Long-term Renal Function Outcomes After Stereotactic Ablative Body Radiotherapy for Primary Renal Cell Carcinoma Including Patients with a Solitary Kidney: A Report from the International Radiosurgery Oncology Consortium of the Kidney.

Kidney cancer Radiosurgery Renal cell carcinoma Stereotactic ablative radiotherapy Stereotactic body radiotherapy

Journal

European urology oncology
ISSN: 2588-9311
Titre abrégé: Eur Urol Oncol
Pays: Netherlands
ID NLM: 101724904

Informations de publication

Date de publication:
09 Jul 2024
Historique:
received: 12 02 2024
revised: 29 05 2024
accepted: 24 06 2024
medline: 11 7 2024
pubmed: 11 7 2024
entrez: 10 7 2024
Statut: aheadofprint

Résumé

Renal function preservation is particularly important following nonoperative treatment of localized renal cell carcinoma (RCC) since patients are often older with medical comorbidities. Our objective was to report long-term renal function outcomes after stereotactic ablative radiotherapy (SABR) including patients with a solitary kidney. Patients with primary RCC treated with SABR with ≥2 yr of follow-up at 12 International Radiosurgery Consortium for Kidney institutions were included. Renal function was measured by estimated glomerular filtration rate (eGFR). In total, 190 patients (56 with a solitary kidney) underwent SABR and were followed for a median of 5.0 yr (interquartile range [IQR]: 3.4-6.8). In patients with a solitary kidney versus bilateral kidneys, pre-SABR eGFR (mean [standard deviation]) was 61.1 (23.2) versus 58.0 (22.3) ml/min (p = 0.32) and the median tumor size was 3.65 cm (IQR: 2.59-4.50 cm) versus 4.00 cm (IQR: 3.00-5.00 cm; p = 0.026). At 5 yr after SABR, eGFR decreased by -14.5 (7.6) and -13.3 (15.9) ml/min (p = 0.67), respectively, and there were similar rates of post-SABR dialysis (3.6% [n = 2/56] vs 3.7% [n = 5/134]). A multivariable analysis demonstrated that increasing tumor size (odds ratio [OR] per 1 cm: 1.57; 95% confidence interval [CI]: 1.14-2.16, p = 0.0055) and baseline eGFR (OR per 10 ml/min: 1.30; 95% CI: 1.02-1.66, p = 0.034) were associated with an eGFR decline of ≥15 ml/min at 1 yr. With long-term follow-up after SABR, kidney function decline remains moderate, with no observed difference between patients with a solitary kidney and bilateral kidneys. Tumor size and baseline eGFR are dominant factors predictive of long-term renal function decline. With long-term follow-up, stereotactic ablative radiotherapy (SABR) yields moderate long-term renal function decline and low dialysis rates even in patients with a solitary kidney. SABR thus represents a promising noninvasive, nephron-sparing option for patients with localized renal cell carcinoma.

Sections du résumé

BACKGROUND AND OBJECTIVE OBJECTIVE
Renal function preservation is particularly important following nonoperative treatment of localized renal cell carcinoma (RCC) since patients are often older with medical comorbidities. Our objective was to report long-term renal function outcomes after stereotactic ablative radiotherapy (SABR) including patients with a solitary kidney.
METHODS METHODS
Patients with primary RCC treated with SABR with ≥2 yr of follow-up at 12 International Radiosurgery Consortium for Kidney institutions were included. Renal function was measured by estimated glomerular filtration rate (eGFR).
KEY FINDINGS AND LIMITATIONS UNASSIGNED
In total, 190 patients (56 with a solitary kidney) underwent SABR and were followed for a median of 5.0 yr (interquartile range [IQR]: 3.4-6.8). In patients with a solitary kidney versus bilateral kidneys, pre-SABR eGFR (mean [standard deviation]) was 61.1 (23.2) versus 58.0 (22.3) ml/min (p = 0.32) and the median tumor size was 3.65 cm (IQR: 2.59-4.50 cm) versus 4.00 cm (IQR: 3.00-5.00 cm; p = 0.026). At 5 yr after SABR, eGFR decreased by -14.5 (7.6) and -13.3 (15.9) ml/min (p = 0.67), respectively, and there were similar rates of post-SABR dialysis (3.6% [n = 2/56] vs 3.7% [n = 5/134]). A multivariable analysis demonstrated that increasing tumor size (odds ratio [OR] per 1 cm: 1.57; 95% confidence interval [CI]: 1.14-2.16, p = 0.0055) and baseline eGFR (OR per 10 ml/min: 1.30; 95% CI: 1.02-1.66, p = 0.034) were associated with an eGFR decline of ≥15 ml/min at 1 yr.
CONCLUSIONS AND CLINICAL IMPLICATIONS CONCLUSIONS
With long-term follow-up after SABR, kidney function decline remains moderate, with no observed difference between patients with a solitary kidney and bilateral kidneys. Tumor size and baseline eGFR are dominant factors predictive of long-term renal function decline.
PATIENT SUMMARY RESULTS
With long-term follow-up, stereotactic ablative radiotherapy (SABR) yields moderate long-term renal function decline and low dialysis rates even in patients with a solitary kidney. SABR thus represents a promising noninvasive, nephron-sparing option for patients with localized renal cell carcinoma.

Identifiants

DOI: 10.1016/j.euo.2024.06.012 PMID: 38987159
pubmed: 38987159
pii: S2588-9311(24)00159-7
doi: 10.1016/j.euo.2024.06.012
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024. Published by Elsevier B.V.

Auteurs

Vivian S Tan (VS)

London Health Sciences Centre, London, ON, Canada.

Rohann J M Correa (RJM)

London Health Sciences Centre, London, ON, Canada.

Andrew Warner (A)

London Health Sciences Centre, London, ON, Canada.

Muhammad Ali (M)

Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.

Alexander Muacevic (A)

University of Munich Hospitals, Munich, Germany.

Lee Ponsky (L)

University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.

Rodney J Ellis (RJ)

GenesisCare USA, Fort Myers, FL, USA; Northeast Ohio Medical University Rootstown, OH, USA.

Simon S Lo (SS)

University of Washington School of Medicine, Seattle, WA, USA.

Hiroshi Onishi (H)

University of Yamanashi, Yamanashi, Japan.

Anand Swaminath (A)

Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada.

Young Suk Kwon (Y)

University of Texas - Southwestern Medical Center, Dallas, TX, USA.

Scott C Morgan (SC)

The Ottawa Hospital, Ottawa, ON, Canada.

Fabio L Cury (FL)

McGill University Health Centre, Montreal, QC, Canada.

Bin S Teh (BS)

Houston Methodist Hospital, Cancer Center and Research Institute, Houston, TX, USA.

Anand Mahadevan (A)

NYU Langone Health - Laura and Isaac Perlmutter Cancer Center, New York, NY, USA.

Irving D Kaplan (ID)

Beth Israel Deaconess Medical Center, Boston, MA, USA.

William Chu (W)

Sunnybrook Health Sciences Centre and the University of Toronto, Toronto, ON, Canada.

Raquibul Hannan (R)

University of Texas - Southwestern Medical Center, Dallas, TX, USA.

Michael Staehler (M)

University of Munich Hospitals, Munich, Germany.

Nicholas G Zaorsky (NG)

University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.

Alexander V Louie (AV)

London Health Sciences Centre, London, ON, Canada; Sunnybrook Health Sciences Centre and the University of Toronto, Toronto, ON, Canada.

Shankar Siva (S)

Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia. Electronic address: Shankar.Siva@petermac.org.

Classifications MeSH