Lung metastasis from renal cell carcinoma: SBRT alone or in association with target therapy as a potential treatment option
PO-1401
Abstract
Lung metastasis from renal cell carcinoma: SBRT alone or in association with target therapy as a potential treatment option
Authors: Flavia Zerbetto1, Silvia Foti2, Chiara Deantoni1, Marcella Pasetti3, Anna Chiara4, Tummineri Roberta3, Sara Broggi5, Nadia Gisella Di Muzio6
1IRCCS San Raffaele Scientific Institute, Department of Radiotherapy, Milan, Italy; 2IRCCS San Raffaele Scientific Institute, Department of Medical Oncology, Milan, Italy; 3IRCCS San Raffaele Scientific Institute, (1) Department of Radiotherapy, Milan, Italy; 4IRCCS San Raffaele Scientific Institute, Department of Radiotherapy, milan, Italy; 5IRCCS San Raffaele Scientific Institute, Milan, Italy, Medical Physics, Milan, Italy; 6Vita –Salute S. Raffaele University , (3) Department of Radiotherapy, Milan, Italy
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Purpose or Objective
The introduction of new target therapy in metastatic renal cell carcinoma RCC has improved the prognosis of these patients (pts). Recently the role of robotic Stereotactic Body Radiotherapy (SBRT) in oligometastatic setting is emerging as a promising treatment option. Our aim is to evaluate toxicity and local control (LC) of SBRT with CyberKnife® (Accuray, Sunnyvales, CA-CK) in the management of lung metastasis (LM) from RCC as monotherapy or in combination with new target therapy.
Material and Methods
From 02/2018 to 07/2020, 24 LM in 18 RCC pts were treated with CK in our Institute. Median maximum diameter of the lesions was 1.75 cm (0.6-5,9 cm). Maximum number of lesion treated for patient was three. Median prescribed dose was 45 (30-60) Gy in 1-5 fractions, at a median isodose of 80% (73-85%). The Biologically Effective Dose (BED), considering an alpha/beta ratio of 10 was 112.5 (48-120) Gy. Five patients underwent SBRT only, while in the other 12 pts radiation treatment was associated to immunotherapy (Nivolumab) or Thyrosine Kynase Inhibitors (TKY: Sunitinib, Pazopanib or Carbozatinib).
Results
Median follow-up was 9.4 months (3-31.6). No acute toxicity was registered. Only one patient presented G2 asymptomatic early-late radio-induced pneumonia computer tomography (CT) documented 16 weeks after the end of SBRT and subsequently solved with steroid therapy. In this case three LM were concomitant treated with SBRT and Nivolumab, for a cumulative PTV of 65,22 square cm. No other late toxicities were recorded.
Six LM (25%) presented complete CT or 18F-FDG-PET/CT response, six LM (25%) were in partial response, while stable disease was observed in 12 LM (50%). In the six cases with complete response, five were treated with concurrently TKY (4 with Sunitinib and 1 with Pazopanib). No local progressive disease were observed.
Conclusion
In our experience robotic SBRT in LM from RCC cancer is a feasible treatment with excellent local short-term control. Apparently the concomitant use of immunotherapy or TKY doesn’t increase the toxicity, except in case of high volumes of treatment. Longer follow-up is necessary to verify the toxicity, the stability of the complete local response over time and to better evaluate if the early stable disease will become a complete response