In this study, we report the results of one of the largest retrospective cohorts of patients treated with SBRT for primary RCC, including a total of 144 patients from 16 centers in Australia, France, Italy, and the Netherlands.1
The median tumor size was 4.4 cm (T1b stage) in an elderly population (median age: 76 years). The two main treatment regimens were 42 Gy in three fractions and 26 Gy in a single fraction. Local control probability was excellent—96% at five years—with a low rate (2%) of grade 3–4 toxicities, including 1% requiring dialysis.
Regarding toxicity, preserving healthy renal parenchyma remains a challenge during local RCC treatment. The median decline in renal function was acceptable at -7 ml/min, with a median baseline eGFR of 60 ml/min.
An overall survival of 58 months, contrasted with a cumulative incidence of cancer-related deaths of 8% at five years, highlights the frailty of the patients currently offered this treatment in Europe.
The outcomes reported in the first multicenter prospective trial, FASTRACK II, are very encouraging.2 Prospective registry studies are ongoing and will further establish the role of SBRT, particularly for treating RCC > T1a stage or tumors located near the hilum.3
A recent systematic review and meta-analysis evaluated the efficacy and safety of non-invasive and minimally invasive ablative treatments—such as SBRT, radiofrequency ablation, microwave ablation, and cryoablation—in managing localized renal cell carcinoma.4 The study found that all four modalities offer high local control rates and low incidences of severe adverse events, supporting their use as effective treatment options for patients unsuitable for surgery.
SBRT for primary renal cell carcinoma in inoperable patients should be considered a standard treatment, alongside other ablative therapies. The feasibility of prospective randomized controlled trials comparing SBRT to surgery or minimally invasive ablative treatments appears challenging due to the accessibility of these treatments and their very similar outcomes. Comparisons based on cost-effectiveness and quality of life seem to be the most promising avenues for further clinical research. We are planning to launch such a project in France.
SBRT (CyberKnife) treatment plan for primary RCC T1aN0M0 (42 Gy in 3 fractions)
Written by:
- Ludwige Abancourt, MD, Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France
- David Pasquier, MD, PhD, Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France; Univ. Lille, Centre de recherche en informatique, Signal et automatique de Lille, Cristal UMR 9189, Lille, France
- Abancourt L, Ali M, Quivrin M, Wallet J, Schick U, Ingrosso G, Supiot S, Franzese C, Scorsetti M, Kerkmeijer L, Fodor A, Muzio ND, Jousset N, Boisserie T, Detti B, Nicosia L, Alongi F, Trippa F, Leleu T, Dessoude L, Terlizzi M, Blanchard P, Scher N, Toledano A, Baude J, Lartigau É, Barthoulot M, Siva S, Pasquier D. Results of Stereotactic Body Radiation Therapy for Primary Renal Cell Carcinoma in a Large Multicenter Series. Eur Urol Oncol. 2025 Feb 6:S2588-9311(25)00001
- Siva S, Bressel M, Sidhom M, Sridharan S, Vanneste BGL, Davey R, et al. Stereotactic ablative body radiotherapy for primary kidney cancer (TROG 15.03 FASTRACK II): a non-randomised phase 2 trial. Lancet Oncol 2024;25:308–16.
- Siva S, Ali M, Correa RJM, Muacevic A, Ponsky L, Ellis RJ, et al. 5-year outcomes after stereotactic ablative body radiotherapy for primary renal cell carcinoma: an individual patient data meta-analysis from IROCK (the International Radiosurgery Consortium of the Kidney). Lancet Oncol 2022:S1470204522006568.
- Huang RS, Chow R, Benour A, Chen D, Boldt G, Wallis CJD, Swaminath A, Simone CB 2nd, Lock M, Raman S. Comparative efficacy and safety of ablative therapies in the management of primary localised renal cell carcinoma: a systematic review and meta-analysis. Lancet Oncol. 2025 Feb 5:S1470-2045(24)00731-9