title: Radiation therapy following targeted therapy in oligometastatic renal cell carcinoma.
abstract: Up to 40% of patients with renal cell carcinoma (RCC) with initially localized disease eventually develop metastasis following nephrectomy. The current standard of care for metastatic RCC (mRCC) is targeted therapy. However, complete response remains rare. A state of oligometastatic disease may exist, in which metastases are present in a limited number of locations; such cases may benefit from metastasis-directed local therapy, based on the evidence supporting resection of limited-volume metastases, allowing for improved disease control. We retrospectively analyzed 7 cases of response of RCC metastases, in patients treated with targeted therapies followed by radiation therapy (RT) of residual metastatic lesions in Paoli-Calmettes Institute (Marseille, France). We analyzed disease response rates, response to sequential strategy, relapse at the irradiated locations and disease evolution. The median follow-up was 34.1 months (range, 19.2-54.5 months). No progression at the irradiated sites was observed. A total of 5 patients had stable disease at the irradiated locations at the last follow-up; 3 remained in complete remission at the assessment, and 2 were stable. Excellent local response and clinical benefit may be achieved without added toxicity. In conclusion, sequential therapeutic strategies with RT following systemic treatment using sunitinib appear to be highly effective in patients with progressive mRCC and prompt the conduction of further confirmatory trials.
authors.affiliation: Department of Medical Oncology, Paoli-Calmettes Institute, 13009 Marseille, France; Research Unit Against Cancer, CRCM-INSERM U1068, Faculty of Science of Luminy, Aix-Marseille University, 13009 Marseille, France.
authors.forename: Gwenaelle
authors.initials: G
authors.lastname: Gravis
authors.affiliation: Department of Medical Oncology, Paoli-Calmettes Institute, 13009 Marseille, France; Faculty of Medicine - Timone Sector, Aix-Marseille II University, 13385 Marseille, France.
authors.forename: Marjorie
authors.initials: M
authors.lastname: Faure
authors.affiliation: Department of Urology, Paoli-Calmettes Institute, 13009 Marseille, France.
authors.forename: Stanislas
authors.initials: S
authors.lastname: Rybikowski
authors.affiliation: Department of Medical Oncology, Paoli-Calmettes Institute, 13009 Marseille, France.
authors.forename: Slimane
authors.initials: S
authors.lastname: Dermeche
authors.affiliation: Research Unit Against Cancer, CRCM-INSERM U1068, Faculty of Science of Luminy, Aix-Marseille University, 13009 Marseille, France; Department of Radiotherapy, Paoli-Calmettes Institute, 13009 Marseille, France.
authors.forename: Marguerite
authors.initials: M
authors.lastname: Tyran
authors.affiliation: Research Unit Against Cancer, CRCM-INSERM U1068, Faculty of Science of Luminy, Aix-Marseille University, 13009 Marseille, France; Department of Radiotherapy, Paoli-Calmettes Institute, 13009 Marseille, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Calderon
authors.affiliation: Department of Pathological Anatomy, Paoli-Calmettes Institute, 13009 Marseille, France.
authors.forename: Jeanne
authors.initials: J
authors.lastname: Thomassin
authors.affiliation: Department of Urology, Paoli-Calmettes Institute, 13009 Marseille, France.
authors.forename: Jochen
authors.initials: J
authors.lastname: Walz
authors.affiliation: Department of Radiotherapy, Paoli-Calmettes Institute, 13009 Marseille, France.
authors.forename: Naji
authors.initials: N
authors.lastname: Salem
keywords: oligometastasis; radiation therapy; renal cell carcinoma; sequential therapy; targeted therapy