Mr-Linac-Guided Stereotactic Radiotherapy for Ct-Indiscernible Intravascular Renal Cell Carcinoma Tumours

Authors

Mihir D Shanker
Zhiqian Henry Yu
Jinzhong Yang
Surena Matin
Matthew T Campbell
Pavlos Msaouel
Nizar Tannir
Surendra Prajapati
Yao Ding
Belinda Lee
Angela Sobremonte
Chad Tang

Publication Date

10-1-2024

Journal

BJUI Compass

Abstract

Inferior vena cava tumour thrombus (IVC‐TT) is a life‐threatening complication of advanced renal cell carcinoma (RCC) occurring in 10%–25% of patients with RCC with one third of patients having concurrent distant metastatic disease. ¹ , ² Surgical resection in the form of radical nephrectomy and caval thrombectomy is the established option for obtaining local control of the disease and is associated with long‐term oncologic control; however, only 50% of patients are operative candidates at time of diagnosis. ³ , ⁴ Untreated RCC IVC‐TT has a poor natural history, with a median survival of 5 months with a 1‐year disease‐specific survival of 29%. ⁵ Stereotactic ablative body radiotherapy (SBRT) is a potentially feasible and safe option in patients who are not surgical candidates with the potential to be used for a wide range of RCC indications, from definitive local control in inoperable candidates, advanced‐stage disease palliation and to improve survival outcomes in oligometastatic settings. However, renal disease‐restricted contrast use and poor visualization of RCC IVC‐TT with conventional computed tomography (CT) impairs precise planning and treatment delivery. Magnetic resonance linear accelerator (MR‐Linac)‐based therapy is a novel technology, which allows advanced visualization of thrombi targets for improved delineation, inter‐ and intra‐fraction monitoring and adaptive treatment.

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