title: Definitive, high-dose-per-fraction, conformal, stereotactic external radiation for renal cell carcinoma.
abstract: BACKGROUND
  Localized renal cell carcinoma is conventionally treated surgically. Preoperative and adjuvant external radiation have not improved survival. However, renal cell cancer brain metastases, although radioresistant to conventional external radiation, have been responsive to radiosurgery. The following report was compiled with information from our experience using high-dose-per-fraction, conformal radiation delivered to patients who refused definitive surgery.
  
  
  METHODS
  Nine patients with nonmetastatic renal cell carcinomas were identified, 2 of which had bilateral renal cell cancers. Patients were treated definitively with 40 Gy in 5 fractions using conformal external radiation.
  
  
  RESULTS
  With a median follow up of 26.7 months, 4 of the 9 patients are alive. The survivors have a minimum follow up of 48 months. At presentation, all 4 of the survivors had tumors < or =3.4 cm in largest dimension, had clinically negative nodes, and presented no clinical evidence of penetration of Gerota fascia or renal vein extension.
  
  
  CONCLUSIONS
  High-dose-per-fraction, conformal external radiation may have a curative role for small, node-negative, organ-confined renal cell carcinomas.
authors.affiliation: Department of Radiation Oncology, Staten Island University Hospital, Staten Island, New York, USA. jbeitler92@alumni.gsb.columbia.edu
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Beitler
authors.forename: Denise
authors.initials: D
authors.lastname: Makara
authors.forename: Phillip
authors.initials: P
authors.lastname: Silverman
authors.forename: Gil
authors.initials: G
authors.lastname: Lederman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000532:radiotherapy*; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D020266:Radiotherapy, Conformal