Controlled outcome assessment of radiotherapy for primary renal cell carcinoma (RCC) remains limited, particularly regarding its impact on ipsilateral renal function and predictors of response. We evaluated oncological and renal function outcomes of stereotactic body radiation therapy (SBRT) for RCC and identified genomic predictors of response. Our study cohort comprised 83 surgically unfit patients with cT1a RCC who were prospectively enrolled to receive SBRT of 42 Gy in three fractions between 2016 and 2022. The median tumor size was 2.3 cm and local control was achieved in 78 patients, including eight with a complete response. The 3-yr survival rates were 96% (95% confidence interval [CI] 89.8-99.9) for progression-free survival and 96% (95% CI 89.4-99.9%) for cancer-specific survival. The glomerular filtration rate of the treated kidney decreased up to 12-18 mo (-9.8 ml/min/1.73 m2) but stabilized thereafter. Transcriptome sequencing conducted on biopsy specimens from five responders and eight nonresponders showed enrichment of apical surface/junction pathways among responders, and enrichment of cell cycle, DNA repair, oxidative phosphorylation, and hypoxia pathways among nonresponders. A machine learning model based on gene expression demonstrated good predictive performance, with a cross-validated area under the receiver operating characteristic curve of 0.9. SBRT for T1a RCC was acceptable in terms of intermediate-term cancer control and preservation of renal function. Distinctive genomic profiles may aid in identifying optimal candidates pending external validation.
European urology oncology. 2025 Jun 14 [Epub ahead of print]
Cheryn Song, Chang Ohk Sung, Dongsu Kim, Yunlim Kim, Hanjong Ahn, Mi-Hyun Kim, Jeong Kon Kim, Yong Mee Cho, Yeon Joo Kim, Young Seok Kim
Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. Electronic address: ., Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; Bioinformatics Core Laboratory, Convergence Medicine Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea., Department of Urology, Asan Medical Center, Seoul, Korea., Department of Urology, Asan Institute of Life Sciences, Seoul, Korea., Department of Radiology, Asan Medical Center, Seoul, Korea., Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea., Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea., Department of Radiation Oncology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.