Utilization of Stereotactic Ablative Body Radiation Therapy for Intact Renal Cell Carcinoma: Trends in Treatment and Predictors of Outcome

Abstract

Purpose: Surgery is the standard-of-care treatment in patients with localized renal cell carcinoma (RCC), offering excellent chance of cure. However, there is a subset of patients who are ineligible for surgery and instead manage with ablative therapies, such as stereotactic ablative body radiation therapy (SABR). We used the National Cancer Database to examine trends in the use of SABR for inoperable RCC and identify any predictors of outcome. Methods and Materials: We queried the National Cancer Database for patients with unresected RCC between 2004 and 2016 who were treated with SABR. Kaplan–Meier analyses were used to determine overall survival. Multivariable Cox regression was used to identify predictors of survival. Results: We identified 347 patients meeting eligibility criteria. Median age was 74, and the majority of patients were clinical stage T1-2 (80%) and N0 (97%). The median tumor size was 3.8 cm (interquartile range [IQR], 2.8-5.2 cm). Six percent of patients received systemic therapy. The median dose of SABR was 45 Gy (IQR, 35-54 Gy) in 3 fractions (IQR, 1-5 fractions). The median follow-up was 36 months (IQR, 1-156 months). Predictors of decreased survival were age >74, larger tumors, and N1 or M1 disease. Median survival across the entire cohort was 58 months. Median survival was 92 months, 88 months, 44 months, and 26 months for primary tumors ≤2.5 cm, 2.6-3.5 cm, 3.5-5.0 cm, and >5.0 cm, respectively (P < .0001). Conclusions: SABR is being increasingly used for renal cell carcinoma across the United States with excellent outcomes in smaller tumors.