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.

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.