Stereotactic ablative radiation therapy for renal cell carcinoma with inferior vena cava tumor thrombus.
Inferior vena cava thrombus
Radiation
Renal cell carcinoma
Sbrt
T3b
Journal
Urologic oncology
ISSN: 1873-2496
Titre abrégé: Urol Oncol
Pays: United States
ID NLM: 9805460
Informations de publication
Date de publication:
04 2022
04 2022
Historique:
received:
15
11
2021
revised:
22
12
2021
accepted:
23
12
2021
pubmed:
12
2
2022
medline:
21
4
2022
entrez:
11
2
2022
Statut:
ppublish
Résumé
Inferior vena cava tumor thrombus (IVC-TT) is a rare yet deadly sequel of renal cell carcinoma (RCC) with limited treatment options. The standard treatment is extirpative surgery, which has high rates of morbidity and mortality. As a result, many patients are unfit or unwilling to undergo surgery and face poor prognosis. This stresses the need for alternative options for local disease control. Our study aims to assess the feasibility and oncological outcomes of stereotactic ablative radiation (SAbR) for IVC-TT. A retrospective study reviewing six leading international institutions' experience in treating RCC with IVC-TT with SAbR. Primary end point was overall survival using Kaplan-Meier. Fifteen patients were included in the cohort. Over 50% of patients had high level IVC-TT (level III or IV), 66.7% had metastatic disease. Most eschewed surgery due to high surgical risk (7/15) or recurrent thrombus (3/15). All patients received SAbR to the IVC-TT with a median biologically equivalent dose (BED SAbR for IVC-TT appears feasible and safe. In patients who are not candidates for surgery, SAbR may palliate symptoms and improve outcomes. SAbR may be considered as part of a multimodal treatment approach for patients with RCC IVC-TT.
Sections du résumé
BACKGROUND
Inferior vena cava tumor thrombus (IVC-TT) is a rare yet deadly sequel of renal cell carcinoma (RCC) with limited treatment options. The standard treatment is extirpative surgery, which has high rates of morbidity and mortality. As a result, many patients are unfit or unwilling to undergo surgery and face poor prognosis. This stresses the need for alternative options for local disease control. Our study aims to assess the feasibility and oncological outcomes of stereotactic ablative radiation (SAbR) for IVC-TT.
METHODS
A retrospective study reviewing six leading international institutions' experience in treating RCC with IVC-TT with SAbR. Primary end point was overall survival using Kaplan-Meier.
RESULTS
Fifteen patients were included in the cohort. Over 50% of patients had high level IVC-TT (level III or IV), 66.7% had metastatic disease. Most eschewed surgery due to high surgical risk (7/15) or recurrent thrombus (3/15). All patients received SAbR to the IVC-TT with a median biologically equivalent dose (BED
CONCLUSIONS
SAbR for IVC-TT appears feasible and safe. In patients who are not candidates for surgery, SAbR may palliate symptoms and improve outcomes. SAbR may be considered as part of a multimodal treatment approach for patients with RCC IVC-TT.
Identifiants
pubmed: 35144866
pii: S1078-1439(21)00566-4
doi: 10.1016/j.urolonc.2021.12.018
pmc: PMC9843697
mid: NIHMS1767634
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
166.e9-166.e13Subventions
Organisme : NCI NIH HHS
ID : P50 CA196516
Pays : United States
Organisme : NCI NIH HHS
ID : R01 CA154475
Pays : United States
Organisme : NCI NIH HHS
ID : U01 CA207091
Pays : United States
Informations de copyright
Copyright © 2021 Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Conflict of interests The authors have no conflict of interest.
Références
Int J Radiat Oncol Biol Phys. 2021 Jul 15;110(4):1135-1142
pubmed: 33549705
N Engl J Med. 2018 Aug 02;379(5):417-427
pubmed: 29860937
Nat Med. 2018 Dec;24(12):1845-1851
pubmed: 30397353
PLoS One. 2013 May 30;8(5):e63864
pubmed: 23737955
Urol Oncol. 2013 Oct;31(7):1305-9
pubmed: 22237466
N Engl J Med. 2012 Mar 8;366(10):925-31
pubmed: 22397654
Eur Urol Focus. 2019 Nov;5(6):958-969
pubmed: 31248849
Br J Urol. 1987 May;59(5):390-5
pubmed: 3594097
Cancer Biol Ther. 2015;16(5):657-61
pubmed: 25800036
J Radiat Res. 2016 Sep;57(5):512-523
pubmed: 27053259
J Urol. 2004 Feb;171(2 Pt 1):588-91
pubmed: 14713765
Eur Urol Oncol. 2019 Sep;2(5):515-523
pubmed: 31302061
Urol Oncol. 2015 Sep;33(9):388.e1-9
pubmed: 26004163
BMC Res Notes. 2012 Jun 01;5:5
pubmed: 22658129