title: The treatment of primary and metastatic renal cell carcinoma (RCC) with image-guided stereotactic body radiation therapy (SBRT).
abstract: OBJECTIVE
  Brain metastases from renal cell carcinoma (RCC) have been successfully treated with stereotactic radiosurgery (SRS). Metastases to extra-cranial sites may be treated with similar success using stereotactic body radiation therapy (SBRT), where image-guidance allows for the delivery of precise high-dose radiation in a few fractions. This paper reports the authors' initial experience with image-guided SBRT in treating primary and metastatic RCC.
  
  
  METHODS
  The image-guided Brainlab Novalis stereotactic system was used. Fourteen patients with 23 extra-cranial metastatic RCC lesions (orbits, head and neck, lung, mediastinum, sternum, clavicle, scapula, humerus, rib, spine and abdominal wall) and two patients with biopsy-proven primary RCC (not surgical candidates) were treated with SBRT (24-40 Gy in 3-6 fractions over 1-2 weeks). All patients were immobilised in body cast or head and neck mask. Image-guidance was used for all fractions. PET/CT images were fused with simulation CT images to assist in target delineation and dose determination. SMART (simultaneous modulated accelerated radiation therapy) boost approach was adopted. 4D-CT was utilised to assess tumour/organ motion and assist in determining planning target volume margins.
  
  
  RESULTS
  Median follow-up was nine months. Thirteen patients (93%) who received SBRT to extra-cranial metastases achieved symptomatic relief. Two patients had local progression, yielding a local control rate of 87%. In the two patients with primary RCC, tumour size remained unchanged but their pain improved, and their renal function was unchanged post SBRT. There were no significant treatment-related side effects.
  
  
  CONCLUSIONS
  Image-guided SBRT provides excellent symptom palliation and local control without any significant toxicity. SBRT may represent a novel, non-invasive, nephron-sparing option for the treatment of primary RCC as well as extra-cranial metastatic RCC.
authors: Department of Radiation Oncology, The Methodist Hospital, Houston, Texas, United States.
authors: Bs
authors: B
authors: Teh
authors: C
authors: C
authors: Bloch
authors: M
authors: M
authors: Galli-Guevara
authors: L
authors: L
authors: Doh
authors: S
authors: S
authors: Richardson
authors: S
authors: S
authors: Chiang
authors: P
authors: P
authors: Yeh
authors: M
authors: M
authors: Gonzalez
authors: W
authors: W
authors: Lunn
authors: R
authors: R
authors: Marco
authors: J
authors: J
authors: Jac
authors: Ac
authors: A
authors: Paulino
authors: Hh
authors: H
authors: Lu
authors: Eb
authors: E
authors: Butler
authors: Rj
authors: R
authors: Amato
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