title: Stereotactic radiation therapy of renal cancer inferior vena cava tumor thrombus.
abstract: Renal Cell Carcinoma (RCC) is a common malignancy world-wide that is rising in incidence. Up to 10% of RCC patients present with inferior vena cava (IVC) tumor thrombus (IVC-TT). Although surgery is the only treatment with proven efficacy for IVC-TT, the surgical management of advanced (level III and IV) IVC-TT is difficult with high morbidity and mortality, and offers a poor survival outcome. Currently, there are no treatment options in the setting of recurrent or unresectable RCC IVC-TT. Even though RCC may be resistant to conventionally fractionated radiation therapy, hypofractionated radiation has shown excellent control rates for both primary and metastatic RCC. We report our experience treating 2 RCC patients with Level IV IVC-TT -one recurrent and the other unresectable-with stereotactic ablative radiation therapy (SABR). The first patient is a 75-year-old gentleman with a level IV RCC IVC-TT who presented 9 months after his radical nephrectomy and thrombectomy with a growing level IV IVC-TT that became refractory to 4 targeted agents. He received SABR of 50Gy in 5 fractions and at 2-year follow-up is doing well with a significant decrease in the enhancement and size of the IVC-TT. The second patient is an 83-year-old gentleman who presented with metastatic RCC and level IV IVC-TT but was not a surgical candidate. After progression on temsirolimus, he received SABR of 36Gy in 4 fractions to his IVC-TT and survived 18 months post-SABR. Both patients improved symptomatically and did not experience any acute or late treatment-related toxicity. Their survival of 24 months and 18 months are comparable to the reported median survival of 20 months in patients with level IV IVC-TT that underwent surgical resection. Therefore, SABR can be a potentially safe treatment option in the unresectable setting for RCC patients with IVC-TT and should be further evaluated in prospective trials.
authors: a Department of Radiation Oncology; Harold C Simmons Cancer Center; University of Texas at Southwestern Medical Center ; Dallas , TX , USA.
authors: Raquibul
authors: R
authors: Hannan
authors: Vitaly
authors: V
authors: Margulis
authors: Stephen G
authors: SG
authors: Chun
authors: Nathan
authors: N
authors: Cannon
authors: D W Nathan
authors: DW
authors: Kim
authors: Ramzi E
authors: RE
authors: Abdulrahman
authors: Arthur
authors: A
authors: Sagalowsky
authors: Ivan
authors: I
authors: Pedrosa
authors: Hak
authors: H
authors: Choy
authors: James
authors: J
authors: Brugarolas
authors: Robert D
authors: RD
authors: Timmerman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D008297:Male; D011379:Prognosis; D016634:Radiosurgery / Q000379:methods*; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000473:pathology*; D020246:Venous Thrombosis / Q000209:etiology*
keywords: radiosurgery; renal cell carcinoma; stereotactic body radiotherapy