Extracranial Palliative Radiotherapy for Renal Cell Carcinoma
Faculty and Abstracts
Purpose: Radiation therapy (RT) is routinely used for the palliation of renal cell carcinoma (RCC) symptoms despite a paucity of literature on RT’s efficacy. Since RCC is considered radioresistant to conventionally fractionated RT, here we retrospectively evaluate the factors influencing effective palliation of symptoms with RT for both localized and metastatic RCC.
Methodology: A retrospective review of patients with RCC between 2011 and 2022 at a high-volume academic radiation center was performed to identify symptomatic patients with extracranial metastatic sites. Symptoms were categorized as pain, neurologic (weakness and numbness), respiratory (hemoptysis and cough), and gastrointestinal/genitourinary (GI/GU) bleeding and multiple symptom categories were considered. Symptom relief was evaluated at subsequent on-treatment visits or follow-up encounters. Time to symptom alleviation (days) was measured from the RT start date. Descriptive and survival analyses were performed.
Results: Of 240 patients included in the study cohort, there were 581 irradiated sites. 541 out of 581 (93.0%) patients were treated for pain symptoms, and the other symptoms included neurologic (4.0%), respiratory (4.1%), and GI/GU bleeding (1.6%). The median time to resolution of symptoms was 1.6 months (95% CI: 1.4, 1.9). Symptom relief was observed in 84.6% (95%CI 81.0, 87.9) of patients for pain, 88.6% (95%CI 69.6, 98.1) for neurologic, and 69.9% (95%CI 49.3, 88.0) for respiratory symptoms at 6-months (table 1). Kaplan-Meier analysis showed a quicker symptom resolution with > 5 treatment regimens when compared to 1-5 (Log rank p < 0.01)
Conclusions: RT is effective for the palliation of symptoms in RCC. Further studies are required to fully delineate the impact of dose-fractionation on palliation of symptoms in RCC because of the possible biases associated with patient selection.
