Extracranial Palliative Radiation Therapy for Renal Cell Carcinoma

Symptom management is an integral component of care for patients with renal cell carcinoma (RCC). We evaluated the efficacy of radiation therapy (RT) and factors influencing symptom in an ethnically diverse patient population.

An institutional review board-approved retrospective review was conducted of patients with symptomatic extracranial RCC metastases treated with RT between 2011 and 2022 at a tertiary referral center. Symptoms were categorized as pain, neurologic (paresthesia or weakness), respiratory (dyspnea, hemoptysis, or cough) and gastrointestinal/genitourinary (GI/GU) bleeding. Time to symptom alleviation was measured from the start of RT and assessed during-treatment and follow-up visits. Descriptive and survival analyses were performed. Associations between symptom relief and treatment parameters were evaluated by generalized estimating equations.

We identified 240 symptomatic RCC patients who received RT to 581 metastases including 93.0% for pain, 4.0% for neurologic, 4.1% for respiratory, and 1.6% for GI/GU bleeding. Symptom improvement was observed in 84.0% of patients overall at 6 months (95% confidence interval [CI], 80.4-87.2%). Among symptom categories, pain improved in 84.6% (95% CI, 81.0-87.9%) at 6 months, respiratory symptoms in 69.9% (49.3-88.0%) at 6 months, neurologic symptoms in 88.6% (69.6-98.1%) at 6 months, and GI/GU bleeding in 37.5% (13.9-77.1%) at 1 month. The median times to overall and pain alleviation were 1.6 months (range, 1.4-1.9) and 1.6 months (range, 1.4-1.9), respectively. Although the odds of achieving pain palliation were similar between stereotactic and conventional RT, unexpectedly, symptom relief occurred more quickly with conventional RT (P < .001).

Stereotactic and conventional RT are effective for symptom palliation for patients with metastatic RCC.