Stereotactic Ablative Radiation Therapy for Oligoprogressive Renal Cell Carcinoma

• Main Authors: Jonathan E. Schoenhals, BS, Osama Mohamad, MD, PhD, Alana Christie, MS, Yuanyuan Zhang, MD, PhD, Daniel Li, MD, Nirmish Singla, MD, MSCS, Isaac Bowman, MD, Waddah Arafat, MD, Hans Hammers, MD, Kevin Courtney, MD, PhD, Suzanne Cole, MD, Aditya Bagrodia, MD, Vitaly Margulis, MD, Neil Desai, MD, Aurelie Garant, MD, Hak Choy, MD, Robert Timmerman, MD, James Brugarolas, MD, PhD, Raquibul Hannan, MD, PhD
• Format: Article
• Language: English
• Published: Elsevier 2021-09-01
• Series: Advances in Radiation Oncology
• Online Access: http://www.sciencedirect.com/science/article/pii/S2452109421000506

Purpose: Oligoprogression, defined as limited sites of progression on systemic therapy, in patients with metastatic renal cell carcinoma (mRCC) is not uncommon, possibly because of inter- and intratumoral heterogeneity. We evaluated the effect of stereotactic ablative radiation therapy (SAbR) for longitudinal control of oligoprogressive mRCC. Methods and Materials: Patients with extracranial mRCC were included in this retrospective analysis if they progressed in ≤3 sites on systemic therapy while demonstrating response/stability at other sites and received SAbR to all progressing sites without switching systemic therapy. Our primary endpoint was modified progression-free survival (mPFS), which we calculated from the start of SAbR to the start of a subsequent systemic therapy, death, or loss to follow-up. Results: We identified 36 patients with a median follow-up of 20.4 months (interquartile range, 10.9-29.4). Forty-three sites were treated with SAbR with a median dose of 36 Gy (range, 18-50) in 3 fractions (range, 1-5). Median time to SAbR from the start of systemic therapy was 11.4 months (interquartile range, 6.1-17.1). Median mPFS was 9.2 months (95% confidence interval [CI], 5.9-13.2). Patients receiving SAbR while on immunotherapy exhibited a longer median mPFS (>28.4 months, log-rank P = .0001) than patients not on immunotherapy (9.2 months). Median overall survival from SAbR administration was 43.4 months (95% CI, 21.5-not Reached). The 1-year local control rate was 93% (95% CI, 78.7-97.5). Most SAbR-related toxicities were grade 1 to 2 (33% of patients), with one grade 5 hemoptysis event possibly related to SAbR or disease progression. Conclusions: SAbR has the potential to extend the the duration of current systemic therapy for selected patients with mRCC, preserving subsequent therapies for later administration possibly enabling longer treatment duration.