title: Single fraction radiosurgery for the treatment of renal tumors.
abstract: OBJECTIVE
  High dose local stereotactic radiosurgery was performed in select patients to improve local tumor control and overall survival. We report on patients with renal tumors treated with single fraction robotic stereotactic radiosurgery.
  
  
  METHODS
  A total of 40 patients with a median age of 64 years who had an indication for nephrectomy and subsequent hemodialysis were entered in a prospective case-control study of single fraction stereotactic radiosurgery. Of the patients 11 had transitional cell cancer and 29 had renal cell cancer. Tumor response, renal function, survival and adverse events were estimated every 3 months. Followup was at least 6 months.
  
  
  RESULTS
  A total of 45 renal tumors were treated. Median followup was 28.1 months (range 6.0 to 78.3). The local tumor control rate 9 months after stereotactic radiosurgery was 98% (95% CI 89-99). There was a measurable size reduction in 38 lesions, including complete remission in 19. Renal function remained stable. Using the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation median creatinine clearance was 76.8 (range 25.3 to 126.3) and 70.3 ml/minute/1.73 m(2) (range 18.6 to 127.3) at baseline and followup, respectively (p = 0.89). Grade I erythrodermia developed in 1 patient, 3 reported grade I fatigue and 2 reported grade I nausea. Nephrectomy was avoided in all cases.
  
  
  CONCLUSIONS
  Single fraction stereotactic radiosurgery as an outpatient procedure is a treatment modality with short-term safety and efficacy. It avoids treatment related loss of renal function and hemodialysis in select patients with transitional or renal cell cancer. At short followup oncologic results were similar to those of other ablative techniques for renal tumors. To date functional results have been excellent. Further studies are needed to determine the long-term results and limits of stereotactic radiosurgery in this setting.
authors.affiliation: Department of Urology, Klinikum Grosshadern, Ludwig Maximilians University of Munich, Munich, Germany. Electronic address: michael.staehler@med.uni-muenchen.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Staehler
authors.affiliation: Department of Urology, Klinikum Grosshadern, Ludwig Maximilians University of Munich, Munich, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Bader
authors.affiliation: Department of Urology, Klinikum Grosshadern, Ludwig Maximilians University of Munich, Munich, Germany.
authors.forename: Boris
authors.initials: B
authors.lastname: Schlenker
authors.affiliation: Department of Urology, Klinikum Grosshadern, Ludwig Maximilians University of Munich, Munich, Germany.
authors.forename: Jozefina
authors.initials: J
authors.lastname: Casuscelli
authors.affiliation: Department of Urology, Klinikum Grosshadern, Ludwig Maximilians University of Munich, Munich, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Karl
authors.affiliation: Department of Urology, Klinikum Grosshadern, Ludwig Maximilians University of Munich, Munich, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Roosen
authors.affiliation: Department of Urology, Klinikum Grosshadern, Ludwig Maximilians University of Munich, Munich, Germany.
authors.forename: Christian G
authors.initials: CG
authors.lastname: Stief
authors.affiliation: Division of Surgical Oncology, Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: Axel
authors.initials: A
authors.lastname: Bex
authors.affiliation: European Cyberknife Center Munich, Munich, Germany.
authors.forename: Berndt
authors.initials: B
authors.lastname: Wowra
authors.affiliation: European Cyberknife Center Munich, Munich, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Muacevic
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016634:Radiosurgery / Q000379:methods*
keywords: carcinoma; kidney; radiosurgery; renal cell; robotics; transitional cell