The use of SABR is well established in many cancers, however, its application within kidney cancer is relatively new. This is largely due to the historical notion that renal cell carcinoma (RCC) is highly radioresistant. As there is growing literature demonstrating good safety and efficacy of SABR in both localized and oligometastatic RCC, an overview of current and best practice will help improve the quality of care by practicing clinicians.

This activity discusses the emerging role of SABR in primary and metastatic RCC. An overview on the historical concept of radioresistance in RCC and the rationale for SABR are introduced. Building on this, relevant epidemiology, comparative effectiveness, and health services data are reviewed. Indications for primary renal SABR are discussed within the hierarchy of alternative ablative/extirpative techniques. An overview of technical considerations and response assessment is provided, with a focus on different treatment platforms, immobilization techniques, motion management strategies, dose prescriptions and organ at risk constraints. Challenging scenarios such as the presence of a single kidney, IVC thrombus, and large/anatomically challenging tumors are discussed. Various clinical considerations for SABR within metastatic RCC are explored, including its application for oligometastatic targets, treatment of oligoprogressive lesions to prolong current line systemic therapy, and as an alternative to cytoreductive nephrectomy. Synergy and risk in the context of rapidly evolving systemic therapies are discussed. Finally, the recent ASCO guideline for the management of stage IV kidney cancer, inclusive of systemic therapy, surgery and radiotherapy, is reviewed.

Topics:

1. A Primer on Kidney SABR
   Rohann J.M. Correa, MD, PhD, FRCPC
2. Technical Considerations, Response Assessment and Challenging Cases in Primary Renal SABR
   Shankar Siva, PhD, MBBS, FRANCZR
3. Multidisciplinary Management from Medical Oncology
   Rana Mckay, MD
4. Stereotactic Radiotherapy for Metastatic Renal Cell Carcinoma: Synergy and Side Effects
   Nicholas Zaorsky, MD, MS
5. Q and A
   Full Panel

This activity is available from June 11, 2024, through 11:59 p.m. Eastern time on June 10, 2026. 

This activity was originally recorded at the 2023 ASTRO Annual Meeting.