Stereotactic Radiotherapy as a Treatment Option for Renal Tumors in the Solitary Kidney

A Multicenter Analysis from the IROCK

Rohann J.M. Correa, Alexander V. Louie, Michael Staehler, Andrew Warner, Senthilkumar Gandhidasan, Lee Ponsky, Rodney J. Ellis, Irving Kaplan, Anand Mahadevan, William Chu, Anand Swaminath, Hiroshi Onishi, Bin S. Teh, Simon S. Lo, Alexander Muacevic, Shankar Siva

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Abstract

Purpose: Stereotactic ablative radiotherapy is an emerging treatment for renal cell carcinoma. Our study objective was to evaluate this therapy in patients with a solitary kidney, focusing on oncologic and renal function outcomes. Materials and Methods: We pooled individual patient data from 9 IROCK (International Radiosurgery Oncology Consortium for Kidney) institutions in Germany, Australia, the United States of America, Canada and Japan. Median followup was 2.6 years. Baseline characteristics and outcomes were compared between the solitary and bilateral kidney cohorts. Predictors of renal function after stereotactic ablative radiotherapy were assessed by logistic regression modeling. Results: A total of 81 patients with a solitary kidney underwent stereotactic ablative radiotherapy. Mean age was 67.3 years and 97.5% of patients had good performance status, including ECOG (Eastern Cooperative Oncology Group) 0-1 or KPS (Karnofsky Performance Status) 70% or greater. Median tumor diameter was 3.7 cm (IQR 2.5-4.3) and 37% of tumors were 4 cm or greater. The 138 patients in the bilateral cohort harbored larger tumors and were older (p <0.001) with a lower baseline estimated glomerular filtration rate (p = 0.024). After stereotactic ablative radiotherapy in the solitary kidney cohort the mean ± SD estimated glomerular filtration rate decrease was -5.8 ± 10.8 ml per minute (-9%). No patient with a solitary kidney required dialysis. After stereotactic ablative radiotherapy a tumor size of 4 cm or greater was associated with an estimated glomerular filtration rate decrease of 15 ml per minute or greater (OR 4.2, p = 0.029). At 2 years the rates of local control, and progression-free, cancer specific and overall survival in the solitary cohort were 98.0%, 77.5%, 98.2% and 81.5%, respectively. There was no significant difference in renal function or oncologic outcomes between the cohorts (p >0.05). Conclusions: In this analysis of the IROCK database stereotactic ablative radiotherapy in patients with a solitary kidney had an acceptable impact on renal function and achieved excellent oncologic outcomes, similar to those in patients with bilateral kidneys. Thus, stereotactic ablative radiotherapy represents a viable treatment option in patients with renal cell carcinoma in a solitary kidney.

Original languageEnglish (US)
Pages (from-to)1097-1103
Number of pages7
JournalJournal of Urology
Volume201
Issue number6
DOIs
StatePublished - Jun 1 2019

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Radiosurgery
Radiotherapy
Kidney
Neoplasms
Therapeutics
Renal Cell Carcinoma
Karnofsky Performance Status
Canada
Germany
Japan
Logistic Models
Databases

