Definitive Radiotherapy for Extracranial Oligoprogressive Metastatic Renal Cell Carcinoma as a Strategy to Defer Systemic Therapy Escalation

Authors

Brian De
Aradhana M Venkatesan
Pavlos Msaouel
Amol J Ghia
Jing Li
Debra N Yeboa
Quynh-Nhu Nguyen
Andrew J Bishop
Eric Jonasch
Amishi Y Shah
Matthew T Campbell
Jennifer Wang
Amado J Zurita-Saavedra
Jose A Karam
Christopher G Wood
Surena F Matin
Nizar M Tannir
Chad Tang

Publication Date

5-1-2022

Journal

BJU International

Abstract

Objective: To study whether delivering definitive radiotherapy (RT) to sites of oligoprogression in metastatic renal cell carcinoma (mRCC) enabled deferral of systemic therapy (ST) changes without compromising disease control or survival.

Patients and methods: We identified patients with mRCC who received RT to three or fewer sites of extracranial progressive disease between 2014 and 2019 at a large tertiary cancer centre. Inclusion criteria were: (1) controlled disease for ≥3 months before oligoprogression, (2) all oligoprogression sites treated with a biologically effective dose of ≥100 Gy, and (3) availability of follow-up imaging. Time-to-event end-points were calculated from the start of RT.

Results: A total of 72 patients were identified (median follow-up 22 months, 95% confidence interval [CI] 19-32 months), with oligoprogressive lesions in lung/mediastinum (n = 35), spine (n = 30), and non-spine bone (n = 5). The most common systemic therapies before oligoprogression were none (n = 33), tyrosine kinase inhibitor (n = 23), and immunotherapy (n = 13). At 1 year, the local control rate was 96% (95% CI 87-99%); progression-free survival (PFS), 52% (95% CI 40-63%); and overall survival, 91% (95% CI 82-96%). At oligoprogression, ST was escalated (n = 16), maintained (n = 49), or discontinued (n = 7), with corresponding median (95% CI) PFS intervals of 19.7 (8.2-27.2) months, 10.1 (6.9-13.2) months, and 9.8 (2.4-28.9) months, respectively. Of the 49 patients maintained on the same ST at oligoprogression, 21 did not subsequently have ST escalation.

Conclusion: Patients with oligoprogressive mRCC treated with RT had comparable PFS regardless of ST strategy, suggesting that RT may be a viable approach for delaying ST escalation. Randomised controlled trials comparing treatment of oligoprogression with RT vs ST alone are needed.

Keywords

Carcinoma, Renal Cell, Female, Humans, Kidney Neoplasms, Male, Progression-Free Survival, Protein Kinase Inhibitors, Radiosurgery, Retrospective Studies, metastatic renal cell carcinoma, oligoprogression, stereotactic body radiotherapy, systemic therapy

DOI

10.1111/bju.15541

PMID

34228889

PMCID

PMC10097479

PubMedCentral® Posted Date

5-1-2023

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes