The growing incidence of renal cell carcinoma (RCC) raises many questions about the management of these patients. The late clinical presentation, the presence of locally advanced or metastatic disease at diagnosis, the difficulty of radical surgical excision, and radioresistance make it one of the more challenging tumors to treat. The primary objective of this article is to propose an updated and critical review of the role of radiotherapy (RT) in the treatment of RCC.
Methods
This literature review is based on data from meta-analyses and randomized, prospective, and retrospective studies. We collected reports from 1970 to the present about preoperative RT, postoperative RT, stereotactic body RT, radiosurgery, and intraoperative RT in locally advanced renal cancer and in metastatic diseases.
Results
We emphasize the progress made in RT technology that allowed the creation of a more personalized and focused treatment with a minimum rate of complications.
Conclusions
In the coming years, new studies will be published to confirm and increase the indications for use of RT.
ParasharBPatroKCSmithMAroraSNoriDWernicke AG. Role of radiation therapy for renal tumors. Semin Intervent Radiol.2014;31 (1):86–90.
2.
McGuireBBFitzpatrickJMBMI and the risk of renal cell carcinoma. Curr Opin Urol.2011;21 (5):356–361.
3.
ChowWHDongLMDevesaSSEpidemiology and risk factors for kidney cancer. Nat Rev Urol.2010;7 (5):245–257.
4.
WeikertSLjungbergBContemporary epidemiology of renal cell carcinoma: perspectives of primary prevention. World J Urol.2010;28 (3):247–252.
5.
De MeerleerGKhooVEscudierBRadiotherapy for renal-cell carcinoma. Lancet Oncol.2014;15 (4):e170–e177.
6.
BlancoAITehBSAmatoRJRole of radiation therapy in the management of renal cell cancer. Cancers (Basel).2011;3 (4):4010–4023.
7.
NomiyaTTsujiHHirasawaNCarbon ion radiation therapy for primary renal cell carcinoma: initial clinical experience. Int J Radiat Oncol Biol Phys.2008;72 (3):828–833.
8.
DenginaNTsimafeyeuIMitinTCurrent Role of Radiotherapy for Renal-Cell Carcinoma: Review. Clin Genitourin Cancer.2016;S1558-767316:30277-4.
9.
SingerEAGuptaGNSrinivasanRTargeted therapeutic strategies for the management of renal cell carcinoma. Curr Opin Oncol.2012;24 (3):284–290.
10.
MasucciGVWersällPKiesslingRLundqvistALewensohnRStereotactic Ablative Radio Therapy (SABR) followed by immunotherapy a challenge for individualized treatment of metastatic solid tumours. J Transl Med.2012;10 (1):104.
11.
KaoJChenCTTongCCConcurrent sunitinib and stereotactic body radiotherapy for patients with oligometastases: final report of a prospective clinical trial. Target Oncol.2014;9 (2):145–153.
12.
KirovaYMServoisVChargariCAmessisMZerbibMBeuzebocPFurther developments for improving response and tolerance to irradiation for advanced renal cancer: concurrent (mTOR) inhibitor RAD001 and helical tomotherapy. Invest New Drugs.2012;30 (3):1241–1243.
13.
AnbalaganSPiresIMBlickCRadiosensitization of renal cell carcinoma in vitro through the induction of autophagy. Radiother Oncol.2012;103 (3):388–393.
14.
ZhuHWangZXuQInhibition of STAT1 sensitizes renal cell carcinoma cells to radiotherapy and chemotherapy. Cancer Biol Ther.2012;13 (6):401–407.
15.
QiDHuYZhangYPengTJiWEffect of Ku70 expression on radiosensitivity in renal carcinoma 786-O cells. Cancer Cell Int.2014;14 (1):44.
16.
CooperSJvon RoemelingCAKangKHReexpression of tumor suppressor, sFRP1, leads to antitumor synergy of combined HDAC and methyltransferase inhibitors in chemoresistant cancers. Mol Cancer Ther.2012;11 (10):2105–2115.
17.
KijimaTKogaFFujiiYYoshidaSTatokoroMKiharaKZoledronic acid sensitizes renal cell carcinoma cells to radiation by downregulating STAT1. PLoS ONE.2013;8 (5):e64615.
18.
JuuselaHMalmioKAlfthanOOravistoKJPreoperative irradiation in the treatment of renal adenocarcinoma. Scand J Urol Nephrol.1977;11 (3):277–281.
19.
