Nicholas Zaorsky, MD, MS: Protecting kidney function after local renal cell carcinoma therapy

Stereotactic body radiotherapy (SBRT), partial nephrectomy (PN), and ablative therapies are linked to less harmful effects on kidney function among the options for localized renal cell carcinoma (RCC) treatment, according to new research.

A new abstract presented at the American Society for Radiation Oncology (ASTRO) 2024 Annual Meeting in Washington, DC, this week showed SBRT, PN and ablation were linked to lesser declines in estimated glomerular filtration rate (eGFR) versus radical nephrectomy (RN) among patients treated for RCC. Investigators additionally observed the fewest rates of grade ≥3 toxicities with SABR treatment compared to the other local therapy options.

Presented by investigator Nicholas Zaorsky, MD, MS, of the University Hospitals Case Medical Center, investigators believe the findings could help inform patient-tailored care conversations around long-term RCC management. The systematic review and meta-analysis may also help inform future clinical trials assessing disparities in local RCC therapy options.

In an interview with Urology Times during ASTRO 2024, Zaorsky discussed the significance of his team’s findings—particularly at a time when kidney cancer diagnoses have increased dramatically due to innovation in cross-section imaging. With this rise of new cases, there have been more datapoints to observe the effect of the 3 pathways of treatment: nephrectomies, ablations, and radiation.

“We know that there are no randomized studies out there that compare them head-to-head—there's no prospective trial that has compared treatment 1 versus 2, etc.," Zaorsky said. "And we know at the same time that each of these treatments can affect kidney function.”

Their meta-analysis findings confirmed that radiation therapy, specifically SBRT, may provide the best combination of preserved renal function and significantly lowered toxicity rates among all the observed treatment arms.

“This, in combination with the results of trials that have been presented and published within the past few years from the IROC consortium—where we see that the cancer control rate is above 95% or close to 100%—we think that radiation therapy is one of the best treatment options available for kidney cancer,” Zaorsky said. “And so, we hope that this study can help guide discussions among physicians and patients, in terms of selecting the best treatment option, and it can also help to guide a randomized, controlled trial—and powering the trial appropriately, so that we can get some prospective data to compare the different treatments.”

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.}