A review of stereotactic ablative radiotherapy for nonmetastatic renal cell carcinoma.

Renal cell carcinoma (RCC) is an uncommon malignancy whose incidence has been increasing over the past few decades, posing treatment challenges for elderly or infirm patients who are not surgical candidates. Stereotactic ablative radiotherapy (SABR) has emerged as a promising non-invasive treatment modality for RCC. The high dose-per-fraction used in SABR overcomes some of the mechanisms of radioresistance that has hindered the effective treatment of RCC with conventional radiotherapy. For primary RCC, local control rates for SABR exceed 90%, with typically minimal grade 3 or higher toxicities, offering a viable alternative for inoperable patients and those not eligible for or unable to tolerate radiofrequency or cryotherapy ablation. SABR can also be used in patients with a solitary kidney as a strategy for renal preservation to avoid need for dialysis. Given its excellent local control rates, low toxicity and preservation of renal function, SABR offers an attractive alternative to more invasive modalities for treatment of localized RCC.

Helical Tomotherapy Versus 3-Dimensional Conformal Radiation Therapy in High-Risk Prostate Cancer: A Phase 3 Randomized Controlled Trial.

PURPOSE: We present long-term outcomes from a phase 3 randomized controlled trial that compared helical tomotherapy with 3-dimensional conformal radiation therapy (3D-CRT) in the treatment of high-risk prostate cancer. METHODS AND MATERIALS: Newly diagnosed patients with high-risk prostate cancer were randomly allocated to receive radical radiation therapy (RT) using 3D-CRT or helical tomotherapy. In both arms, patients received an initial dose of 46 Gy in 23 fractions to the prostate and pelvic lymph nodes, followed by an additional boost to the prostate of 32 Gy in 16 fractions. RT was combined with 3 years of adjuvant androgen deprivation. The primary endpoint was late (>90 days since RT initiation) rectal toxicity. RESULTS: Overall,123 patients were randomly assigned to either the 3D-CRT (n = 60) or tomotherapy (n = 63) arms. The median follow-up was 161 months. Overall, the proportion of patients with grade ≥ 2 late rectal toxicity was 8.3% (95% CI, 3.1-19.1; n = 5) in the 3D-CRT arm and 11.1% (95% CI, 5.0-22.2; n = 7) in the tomotherapy arm with no significant between-arm difference (P = .83). There was no significant difference (P = .17) in the proportion of patients with late grade ≥ 2 genitourinary toxicity:10.0% (95% CI, 4.1-21.2) in the 3D-CRT arm and 20.6% (95% CI, 11.9-33.0) in the tomotherapy arm. There was no significant difference in the hazard of biochemical progression or death between the 2 groups (hazard ratio for the tomotherapy arm: 0.72; 95% CI, 0.46-1.15; P = .17). CONCLUSIONS: In this phase 3 trial, the overall incidence of grade ≥ 2 rectal toxicity was low and was not significantly different between the 2 arms. There was no significant evidence of improved biochemical progression-free survival in patients treated with tomotherapy. These findings should be interpreted considering the possibility of type II errors due to limited sample size and low event rates.

An observational study on tumour response of portal vein tumour thrombus in hepatocellular carcinoma.

Objectives: Stereotactic body radiotherapy (SBRT) can sterilize the portal vein tumour thrombus (PVTT) and may make the patient eligible for liver transplant. We assessed the radiological response of PVTT after SBRT and check incidence of radiation induced liver disease (RILD). Methods: PVTT treatment response was measured at 4-6 weeks as per mRECIST criteria, volume of PVTT and its enhancement in arterial phase. Biochemical data and Child-Pugh scoring (CPC) were evaluated to determine RILD incidence. Results: 31 Patients were included. Complete response was seen in 5 patients (16.1%), partial response in 13 patients (41.9%), stable disease in 12 patients (38.7%). Mean volume of PVTT was 15.05 cc before SBRT and 7.83 cc afterwards (p = 0.001). The mean enhancement of the lesion was 86.19HU before SBRT vs 58.58HU after SBRT (p = 0.000). Two patients had grade 3 adverse events. Conclusion: Volume, enhancement, and major axis length of PVTT showed statistically significant improvement after SBRT. No case had RILD after SBRT.