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Renal Cell Carcinoma: Neoadjuvant Radiation Followed by Nephrectomy and Thrombectomy

By: Lauren Harrison, MS
Posted: Monday, August 23, 2021

Results from a phase I/II trial suggest that a new approach utilizing targeted, neoadjuvant stereotactic ablative radiation followed by radical nephrectomy and thrombectomy for patients with renal cell carcinoma appears to be safe. This work was published by Raquibul Hannan, MD, PhD, of The University of Texas Southwestern Medical Center, Dallas, and colleagues in the International Journal of Radiation Oncology • Biology • Physics.

“By irradiating the tumor inside the vein, stereotactic ablative radiation has the potential to reduce metastases from fragments that break off as the tumor is being removed during surgery,” said Dr. Hannan in an institutional press release.

This trial enrolled six patients with newly diagnosed renal cell cancer and inferior vena cava (IVC) tumor thrombus. Patients underwent neoadjuvant stereotactic ablative radiation to the IVC thrombus with 40 Gy in 5 fractions, followed by open radical nephrectomy and IVC thrombectomy within 4 to 14 days of radiation therapy. No intraoperative complications and no intraoperative difficulties attributed to the radiation, including no evidence of edema or fibrosis, were reported.

After a median of 24 months, all six patients were alive. One patient developed lung metastasis 12 months after surgery. Another patient had immediate disease progression after surgery but then had a complete response to interleukin-2 treatment. A partial response in multiple lung nodules was seen in another patient, but the disease progressed to other sites.

There were 81 different adverse events reported within 90 days of surgery, 73% of which were grade 1 and 23% were grade 2. The most common adverse event related to the neoadjuvant radiation was nausea, with the highest being grade 2. After surgery, the most common adverse events were abdominal pain and constipation. The two most clinically significant adverse events were upper respiratory tract infection and upper extremity deep vein thrombosis. One patient developed acute cholecystitis within 90 days of surgery and underwent cholecystectomy.

Disclosure: The study authors reported no conflicts of interest.

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