Considering patient-reported outcomes in kidney cancer care, with Nicholas Zaorsky, MD, PhD

New data presented at the American Society for Radiation Oncology (ASTRO) 2024 Annual Meeting in Washington, DC, showed stereotactic body radiotherapy (SBRT), along with partial nephrectomies and ablative therapies, are less likely to impact longterm kidney function versus radical nephrectomy in patients with localized renal cell carcinoma (RCC).¹

The findings, presented by study author Nicholas Zaorsky, MD, MS, of the University Hospitals Case Medical Center, may shine a light on a prevalent misconception regarding the risks of stereotactic radiation for clinicians outside of radiation oncology.

In the second segment of an interview with Urology Times while at ASTRO 2024,² Zaorsky discussed the greater takeaways of his team’s research—namely the observed low toxicity rate associated with radiation therapy for RCC. The findings buck against major trends of care for kidney cancer.

“Our research specifically looked at the trying to quantify renal function, and trying to quantify how much are the kidneys impacted by this treatment, and how do we best go forward in looking at minimizing the impact on the kidneys while hopefully still maintaining patient quality of life,” Zaorsky said. “If you look at the National Cancer database, which is the US database that looks at the treatments that are used for cancer, about 90% of patients currently receive some form of surgery for their kidney cancer.“

Zaorsky additionally discussed the prospect of advancing the findings of these analyses toward a randomized controlled trial that specifically considered patient-reported quality of life outcomes associated with different RCC treatment modalities—outcomes generally not considered in the initiation and follow-through of kidney cancer therapy.

“If we want to increase the use of something like radiation therapy, or build a randomized controlled trial that compares the treatments—or even get the patients an opinion about radiation therapy—I think that it's critical for the patients to be discussed at multidisciplinary tumor boards and to have that patient see multiple physicians,” Zaorsky said. “It's also important to note that radiation therapy is already listed in the NCCN guidelines as a category 1 recommendation for many patients, and so I think it's very reasonable for surgeons and for oncologists to have to basically automatically refer patients once they're diagnosed to have them meet with a radiation oncologist.”

References

1. ^{Rajoulh C, Ali M, Wang M, Siva S et al. Renal Function after Definitive Local Therapy for Primary Renal Cell Carcinoma: A Meta-Analysis. Poster presented at: American Society for Radiation Oncology (ASTRO) 2024 Annual Meeting. Washington, DC. September 29 – October 2, 2024.}
2. ^{Kunzmann K. Nicholas Zaorsky, MD, MS: Protecting kidney function after local renal cell carcinoma therapy. Urology Times. Published October 1, 2024. https://www.urologytimes.com/view/nicholas-zaorsky-md-ms-protecting-kidney-function-after-local-renal-cell-carcinoma-therapy}