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Stereotactic Ablative Radiation for Systemic Therapy-naïve Oligometastatic Kidney Cancer
Raquibul Hannan1, Michael Christensen2, Alana Christie3
1Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Background:
Evidence-based guidelines for the management of systemic therapy-naïve oligometastatic renal cell carcinoma (RCC) are lacking.
Objective:
To evaluate the potential of stereotactic ablative radiotherapy (SAbR) to provide longitudinal disease control while preserving quality of life (QOL) in patients with systemic therapy-naïve oligometastatic RCC.
Design, Setting, And Participants:
RCC patients with three or fewer extracranial metastases were eligible. SAbR was administered longitudinally to all upfront and, as applicable, subsequent metastases.
Outcome Measurements And Statistical Analysis:
This prospective phase II single-arm trial was powered to achieve a primary objective of freedom from systemic therapy for >1 yr in >60% of patients (using the Clopper and Pearson methodology). Secondary endpoints included progression-free survival (PFS), defined as the time from first SAbR to progression not amenable to SAbR (local failure at SAbR-treated sites, new metastases not amenable to SAbR, more than three new metastases, or brain metastases); patient-reported QOL metrics; local control (LC) rates; toxicity; cancer-specific survival (CSS); and overall survival (OS).
Results And Limitations:
Twenty-three patients received SAbR to 33 initial and 57 total sites. The median follow-up was 21.7 mo (interquartile range 16.3-30.3). Exceeding the prespecified 60% benchmark, freedom from systemic therapy at 1 yr was 91.3% (95% confidence interval [CI]: 69.5, 97.8). One-year PFS was 82.6% (95% CI: 60.1, 93.1). QOL was largely unaffected. LC was 100%. There were no grade 3/4 toxicities, but there was one death due to immune-related colitis 3 mo after SAbR while on subsequent checkpoint inhibitor therapy, where a SAbR contribution could not be excluded. One-year OS was 95.7% (95% CI: 72.9, 99.4); one-year CSS was 100%.
Conclusions:
SAbR for oligometastatic RCC was associated with meaningful longitudinal disease control while preserving QOL. These data support further evaluation of SAbR for systemic therapy-naïve oligometastatic RCC.
Patient Summary:
Sequential stereotactic radiation therapy can safely and effectively control metastatic kidney cancer with limited spread for over a year without compromising patients' quality of life.
Insights
Stereotactic ablative radiotherapy (SAbR) effectively controls oligometastatic renal cell carcinoma (RCC) in patients not yet on systemic therapy. This approach achieved high rates of freedom from systemic therapy and progression-free survival while preserving quality of life.
Area of Science:
- Oncology
- Radiation Oncology
- Medical Physics
Background:
- Systemic therapy-naïve oligometastatic renal cell carcinoma (RCC) lacks evidence-based management guidelines.
- Oligometastatic disease represents an intermediate state between localized and widespread metastatic cancer.
Purpose of the Study:
- To evaluate stereotactic ablative radiotherapy (SAbR) for longitudinal disease control in systemic therapy-naïve oligometastatic RCC.
- To assess SAbR's impact on patient quality of life (QOL).
Main Methods:
- Prospective phase II single-arm trial involving 23 RCC patients with ≤3 extracranial metastases.
- SAbR administered longitudinally to all initial and subsequent metastases.
- Primary endpoint: freedom from systemic therapy >1 year; secondary endpoints: PFS, QOL, LC, toxicity, CSS, OS.
Main Results:
- Freedom from systemic therapy at 1 year was 91.3%, exceeding the 60% benchmark.
- One-year progression-free survival (PFS) was 82.6% with 100% local control (LC).
- Quality of life (QOL) was largely unaffected; no grade 3/4 toxicities observed.
Conclusions:
- SAbR provides meaningful longitudinal disease control for oligometastatic RCC while preserving QOL.
- These findings support further investigation of SAbR in this patient population.
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