Renal Radiosurgery: Initial Clinical Experience With Histological Evaluation

Center for Urologic Oncology and Minimally Invasive Therapies, University Hospitals Case Medical Center, Cleveland, OH 44106, USA.
Surgical Innovation (Impact Factor: 1.46). 01/2008; 14(4):265-9. DOI: 10.1177/1553350607310546
Source: PubMed


The purpose of this study was to determine whether radiosurgical technology can be safely applied to renal tumors. Patients received radiosurgical treatment of renal lesions. At 8 weeks after radiosurgical treatment, patients underwent a partial or radical nephrectomy and histologic evaluation. The patients received a radiation dose of 4 Gy per fraction for 4 fractions. Patients were followed, and radiation-induced toxicities were noted. Three patients were treated for a minimum of 1 year of follow-up. All patients completed the treatments, tolerating each of the 4 fractions with no adverse events. No acute toxicities or changes in renal function were noted. None of the patients had any evidence of acute radiation injury or toxicity noted at the time of surgery or within the subsequent 12 months after the radiosurgical treatment. The last patient treated was found to have a cavity with no microscopic evidence of viable tumor after radiosurgical treatment; pathology was consistent with necrotic renal cell carcinoma, papillary type. The other 2 tumors demonstrated pathologic evidence of viable renal cell carcinoma (grade I and grade II). Tumor size remained relatively unchanged for 8 weeks after the radiosurgical treatment in all patients. The authors are extremely encouraged and cautiously optimistic with the initial results. Radiosurgery for renal tumors appears to be safe at this initial dose level.

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    • "Teh et al. concluded that image-guided SBRT provides excellent local control on imaging without any significant toxicity, and SBRT may represent a novel, non-invasive, nephron-sparing option for the treatment of primary RCC [12]. Histologically, Ponsky et al. reported three cases of pathological evaluation of RCC at eight weeks after SBRT [13]. In the report, histological complete response was found in one of three patients with primary RCC after receiving SBRT dose of 16 Gy in 4 fractions. "
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    ABSTRACT: Treatment of primary renal cell carcinoma using radiotherapy with curative intent is rare, because renal cell carcinoma is generally regarded as a radiation-resistant tumor. Recently, stereotactic body radiation therapy has been radically applied for cancers in various organs including renal cell carcinoma. However, there were few reports describing pathological changes of renal cell carcinoma post stereotactic body radiation therapy. This is the first report we are aware of documenting late histological effects of stereotactic body radiation therapy on renal cell carcinoma and surrounding normal tissue. A right renal tumor was identified in a Japanese 70-year-old man on follow-up computed tomography for his chronic hepatitis. T1N0M0 renal cell carcinoma was clinically diagnosed as the tumor was 3 cm in diameter and well-enhanced with intravenously infused contrast material in the arterial phase on computed tomography. No metastases in regional lymph nodes or distant sites were evident. Stereotactic body radiation therapy was selected as an alternative therapy to surgery because of his poor liver function. A total dose of 60 Gy in 10 fractions over 12 days was delivered using a 10-megavolt X-ray. The renal tumor gradually decreased in size and partial response had been achieved at 2 years after completing stereotactic body radiation therapy. Hepatocellular carcinoma was identified during follow-up in the patient and he died of progression of hepatocellular carcinoma with hepatic failure 2.5 years after completing stereotactic body radiation therapy. Autopsy was done and it showed almost complete necrosis of tumor tissues with a small amount of viable renal carcinoma cells. These pathological findings suggested marked effects of stereotactic body radiation therapy on clear cell renal cell carcinoma. Our case demonstrates a good pathological response with small foci of remnant viable cancer cells after stereotactic body radiation therapy of 60Gy in 10 fractions for small renal cell carcinoma. Although further experiences and longer follow-up are mandatory to conclude the optimal treatment schedule and efficacy of stereotactic body radiation therapy for renal cell carcinoma, stereotactic body radiation therapy may represent a novel less-invasive option for the treatment of primary renal cell carcinoma.
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