WersällPJBlomgrenHLaxIExtracranial stereotactic radiotherapy for primary and metastatic renal cell carcinoma. Radiother Oncol.2005;77 (1):88–95.
20.
SvedmanCSandströmPPisaPA prospective Phase II trial of using extracranial stereotactic radiotherapy in primary and metastatic renal cell carcinoma. Acta Oncol.2006;45 (7):870–875.
21.
SteinMKutenAHalpernJCoachmanNMCohenYRobinsonEThe value of postoperative irradiation in renal cell cancer. Radiother Oncol.1992;24 (1):41–44.
22.
ChangJHCheungPErlerDSonierMKorolRChuWStereotactic Ablative Body Radiotherapy for Primary Renal Cell Carcinoma in Non-surgical Candidates: Initial Clinical Experience. Clin Oncol (R Coll Radiol).2016;28 (9):e109–e114.
23.
SwaminathAChuWStereotactic body radiotherapy for the treatment of medically inoperable primary renal cell carcinoma: Current evidence and future directions. Can Urol Assoc J.2015;97-8:275–280.
24.
NikolaevABendaRPalliative Radiation Therapy for Symptomatic Control of Inoperable Renal Cell Carcinoma. Urol Case Rep.2015;4:51–52.
25.
MakarewiczRZarzyckaMKulińskaGWindorbskaWThe value of postoperative radiotherapy in advanced renal cell cancer. Neoplasma.1998;45 (6):380–383.
26.
KjaerMIversenPHvidtVA randomized trial of postoperative radiotherapy versus observation in stage II and III renal adenocarcinoma. A study by the Copenhagen Renal Cancer Study Group. Scand J Urol Nephrol.1987;21 (4):285–289.
27.
GezELibesMBar-DeromaRRubinovRSteinMKutenAPostoperative irradiation in localized renal cell carcinoma: the Rambam Medical Center experience. Tumori.2002;88 (6):500–502.
28.
UlutinHCAksuGFaydaMKuzhanOTahmazLBeyzadeogluMThe value of postoperative radiotherapy in renal cell carcinoma: a single-institution experience. Tumori.2006;92 (3):202–206.
29.
AbdulmoniemRHaikalTDarwieshHIs Post Operative Radiotherapy Justified for Completely Resected Locally Advanced Renal Cell Cancers?Journal of Cancer Therapy.2013;4 (09):1429–1434.
30.
TunioMAHashmiARafiMNeed for a new trial to evaluate postoperative radiotherapy in renal cell carcinoma: a meta-analysis of randomized controlled trials. Ann Oncol.2010;21 (9):1839–1845.
31.
De WolfKVermaelenKDe MeerleerGLambrechtB N and OstPThe potential of radiotherapy to enhance the efficacy of renal cell carcinoma therapy. OncoImmunology.2015;4:10e1042198.
32.
ParkSKimKHRheeWJLeeJChoYKoomWSTreatment outcome of radiation therapy and concurrent targeted molecular therapy in spinal metastasis from renal cell carcinoma. Radiat Oncol J.2016;34 (2):128–134.
33.
GravisGFaureMRybikowskiSRadiation therapy following targeted therapy in oligometastatic renal cell carcinoma. Mol Clin Oncol.2015;3 (6):1248–1250.
34.
MennittoAVerzoniECalaresoGSpreaficoCProcopioGTreatment of advanced renal cell carcinoma: recent advances and current role of immunotherapy, surgery, and cryotherapy. Tumori.2017;103 (1):15–21.
35.
SharabiABTranPTLimMDrakeCGDeweeseTLStereotactic radiation therapy combined with immunotherapy: augmenting the role of radiation in local and systemic treatment. Oncology (Williston Park).2015;29 (5):331–340.
36.
CampbellSPSongDYPierorazioPMAllafMEGorinMAStereotactic Ablative Radiotherapy for the Treatment of Clinically Localized Renal Cell Carcinoma. J Oncol.2015;2015:547143.
37.
TehBBlochCGalli-GuevaraMThe treatment of primary and metastatic renal cell carcinoma (RCC) with image-guided stereotactic body radiation therapy (SBRT). Biomed Imaging Interv J.2007;3 (1):e6.
38.
SivaSJacksonPKronTImpact of stereotactic radiotherapy on kidney function in primary renal cell carcinoma: Establishing a dose-response relationship. Radiother Oncol.2016;118 (3):540–546.
39.