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Correa, R. J. M., Louie, A. V., Staehler, M., Warner, A., Gandhidasan, S., Ponsky, L., ... Siva, S. (2019). Stereotactic Radiotherapy as a Treatment Option for Renal Tumors in the Solitary Kidney: A Multicenter Analysis from the IROCK. Journal of Urology, 201(6), 1097-1103. https://doi.org/10.1097/JU.0000000000000111
Correa, Rohann J.M. ; Louie, Alexander V. ; Staehler, Michael ; Warner, Andrew ; Gandhidasan, Senthilkumar ; Ponsky, Lee ; Ellis, Rodney J. ; Kaplan, Irving ; Mahadevan, Anand ; Chu, William ; Swaminath, Anand ; Onishi, Hiroshi ; Teh, Bin S. ; Lo, Simon S. ; Muacevic, Alexander ; Siva, Shankar. / Stereotactic Radiotherapy as a Treatment Option for Renal Tumors in the Solitary Kidney : A Multicenter Analysis from the IROCK. In: Journal of Urology. 2019 ; Vol. 201, No. 6. pp. 1097-1103.
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abstract = "Purpose: Stereotactic ablative radiotherapy is an emerging treatment for renal cell carcinoma. Our study objective was to evaluate this therapy in patients with a solitary kidney, focusing on oncologic and renal function outcomes. Materials and Methods: We pooled individual patient data from 9 IROCK (International Radiosurgery Oncology Consortium for Kidney) institutions in Germany, Australia, the United States of America, Canada and Japan. Median followup was 2.6 years. Baseline characteristics and outcomes were compared between the solitary and bilateral kidney cohorts. Predictors of renal function after stereotactic ablative radiotherapy were assessed by logistic regression modeling. Results: A total of 81 patients with a solitary kidney underwent stereotactic ablative radiotherapy. Mean age was 67.3 years and 97.5{\%} of patients had good performance status, including ECOG (Eastern Cooperative Oncology Group) 0-1 or KPS (Karnofsky Performance Status) 70{\%} or greater. Median tumor diameter was 3.7 cm (IQR 2.5-4.3) and 37{\%} of tumors were 4 cm or greater. The 138 patients in the bilateral cohort harbored larger tumors and were older (p <0.001) with a lower baseline estimated glomerular filtration rate (p = 0.024). After stereotactic ablative radiotherapy in the solitary kidney cohort the mean ± SD estimated glomerular filtration rate decrease was -5.8 ± 10.8 ml per minute (-9{\%}). No patient with a solitary kidney required dialysis. After stereotactic ablative radiotherapy a tumor size of 4 cm or greater was associated with an estimated glomerular filtration rate decrease of 15 ml per minute or greater (OR 4.2, p = 0.029). At 2 years the rates of local control, and progression-free, cancer specific and overall survival in the solitary cohort were 98.0{\%}, 77.5{\%}, 98.2{\%} and 81.5{\%}, respectively. There was no significant difference in renal function or oncologic outcomes between the cohorts (p >0.05). Conclusions: In this analysis of the IROCK database stereotactic ablative radiotherapy in patients with a solitary kidney had an acceptable impact on renal function and achieved excellent oncologic outcomes, similar to those in patients with bilateral kidneys. Thus, stereotactic ablative radiotherapy represents a viable treatment option in patients with renal cell carcinoma in a solitary kidney.",
author = "Correa, {Rohann J.M.} and Louie, {Alexander V.} and Michael Staehler and Andrew Warner and Senthilkumar Gandhidasan and Lee Ponsky and Ellis, {Rodney J.} and Irving Kaplan and Anand Mahadevan and William Chu and Anand Swaminath and Hiroshi Onishi and Teh, {Bin S.} and Lo, {Simon S.} and Alexander Muacevic and Shankar Siva",
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Correa, RJM, Louie, AV, Staehler, M, Warner, A, Gandhidasan, S, Ponsky, L, Ellis, RJ, Kaplan, I, Mahadevan, A, Chu, W, Swaminath, A, Onishi, H, Teh, BS, Lo, SS, Muacevic, A & Siva, S 2019, 'Stereotactic Radiotherapy as a Treatment Option for Renal Tumors in the Solitary Kidney: A Multicenter Analysis from the IROCK', Journal of Urology, vol. 201, no. 6, pp. 1097-1103. https://doi.org/10.1097/JU.0000000000000111

Stereotactic Radiotherapy as a Treatment Option for Renal Tumors in the Solitary Kidney : A Multicenter Analysis from the IROCK. / Correa, Rohann J.M.; Louie, Alexander V.; Staehler, Michael; Warner, Andrew; Gandhidasan, Senthilkumar; Ponsky, Lee; Ellis, Rodney J.; Kaplan, Irving; Mahadevan, Anand; Chu, William; Swaminath, Anand; Onishi, Hiroshi; Teh, Bin S.; Lo, Simon S.; Muacevic, Alexander; Siva, Shankar.

In: Journal of Urology, Vol. 201, No. 6, 01.06.2019, p. 1097-1103.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Stereotactic Radiotherapy as a Treatment Option for Renal Tumors in the Solitary Kidney

T2 - A Multicenter Analysis from the IROCK

AU - Correa, Rohann J.M.

AU - Louie, Alexander V.

AU - Staehler, Michael

AU - Warner, Andrew

AU - Gandhidasan, Senthilkumar

AU - Ponsky, Lee

AU - Ellis, Rodney J.

AU - Kaplan, Irving

AU - Mahadevan, Anand

AU - Chu, William

AU - Swaminath, Anand

AU - Onishi, Hiroshi

AU - Teh, Bin S.

AU - Lo, Simon S.

