MP14-12 STEREOTACTIC ABLATIVE RADIATION THERAPY (SABR) FOR TREATMENT OF RENAL CELL CARCINOMA (RCC) WITH INFERIOR VENA CAVA TUMOR THROMBUS (IVC-TT) (2020)

You have accessJournal of UrologyKidney Cancer: Advanced (including Drug Therapy) I (MP14)1 Apr 2020MP14-12 STEREOTACTIC ABLATIVE RADIATION THERAPY (SABR) FOR TREATMENT OF RENAL CELL CARCINOMA (RCC) WITH INFERIOR VENA CAVA TUMOR THROMBUS (IVC-TT) Yuval Freifeld*, Haifa Israel, Ivan Pedrosa, Mark Mcloughlin, Rohann Correa, Alexander V. Louie, Jose Alberto Maldonado, Chad Tang, Brian Kadow, Alexander Kutikov, Robert Uzzo, Camillo Porta, Nicholas W Bucknell, Shankar Siva, James Brugarolas, Vitaly Margulis, and Raquibul Hannan Yuval Freifeld*Yuval Freifeld* More articles by this author , Haifa IsraelHaifa Israel More articles by this author , Ivan PedrosaIvan Pedrosa More articles by this author , Mark McloughlinMark Mcloughlin More articles by this author , Rohann CorreaRohann Correa More articles by this author , Alexander V. LouieAlexander V. Louie More articles by this author , Jose Alberto MaldonadoJose Alberto Maldonado More articles by this author , Chad TangChad Tang More articles by this author , Brian KadowBrian Kadow More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , Robert UzzoRobert Uzzo More articles by this author , Camillo PortaCamillo Porta More articles by this author , Nicholas W BucknellNicholas W Bucknell More articles by this author , Shankar SivaShankar Siva More articles by this author , James BrugarolasJames Brugarolas More articles by this author , Vitaly MargulisVitaly Margulis More articles by this author , and Raquibul HannanRaquibul Hannan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000839.012AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The mainstay of treatment for patients with RCC IVC-TT is surgical resection; however, surgery is associated with high morbidity rates. Furthermore, many of these patients are high-risk surgical candidates due to advanced age or comorbidities. Untreated RCC IVC-TT is associated with a particularly poor prognosis stressing the need for alternative measures for disease control. SAbR is an effective non-invasive treatment modality for both localized and metastatic cancers. While its use is growing in RCC, there is limited data on its use in IVC-TT. Herein, we report the first case series of RCC patients treated with SAbR to IVC-TT, based on a multi-institutional cohort. METHODS: Leading international institutions with an interest in radiotherapy for RCC were approached to contribute patient cases of RCC IVC-TT treated with SAbR. Patient, tumor and treatment characteristics, as well as outcomes were retrospectively reviewed. Institutional review board approval was obtained locally by each participating center and de-identified data were used for the combined database analysis. RESULTS: Fourteen patients from 6 institutions were included in this report. Median age at the time of SAbR was 71.5 years (range 38-91). Thrombus level (Mayo classification) was I in 21% (3/14), II in 29% (4/14), III in 21% (3/14) and IV in 29% (4/14) of patients. Median thrombus diameter was 3.0 cm (1.0-4.6). 64% (9/14) had metastatic disease, 71% (10/14) of patients received systemic therapy prior to SAbR treatment, of those, 8 received ongoing treatment at the time of radiation. 57% (8/14) did not undergo surgery due to high surgical risk, 14% (2/14) had recurrent thrombus, other reasons for not performing surgery included, inoperable tumor, liver metastases and patient refusal. Median radiation dose was 40 Gy (range: 25-50) divided into 1-5 fractions with a maximal dose of 26 Gy delivered in a single fraction. 36% (5/12) of patients also received SAbR directed at the primary tumor, and 3 had additional radiation to metastatic sites. Median follow-up after SAbR was 12 months (range: 1-42), during which 43% (6/14) of patients died. Median overall survival was 25 months. Of the 12 patients with available post SAbR imaging at the tumor thrombus site, 33% (4/12) demonstrated thrombus regression, whereas a stable thrombus size was noted in the remaining 67% (8/14). Of those with response, 2 had reduction of enhancement in the tumor thrombus, although this parameter was not estimated in the other patients. No patient demonstrated radiological progression of the tumor thrombus.Only minor (grade 1-2) short-term treatment related adverse events were reported and included mainly fatigue, nausea and dermatitis. CONCLUSIONS: SAbR for RCC IVC–TT appears feasible and safe. In selected patients who are not candidates for surgical resection this treatment modality may be used for local disease control. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e200-e200 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yuval Freifeld* More articles by this author Haifa Israel More articles by this author Ivan Pedrosa More articles by this author Mark Mcloughlin More articles by this author Rohann Correa More articles by this author Alexander V. Louie More articles by this author Jose Alberto Maldonado More articles by this author Chad Tang More articles by this author Brian Kadow More articles by this author Alexander Kutikov More articles by this author Robert Uzzo More articles by this author Camillo Porta More articles by this author Nicholas W Bucknell More articles by this author Shankar Siva More articles by this author James Brugarolas More articles by this author Vitaly Margulis More articles by this author Raquibul Hannan More articles by this author Expand All Advertisement PDF downloadLoading ...