Stereotactic body radiation therapy for kidney cancer. Where do we stand?

At present, surgery is still the gold standard for the local treatment of renal cancer. Nonetheless, in several clinical scenarios, stereotactic body radiation therapy (SBRT) also known as stereotactic ablative body radiotherapy (SABR) is emerging as a highly effective ablative technique in fragile patients and those with significant comorbidities, as well as in cases where percutaneous therapy (cryoablation or radiofrequency) is not viable. However, considering the intrinsic radioresistance of renal tumors, the optimal treatment schemes have not been established. In oligometastatic patients, it has been reported that the control of the oligometastases can be a potentially curable approach. Being a technique than can be administered exclusively or in combination with systemic therapy, treatment individualization based on patient characteristics is key. Another scenario under investigation is oligoprogression, where SBRT offers the possibility of delaying further lines of systemic therapy by eliminating subclones of resistant tumor with ablative doses, with the additional opportunity of stimulating the immune system (immunomodulatory role). In this review, we have conducted an analysis of recently published studies that test the role of this technique in different clinical scenarios of this disease. We have found promising results that make SBRT a potent therapeutic approach with low toxicity. We also comment on ongoing studies that will generate the necessary evidence needed for the implementation of this technique in our daily clinical practice.

Radiocirugía para el control sintomático en pacientes con cáncer en estadios avanzados / Radiosurgery for symptomatic control in patients with advanced stage cancer

La radioterapia es una modalidad terapéutica cada vez más usada en el campo de los cuidados paliativos. Los avances técnicos en Oncología Radioterápica permiten que la radiocirugía estereotáxica y la radioterapia estereotáxica corporal puedan administrar altas dosis de radiación de manera precisa y conformada a la lesión que queremos tratar usando esquemas de tratamientos cortos en el tiempo, sin afectar al tejido sano periférico. Esto es lo que recibe el nombre de hipofraccionamiento, y es el fundamento de esta técnica. El esquema de dosis usado con estas técnicas permite lograr un mayor efecto biológico y, por lo tanto, mayor efectividad sobre el tejido irradiado. La radiocirugía proporciona un control sintomático rápido, eficaz y duradero con una toxicidad mínima y, como consecuencia, da lugar a una potencial mejora en la calidad de vida de estos pacientes. Estas características hacen que esta técnica emergente sea una de las mejores opciones de tratamiento disponibles para los pacientes con enfermedad avanzada

External beam radiation therapy is increasingly being used in the field of palliative care. Technical advances in Radiation Oncology enable high doses of radiation to be precisely and accurately delivered to the target lesion using stereotactic radiosurgery and stereotactic body radiotherapy, with short treatment regimens and without affecting the peripheral healthy tissue. This is called hypofractionation, and is the foundation on which the technique rests. Radiosurgery provides a rapid, effective and durable symptomatic control with minimal toxicity and consequently a potential improvement in the quality of life of these patients. These features make this emerging technique one of the best treatment options currently available for patients with advanced disease