AU - Muacevic, Alexander

AU - Siva, Shankar

PY - 2019/6/1

Y1 - 2019/6/1

N2 - Purpose: Stereotactic ablative radiotherapy is an emerging treatment for renal cell carcinoma. Our study objective was to evaluate this therapy in patients with a solitary kidney, focusing on oncologic and renal function outcomes. Materials and Methods: We pooled individual patient data from 9 IROCK (International Radiosurgery Oncology Consortium for Kidney) institutions in Germany, Australia, the United States of America, Canada and Japan. Median followup was 2.6 years. Baseline characteristics and outcomes were compared between the solitary and bilateral kidney cohorts. Predictors of renal function after stereotactic ablative radiotherapy were assessed by logistic regression modeling. Results: A total of 81 patients with a solitary kidney underwent stereotactic ablative radiotherapy. Mean age was 67.3 years and 97.5% of patients had good performance status, including ECOG (Eastern Cooperative Oncology Group) 0-1 or KPS (Karnofsky Performance Status) 70% or greater. Median tumor diameter was 3.7 cm (IQR 2.5-4.3) and 37% of tumors were 4 cm or greater. The 138 patients in the bilateral cohort harbored larger tumors and were older (p <0.001) with a lower baseline estimated glomerular filtration rate (p = 0.024). After stereotactic ablative radiotherapy in the solitary kidney cohort the mean ± SD estimated glomerular filtration rate decrease was -5.8 ± 10.8 ml per minute (-9%). No patient with a solitary kidney required dialysis. After stereotactic ablative radiotherapy a tumor size of 4 cm or greater was associated with an estimated glomerular filtration rate decrease of 15 ml per minute or greater (OR 4.2, p = 0.029). At 2 years the rates of local control, and progression-free, cancer specific and overall survival in the solitary cohort were 98.0%, 77.5%, 98.2% and 81.5%, respectively. There was no significant difference in renal function or oncologic outcomes between the cohorts (p >0.05). Conclusions: In this analysis of the IROCK database stereotactic ablative radiotherapy in patients with a solitary kidney had an acceptable impact on renal function and achieved excellent oncologic outcomes, similar to those in patients with bilateral kidneys. Thus, stereotactic ablative radiotherapy represents a viable treatment option in patients with renal cell carcinoma in a solitary kidney.

AB - Purpose: Stereotactic ablative radiotherapy is an emerging treatment for renal cell carcinoma. Our study objective was to evaluate this therapy in patients with a solitary kidney, focusing on oncologic and renal function outcomes. Materials and Methods: We pooled individual patient data from 9 IROCK (International Radiosurgery Oncology Consortium for Kidney) institutions in Germany, Australia, the United States of America, Canada and Japan. Median followup was 2.6 years. Baseline characteristics and outcomes were compared between the solitary and bilateral kidney cohorts. Predictors of renal function after stereotactic ablative radiotherapy were assessed by logistic regression modeling. Results: A total of 81 patients with a solitary kidney underwent stereotactic ablative radiotherapy. Mean age was 67.3 years and 97.5% of patients had good performance status, including ECOG (Eastern Cooperative Oncology Group) 0-1 or KPS (Karnofsky Performance Status) 70% or greater. Median tumor diameter was 3.7 cm (IQR 2.5-4.3) and 37% of tumors were 4 cm or greater. The 138 patients in the bilateral cohort harbored larger tumors and were older (p <0.001) with a lower baseline estimated glomerular filtration rate (p = 0.024). After stereotactic ablative radiotherapy in the solitary kidney cohort the mean ± SD estimated glomerular filtration rate decrease was -5.8 ± 10.8 ml per minute (-9%). No patient with a solitary kidney required dialysis. After stereotactic ablative radiotherapy a tumor size of 4 cm or greater was associated with an estimated glomerular filtration rate decrease of 15 ml per minute or greater (OR 4.2, p = 0.029). At 2 years the rates of local control, and progression-free, cancer specific and overall survival in the solitary cohort were 98.0%, 77.5%, 98.2% and 81.5%, respectively. There was no significant difference in renal function or oncologic outcomes between the cohorts (p >0.05). Conclusions: In this analysis of the IROCK database stereotactic ablative radiotherapy in patients with a solitary kidney had an acceptable impact on renal function and achieved excellent oncologic outcomes, similar to those in patients with bilateral kidneys. Thus, stereotactic ablative radiotherapy represents a viable treatment option in patients with renal cell carcinoma in a solitary kidney.

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