Radiotherapy for renal-cell carcinoma.
Renal-cell carcinoma is considered to be a radioresistant tumour, but this notion might be wrong. If given in a few (even single) fractions, but at a high fraction dose, stereotactic body radiotherapy becomes increasingly important in the management of renal-cell carcinoma, both in primary settings and in treatment of oligometastatic disease. There is an established biological rationale for the radiosensitivity of renal-cell carcinoma to stereotactic body radiotherapy based on the ceramide pathway, which is activated only when a high dose per fraction is given. Apart from the direct effect of stereotactic body radiotherapy on renal-cell carcinoma, stereotactic body radiotherapy can also induce an abscopal effect. This effect, caused by immunological processes, might be enhanced when targeted drugs and stereotactic body radiotherapy are combined. Therefore, rigorous, prospective randomised trials involving a multidisciplinary scientific panel are needed urgently.
Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium. Electronic address: gert.demeerleer@ugent.be.
Gert
G
De Meerleer
Department of Clinical Oncology, Royal Marsden NHS Foundation Trust, London, UK.
Vincent
V
Khoo
Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France.
Bernard
B
Escudier
Department of Urology, University Hospitals Leuven, Belgium.
Steven
S
Joniau
Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France.
Alberto
A
Bossi
Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium.
Piet
P
Ost
Department of Urology, Vita-Salute University San Raffaele, Milan, Italy.
Alberto
A
Briganti
Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium.
Valérie
V
Fonteyne
Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands.
Marco
M
Van Vulpen
Department of Urology, Ghent University Hospital, Ghent, Belgium.
Nicolaas
N
Lumen
Department of Urology, University Hospital Bern, Bern, Switzerland.
Martin
M
Spahn
Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium.
Marc
M
Mareel
D000818:Animals; D002292:Carcinoma, Renal Cell / Q000098:blood supply / Q000276:immunology / Q000473:pathology / Q000532:radiotherapy*; D059248:Chemoradiotherapy; D019583:Dose Fractionation, Radiation; D004307:Dose-Response Relationship, Radiation; D006801:Humans; D007680:Kidney Neoplasms / Q000098:blood supply / Q000276:immunology / Q000473:pathology / Q000532:radiotherapy*; D016634:Radiosurgery; D018714:Radiotherapy, Adjuvant; D016896:Treatment Outcome