Delphi consensus on stereotactic ablative radiotherapy for oligometastatic and oligoprogressive renal cell carcinoma-a European Society for Radiotherapy and Oncology study endorsed by the European Association of Urology.

The purpose of this European Society for Radiotherapy and Oncology (ESTRO) project, endorsed by the European Association of Urology, is to explore expert opinion on the management of patients with oligometastatic and oligoprogressive renal cell carcinoma by means of stereotactic ablative radiotherapy (SABR) on extracranial metastases, with the aim of developing consensus recommendations for patient selection, treatment doses, and concurrent systemic therapy. A questionnaire on SABR in oligometastatic renal cell carcinoma was prepared by a core group and reviewed by a panel of ten prominent experts in the field. The Delphi consensus methodology was applied, sending three rounds of questionnaires to clinicians identified as key opinion leaders in the field. At the end of the third round, participants were able to find consensus on eight of the 37 questions. Specifically, panellists agreed to apply no restrictions regarding age (25 [100%) of 25) and primary renal cell carcinoma histology (23 [92%] of 25) for SABR candidates, on the upper threshold of three lesions to offer ablative treatment in patients with oligoprogression, and on the concomitant administration of immune checkpoint inhibitor. SABR was indicated as the treatment modality of choice for renal cell carcinoma bone oligometatasis (20 [80%] of 25) and for adrenal oligometastases 22 (88%). No consensus or major agreement was reached regarding the appropriate schedule, but the majority of the poll (54%-58%) retained the every-other-day schedule as the optimal choice for all the investigated sites. The current ESTRO Delphi consensus might provide useful direction for the application of SABR in oligometastatic renal cell carcinoma and highlight the key areas of ongoing debate, perhaps directing future research efforts to close knowledge gaps.

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Declaration of interests The Division of Radiation Oncology of European Institute of Oncology (IEO) has received research funding from Associazione Italiana per la Ricerca sul Cancro (AIRC) and Fondazione IEO-CCM (Istituto Europeo di Oncologia-Centro Cardiologico Monzino) all outside the current project. BAJ-F has received speaker fees from Roche, Bayer, Janssen, Carl Zeiss, Ipsen, Accuray, Astellas, Elekta, and IBA AstraZeneca (all outside the current project). AVL has received speaker fees from AstraZeneca (outside the current project). SGi (in the last 3 years) reports personal honoraria for participation on advisory boards from Amgen and MSD; invited speaker fees for the European Society of Medical Oncology (ESMO), and the Swiss group for Clinical Cancer Research (SAKK), the German-speaking European School of Oncology, and the Swiss Academy of Multidisciplinary Oncology; a travel grant from AstraZeneca and Bayer; institutional honoraria for participation on advisory boards or independent data monitoring–steering committees from AAA International, Amgen, AstraZeneca, Astellas Pharma, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, DAIICHI Sankyo, Innomedica, Ipsen, Meister-ConCept, Modra Pharmaceuticals, MSD, Myriad Genetic, Novartis, Orion, Pfizer, Roche, and Telixpharma; was an invited speaker for SAKK, American Society of Clinical Oncology Genitourinary, ESMO, PeerVoice, Silvio Grasso Consulting, and WebMD-Medscape; and has a patent for a research method for biomarker WO2009138392. The remaining authors declare no competing interests.