Stereotactic ablative radiation therapy for renal cell carcinoma with inferior vena cava tumor thrombus

Yuval Freifeld, Ivan Pedrosa, Mark Mclaughlin, Rohann M. Correa, Alexander V. Louie, J. Alberto Maldonado, Chad Tang, Brian Kadow, Alexander Kutikov, Robert G. Uzzo, Camillo Porta, Nicholas W. Bucknell, Shankar Siva, James Brugarolas, Vitaly Margulis, Robert Timmerman, Raquibul Hannan

Research output: Contribution to journalArticlepeer-review

Abstract

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 (BED10) of 72 Gy (range: 37.5–100.8) delivered in a median of 5 fractions (range 1–5). Median overall survival was 34 months. Radiographic response was observed in 58% of patients. Symptom palliation was recorded in all patients receiving SAbR for this indication. Only grade 1 to 2 adverse events were noted. 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.

Original languageEnglish (US)
Pages (from-to)166.e9-166.e13
JournalUrologic Oncology: Seminars and Original Investigations
Volume40
Issue number4
DOIs
StatePublished - Apr 2022

Keywords

  • Inferior vena cava thrombus
  • Radiation
  • Renal cell carcinoma
  • Sbrt
  • T3b

ASJC Scopus subject areas

  • Oncology
  • Urology

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