An Evolving Role for Radiotherapy in Renal Cell Carcinoma

By Keightley Amen - Last Updated: September 9, 2021

A recent review article in In Vivo discussed the evolving and potentially expanding role of radiotherapy (RT) in renal cell carcinoma (RCC).

“RCC is one of the most aggressive malignancies of the genito-urinary tract, having a poor prognosis, especially in patients with metastasis. Surgical resection remains the gold standard for localized renal cancer disease, with RT receiving much skepticism during the last decades,” wrote the authors, led by Despoina Spyropoulou, of the Department of Radiation Oncology at University of Patras Medical School in Greece. “Although renal cancer is traditionally considered radio-resistant, technological advances in the RT field with regards to modern linear accelerators, as well as advanced RT techniques, have resulted in breakthrough therapeutic outcomes.”

Historically, RT has been used in RCC almost exclusively to palliate symptoms of advanced or metastatic disease, the authors explained, but higher doses and advances in RT technology may be able to change the paradigm, providing local control of cancer while limiting toxicity to surrounding normal tissues.

The authors cited specific promising technologies, including:

  • intensity modulated radiation therapy
  • volumetric-modulated arc therapy
  • stereotactic body radiation therapy

The article also pointed out that RT may be a good treatment choice in certain patient populations, such as:

  • those who have relapsed after surgical intervention
  • elderly or frail patients who may not be able to undergo surgery and have limited life expectancy
  • patients with comorbidities or chronic kidney disease

The authors reviewed studies that support an RT “renaissance” in several settings: preoperatively, intraoperatively, postoperatively, and with palliative intent.

In addition, they said that RT may be added to other therapies to maximize clinical benefit. For example, they wrote, RT combined with immune checkpoint inhibitors (ICIs), “based on the ability of RT to augment the immunogenicity of tumors, which can increase the potential for synergistic interplay and eventually for tumor response.” Another possibility they proposed is combination of RT with tyrosine kinase inhibitors, as these agents “not only mediate the inhibition of angiogenesis, but also have a close interaction with the immune system, leading to immunity reprogramming.”