Stereotactic Radiotherapy and Renal Cell Cancer: Overcoming Radioresistance and the Resistance to Radiate
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:
- A Primer on Kidney SABR
Rohann J.M. Correa, MD, PhD, FRCPC - Technical Considerations, Response Assessment and Challenging Cases in Primary Renal SABR
Shankar Siva, PhD, MBBS, FRANCZR - Multidisciplinary Management from Medical Oncology
Rana Mckay, MD - Stereotactic Radiotherapy for Metastatic Renal Cell Carcinoma: Synergy and Side Effects
Nicholas Zaorsky, MD, MS - 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.
Target Audience
The activity is designed to meet the interests of medical oncologists, radiation oncologists, surgeons, physicists, nurses, diagnostic radiologists, pathologists, radiation therapists, dosimetrists, biologists, and residents.
Learning Objectives
Upon completion of this activity, participants should be able to:
- Discuss the evidence to support SABR as a modality that overcomes radioresistance of primary and metastatic RCC.
- Review practical and technical considerations in the treatment of and surveillance following SABR for primary RCC.
- Discuss the role of novel systemic therapy, surgery and radiotherapy for metastatic RCC.
- Simon S. Lo, MB, ChB, FASTRO, FACR, is employed by the University of Washington School of Medicine/Fred Hutchinson Cancer Center. Dr. Lo serves on the Board of Directors of the Radiosurgery Society (RSS). Dr. Lo is the Lead on the Radiation Therapy Panel for AANS/CNS Low Grade Glioma Guidelines.
- Rohann Jonathan Mark Correa, MD, PhD, FRCPC, is employed by Western University London Health Sciences Centre.
- Shankar Siva, PhD, MBBS, FRANZCR, is employed by Peter MacCallum Cancer Centre, Australia. Dr. Siva receives research funding to his institution from Varian Medical Systems, Merck-Sharp-Dohme, and Bayer Pharmaceuticals. Dr. Siva serves as a committee member on the ART committee of IASLC and serves as advisor to the Radiosurgery Society (RSS) Board of Directors. Dr. Siva receives honoraria from AstraZeneca and Telix Pharmaceuticals.
- Rana R. Mckay, MD, is employed by University of California San Diego. Dr. Mckay receives compensation for consulting work from Janssen, Novartis, Exelixis, Johnson & Johnson, Pfizer, BMS, Dendreon, Bayer, Sanofi, Merck, Esiai, Calithera, AstraZeneca, Myovant, Caris Life Sciences, SeaGen, Sorrento Therapeutics, AVEO, Telix, Tempus, and Eli Lily. Dr. Mckay is an editorial board member for the Journal of Clinical Oncology.
- Nicholas G. Zaorsky, MD, MS, is employed by University Hospitals Seidman Cancer Center, Case Western Reserve University. Dr. Zaorsky receives grant/research funding from the American Cancer Society and the NIH. Dr. Zaorsky receives compensation from the American College of Radiation Oncology.
The person(s) above served as the developer(s) of this activity. Additionally, the Education Committee had control over the content of this activity. All relevant relationships have been mitigated.
The American Society for Radiation Oncology (ASTRO) is accredited by the Accreditation Council of Continuing Medical Education to provide continuing education to physicians.
ASTRO is awarded Deemed Status by the American Board of Radiology to provide SA-CME as part of Part II Maintenance of Certification.
Available Credit
- 1.00 AMA PRA Category 1 Credit™The American Society for Radiation Oncology (ASTRO) is accredited by the Accreditation Council for Continuing Medical Education for physicians. ASTRO designates this for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
- 1.00 Certificate of AttendanceThis activity was designated for 1.00 AMA PRA Category 1 Credit™.
Price
Course Fees:
ASTRO members must log in to the ASTRO website to view and receive the member rate.
Nonmember: $149
Member: $99
Member-in-training: $49
Student/Grad Student/PGY: $49
Postdoctoral Fellow: $49
Policies:
No refunds, extensions, or substitutions will be made for those participants who, for any reason, have not completed the course by the end of the qualification date. The qualification date for each course is listed in the course catalog on the ASTRO website under availability.
Participants using ASTRO's online courses to satisfy the requirement of a Maintenance of Certification (MOC) program should verify the number, type and availability dates of any course before making a purchase. No refunds, extensions, or substitutions will be made for participants who have purchased courses that do not align with their MOC requirement.
The course and its materials will only be available on the ASTRO website until June 11, 2026, regardless of purchase date. At the expiration of the qualification, participants will no longer have access to the course or its materials. ASTRO reserves the right to remove a course before the end of its qualification period.
Required Hardware/software
One of the two latest versions of Google Chrome, Mozilla Firefox, Internet Explorer or Safari.