PMID- 38462092
OWN - NLM
STAT- MEDLINE
DCOM- 20240424
LR  - 20240506
IS  - 1879-0887 (Electronic)
IS  - 0167-8140 (Linking)
VI  - 194
DP  - 2024 May
TI  - Dose-response of localized renal cell carcinoma after stereotactic body radiation 
      therapy: A meta-analysis.
PG  - 110216
LID - S0167-8140(24)00138-5 [pii]
LID - 10.1016/j.radonc.2024.110216 [doi]
AB  - BACKGROUND: Stereotactic ablative radiation therapy (SBRT) is an emerging 
      treatment option for primary renal cell carcinoma (RCC), particularly in patients 
      who are unsuitable for surgery. The aim of this review is to assess the effect of 
      increasing the biologically equivalent dose (BED) via various radiation 
      fractionation regimens on clinical outcomes. METHODS: A literature search was 
      conducted in PubMed (Medline), EMBASE, and the Cochrane Library for studies 
      published up to October 2023. Studies reporting on patients with localized RCC 
      receiving SBRT were included to determine its effectiveness on local control, 
      progression-free survival, and overall survival. A random effects model was used 
      to meta-regress clinical outcomes relative to the BED for each study and 
      heterogeneity was assessed by I(2). RESULTS: A total of 724 patients with RCC 
      from 22 studies were included, with a mean age of 72.7 years (range: 44.0-81.0). 
      Local control was excellent with an estimate of 99 % (95 %CI: 97-100 %, 
      I(2) = 19 %), 98 % (95 %CI: 96-99 %, I(2) = 8 %), and 94 % (95 %CI: 90-97 %, 
      I(2) = 11 %) at one year, two years, and five years respectively. No definitive 
      association between increasing BED and local control, progression-free survival 
      and overall survival was observed. No publication bias was observed. CONCLUSIONS: 
      A significant dose response relationship between oncological outcomes and was not 
      identified, and excellent local control outcomes were observed at the full range 
      of doses. Until new evidence points otherwise, we support current recommendations 
      against routine dose escalation beyond 25-26 Gy in one fraction or 42-48 Gy in 
      three fractions, and to consider de-escalation or compromising target coverage if 
      required to achieve safe organ at risk doses.
CI  - Copyright (c) 2024 The Author(s). Published by Elsevier B.V. All rights reserved.
FAU - Huang, Ryan S
AU  - Huang RS
AD  - Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
FAU - Chow, Ronald
AU  - Chow R
AD  - Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; 
      Princess Margaret Cancer Centre, Temerty Faculty of Medicine, University of 
      Toronto, Toronto, Canada; London Regional Cancer Program, London Health Sciences 
      Centre, Schulich School of Medicine, University of Western Ontario, London, ON, 
      Canada; New York Proton Center, New York, NY, USA.
FAU - Chopade, Pradnya
AU  - Chopade P
AD  - Princess Margaret Cancer Centre, Temerty Faculty of Medicine, University of 
      Toronto, Toronto, Canada.
FAU - Mihalache, Andrew
AU  - Mihalache A
AD  - Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
FAU - Hasan, Asad
AU  - Hasan A
AD  - University of British Columbia, Vancouver, British Columbia, Canada.
FAU - Boldt, Gabriel
AU  - Boldt G
AD  - London Regional Cancer Program, London Health Sciences Centre, Schulich School of 
      Medicine, University of Western Ontario, London, ON, Canada.
FAU - Glicksman, Rachel
AU  - Glicksman R
AD  - Princess Margaret Cancer Centre, Temerty Faculty of Medicine, University of 
      Toronto, Toronto, Canada.
FAU - Simone, Charles B 2nd
AU  - Simone CB 2nd
AD  - New York Proton Center, New York, NY, USA.
FAU - Lock, Michael
AU  - Lock M
AD  - London Regional Cancer Program, London Health Sciences Centre, Schulich School of 
      Medicine, University of Western Ontario, London, ON, Canada.
FAU - Raman, Srinivas
AU  - Raman S
AD  - Princess Margaret Cancer Centre, Temerty Faculty of Medicine, University of 
      Toronto, Toronto, Canada. Electronic address: srinivas.raman@rmp.uhn.ca.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20240309
PL  - Ireland
TA  - Radiother Oncol
JT  - Radiotherapy and oncology : journal of the European Society for Therapeutic 
      Radiology and Oncology
JID - 8407192
SB  - IM
MH  - Humans
MH  - *Carcinoma, Renal Cell/radiotherapy
MH  - Dose Fractionation, Radiation
MH  - *Dose-Response Relationship, Radiation
MH  - *Kidney Neoplasms/radiotherapy
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Dose escalation
OT  - Dose response
OT  - Local control
OT  - Overall survival
OT  - Progression-free survival
OT  - RCC
OT  - Renal cell carcinoma
OT  - SBRT
OT  - Stereotactic body radiation therapy
COIS- Declaration of competing interest The authors declare the following financial 
      interests/personal relationships which may be considered as potential competing 
      interests: RG: institutional grant funding- Astellas, TerSera. Honoraria: Bayer, 
      Tolmar, Knight, TerSera. SR: Institutional grant funding - Astra Zeneca, Knight 
      therapeutics. Honoraria - Bayer, Astra Zeneca, Tersera, Sanofi, Verity pharma.
EDAT- 2024/03/11 00:42
MHDA- 2024/04/25 00:54
CRDT- 2024/03/10 20:17
PHST- 2024/02/05 00:00 [received]
PHST- 2024/03/02 00:00 [revised]
PHST- 2024/03/04 00:00 [accepted]
PHST- 2024/04/25 00:54 [medline]
PHST- 2024/03/11 00:42 [pubmed]
PHST- 2024/03/10 20:17 [entrez]
AID - S0167-8140(24)00138-5 [pii]
AID - 10.1016/j.radonc.2024.110216 [doi]
PST - ppublish
SO  - Radiother Oncol. 2024 May;194:110216. doi: 10.1016/j.radonc.2024.110216. Epub 
      2024 Mar 9.