Institute<\/p>\n<\/p><\/div>\n<\/figcaption><\/figure>\n<\/p><\/div>\n

For some people with kidney cancer, a treatment called stereotactic body radiotherapy (SBRT) appears to be a highly effective treatment when surgery isn\u2019t an option, according to new findings from a clinical trial. <\/p>\n

The trial, called FASTRACK II, only included people with a single tumor in their kidney\u2014called localized<\/a> kidney cancer\u2014who were not able to undergo surgery to have it removed, mostly because of other health problems.<\/p>\n

All 70 people in the trial had their tumors treated with SBRT<\/a>, and over the next few years none had any evidence that their tumors had come back and none died of their disease. Only one patient had evidence of the cancer returning somewhere else in the body 3 years after receiving the treatment.<\/p>\n

Treatment with SBRT also appeared to be safe\u2014in particular, it had no notable impact on patients\u2019 kidney function<\/a>, according to results reported on October 1 at the American Society for Radiation Oncology (ASTRO) annual meeting.<\/p>\n

The results of FASTRACK II \u201care quite exceptional and unexpected,\u201d said the trial\u2019s lead investigator, Shankar Siva, M.B.B.S., Ph.D., of the Peter MacCallum Cancer Centre in Melbourne, Australia.<\/p>\n

The only other treatment options for people with localized kidney cancer who cannot have surgery are \u201cablation<\/a>\u201d techniques that kill tumors with extreme heat or cold, or routine monitoring of the cancer to see if it gets worse, Dr. Siva explained during a press briefing at the ASTRO meeting. <\/p>\n

But ablation doesn\u2019t work well for larger tumors (larger than 4 cm), which most patients in the trial had, he said. And doctors may advise routine monitoring, often called surveillance<\/a>, for small tumors.<\/p>\n

Once surgery has been ruled out, people with larger tumors \u201cdon\u2019t have another curative<\/a> treatment option,\u201d he said. So particularly for people with larger tumors who can\u2019t have surgery, he continued, the trial results suggest that SBRT should be the treatment of choice.<\/p>\n

Other experts agreed. <\/p>\n

Widely accepted cancer treatment guidelines already include SBRT as an option for patients who can\u2019t undergo surgery, explained said Rohann Correa, M.D., of the London Regional Cancer Program in Ontario, Canada, during the briefing. <\/p>\n

These trial results \u201conly bolster the quality of the evidence that backs that recommendation,\u201d Dr. Correa said.<\/p>\n

When surgery isn\u2019t possible, what are the options?<\/h2>\n

The most common form of kidney cancer is called renal cell carcinoma. In most people diagnosed with this form of kidney cancer, the disease is a single tumor, ranging in size from less than 4 centimeters (about 1.5 inches wide) and up to about 10 centimeters (about 4 inches wide).<\/p>\n

Surgery is the most common treatment for localized kidney cancer, explained Saby George, M.D., of Roswell Park Comprehensive Cancer Center in Buffalo, New York, who specializes in treating kidney cancer. Surgery can cure the disease in many patients, Dr. George said. <\/p>\n

For smaller tumors, depending on factors such as their location, surgery typically involves removing only the part of the kidney that includes the tumor, called a partial nephrectomy<\/a>. Otherwise, the entire kidney is removed, known as a radical nephrectomy<\/a>.<\/p>\n

But a small percentage of people diagnosed with localized kidney cancer can\u2019t have surgery. Most often that\u2019s because they have other health conditions\u2014such as obesity, heart disease, or chronic kidney disease\u2014that make surgery dangerous or not feasible.<\/p>\n

Starting in the early 2000s, SBRT emerged as a possible alternative for people who can\u2019t undergo surgery. <\/p>\n

The technique requires patients to undergo several imaging procedures<\/a> that allow doctors to precisely map the tumor in the kidney. Based on that mapping, radiation oncologists then develop a treatment plan<\/a> that allows them to target multiple radiation beams directly to the tumor. The entire procedure is noninvasive<\/a>.<\/p>\n

Killing tumors with extreme heat or cold, called thermal ablation<\/a>, can work well for smaller tumors, Dr. Siva said. But unlike SBRT, he noted, ablation is invasive, requiring a probe to be inserted through an opening in the skin into the tumor. And neither form of ablation is very effective against larger tumors or when the tumor is deeper in the kidney.<\/p>\n

Smaller clinical trials<\/a> of SBRT to treat people who aren\u2019t candidates for surgery had largely positive results<\/a>, but a larger trial conducted at multiple centers\u2014which can provide more definitive evidence of how effective a treatment really is\u2014had yet to be performed. <\/p>\n

Dr. Siva and colleagues launched the FASTRACK II trial with the goal of filling that gap.<\/p>\n

Controlling kidney tumors and no safety concerns<\/h2>\n

The FASTRACK II trial was predominantly conducted in Australia. The average age of the 70 people who participated was 77, and many were clinically obese and had other medical conditions. About one third had tumors smaller than 4 centimeters and, with one exception, the remainder had tumors between 4 and 9 centimeters (see sidebar).<\/p>\n

\u201cThe tumors [in the trial] were larger and more complex than what could be reasonably treated with thermal ablation,\u201d Dr. Siva said.<\/p>\n