PonskyLLoSSZhangYPhase I dose-escalation study of stereotactic body radiotherapy (SBRT) for poor surgical candidates with localized renal cell carcinoma. Radiother Oncol.2015;117 (1):183–187.
40.
NguyenQNShiuASRhinesLDManagement of spinal metastases from renal cell carcinoma using stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys.2010;76 (4):1185–1192.
41.
GersztenPCBurtonSAOzhasogluCStereotactic radiosurgery for spinal metastases from renal cell carcinoma. J Neurosurg Spine.2005;3 (4):288–295.
42.
AminiAAltoosBBourlonMTLocal control rates of metastatic renal cell carcinoma (RCC) to the bone using stereotactic body radiation therapy: Is RCC truly radioresistant?Pract Radiat Oncol.2015;5 (6):e589–e596.
43.
IkushimaHTokuuyeKSumiMFractionated stereotactic radiotherapy of brain metastases from renal cell carcinoma. Int J Radiat Oncol Biol Phys.2000;48 (5):1389–1393.
44.
GoyalLKSuhJHReddyCABarnettGHThe role of whole brain radiotherapy and stereotactic radiosurgery on brain metastases from renal cell carcinoma. Int J Radiat Oncol Biol Phys.2000;47 (4):1007–1012.
45.
NoelGValeryCABoisserieGLINAC radiosurgery for brain metastasis of renal cell carcinoma. Urol Oncol.2004;22 (1):25–31.
46.
PayneBRPrasadDSzeifertGSteinerMSteinerLGamma surgery for intracranial metastases from renal cell carcinoma. J Neurosurg.2000;92 (5):760–765.
47.
MuacevicAKrethFWMackATonnJCWowraBStereotactic radiosurgery without radiation therapy providing high local tumor control of multiple brain metastases from renal cell carcinoma. Minim Invasive Neurosurg.2004;47 (4):203–208.
48.
ShutoTMatsunagaSSuenagaJInomoriSFujinoHTreatment strategy for metastatic brain tumors from renal cell carcinoma: selection of gamma knife surgery or craniotomy for control of growth and peritumoral edema. J Neurooncol.2010;98 (2):169–175.
49.
KanoHIyerAKondziolkaDNiranjanAFlickingerJCLunsfordLDOutcome predictors of gamma knife radiosurgery for renal cell carcinoma metastases. Neurosurgery.2011; 69 (6):1232–1239.
50.
AhmedKABarneyBMMacdonaldOKStereotactic body radiotherapy in the treatment of adrenal metastases. Am J Clin Oncol.2013;36 (5):509–513.
51.
CasamassimaFLiviLMasciulloSStereotactic radiotherapy for adrenal gland metastases: university of Florence experience. Int J Radiat Oncol Biol Phys.2012;82 (2):919–923.
52.
AltoosBAminiAYacoubMLocal Control Rates of Metastatic Renal Cell Carcinoma (RCC) to Thoracic, Abdominal, and Soft Tissue Lesions Using Stereotactic Body Radiotherapy (SBRT). Radiat Oncol.2015;10 (1):218.
53.
HablGUhlMHensleyFPahernikSDebusJRöderFIntraoperative electron radiation therapy (IOERT) in patients with locally recurrent renal cell carcinoma. Radiat Oncol.2013;8 (1):282.
54.
EbleMJStaehlerGWannenmacherM[The intraoperative radiotherapy (IORT) of locally spread and recurrent renal-cell carcinomas]. Strahlenther Onkol.1998;174 (1):30–36.
55.
MasterVAGottschalkARKaneCCarrollPRManagement of isolated renal fossa recurrence following radical nephrectomy. J Urol.2005;174 (2):473–477, discussion 477.
56.
HallemeierCLChooRDavisBJLong-term outcomes after maximal surgical resection and intraoperative electron radiotherapy for locoregionally recurrent or locoregionally advanced primary renal cell carcinoma. Int J Radiat Oncol Biol Phys.2012;82 (5):1938–1943.
57.
CalvoFASoleCVMartinez-MongeRIntraoperative EBRT and resection for renal cell carcinoma: twenty-year outcomes. Strahlenther Onkol.2013;189 (2):129–136.
58.
PalyJJHallemeierCLBiggsPJOutcomes in a multi-institutional cohort of patients treated with intraoperative radiation therapy for advanced or recurrent renal cell carcinoma. Int J Radiat Oncol Biol Phys.2014;88 (3):618–623.
