Delphi consensus on stereotactic ablative radiotherapy for oligometastatic and oligoprogressive renal cell carcinoma—a European Society for Radiotherapy and Oncology study endorsed by the European Association of Urology - 30/04/24

Doi : 10.1016/S1470-2045(24)00023-8

Giulia Marvaso, MD ^a,^d,^{*
Joint first authors}, Barbara Alicja Jereczek-Fossa, ProfMD PhD ^a,^d,^{*
Joint first authors}, Mattia Zaffaroni, MSc ^a,⁎ , Maria Giulia Vincini, MSc ^a, Giulia Corrao, MD ^a, Nicolaus Andratschke, ProfMD ^e, Ehsan H Balagamwala, MD ^f, Jens Bedke, ProfMD ^g, Oliver Blanck, PhD ^h, Umberto Capitanio, ProfMD ^i,^j, Rohann J M Correa, MD PhD ^k, Gert De Meerleer, ProfPhD ^l, Ciro Franzese, MD ^m,ⁿ, Aurora Gaeta, MSc ^b, Sara Gandini, PhD ^b, Cristina Garibaldi, MSc ^c, Peter C Gerszten, MD ^o, Silke Gillessen, ProfMD ^p,^q, William R Grubb, MD ^r, Matthias Guckenberger, ProfMD ^e, Raquibul Hannan, ProfMD PhD ^s, Pavan M Jhaveri, MD ^t, Mirjana Josipovic, PhD ^u,^v, Linda G W Kerkmeijer, MD PhD ^w, Eric J Lehrer, MD ^x, Magnus Lindskog, MD ^y,^z, Alexander V Louie, MD PhD ^aa, Quynh-Nhu Nguyen, MD MHCM ^ab, Piet Ost, ProfMD PhD ^ac, David A Palma, MD ^k, Giuseppe Procopio, ProfMD ^ad, Maddalena Rossi, MSc ^ae, Michael Staehler, ProfPhD ^af, Alison C Tree, MDRes ^ag,^ah, Yat Man Tsang, PhD ^ai, Nicholas Van As, ProfMDRes ^ag,^ah,^aj, Nicholas G Zaorsky, MD MS ^ak, Thomas Zilli, ProfMD ^p,^q, David Pasquier, ProfMD PhD ^al,^am,^{†
Joint last authors}, Shankar Siva, ProfMBBS PhD ^an,^ao,^{†
Joint last authors}
^a Division of Radiation Oncology, European Institute of Oncology, IRCCS, Milan, Italy
^b Department of Experimental Oncology, European Institute of Oncology, IRCCS, Milan, Italy
^c Unit of Radiation Research, European Institute of Oncology, IRCCS, Milan, Italy
^d Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
^e Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
^f Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
^g Department of Urology and Transplantation surgery, Klinikum Stuttgart, Stuttgart, Germany
^h Department of Radiation Oncology, University Medical Center Schleswig Holstein, Kiel, Germany
ⁱ IRCCS San Raffaele Scientific Institute, Milan, Italy
^j University Vita-Salute San Raffaele, Milan, Italy
^k Department of Radiation Oncology, London Health Sciences Centre, London, ON, Canada
^l Department of Radiation Oncology, Leuven University Hospitals, Leuven, Belgium
^m Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Milan, Italy
ⁿ Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
^o Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
^p Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
^q Università della Svizzera Italiana, Lugano, Switzerland
^r Department of Radiation Oncology, Augusta University Medical Center, Augusta, GA, USA
^s Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
^t Department of Radiation Oncology, Baylor College of Medicine, Houston, TX, USA
^u Section of Radiotherapy, Department of Oncology, Rigshospitalet, Copenhagen, Denmark
^v Department of Clinical Medicine, Copenhagen University Hospital, Copenhagen, Denmark
^w Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, Netherlands
^x Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
^y Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
^z Department of Pelvic Cancer, Section of Genitourinary Oncology, Karolinska University Hospital, Stockholm, Sweden
^aa Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
^ab Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
^ac Department of Human Structure and Repair, Ghent University, Ghent, Belgium and Department of Radiation Oncology, Iridium Network, Antwerp, Belgium
^ad Dipartimento Di Oncologia Medica, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
^ae Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
^af Interdisciplinary Centre on Renal Tumours, University of Munich, Munich, Germany
^ag Department of Urology, The Institute of Cancer Research, London, UK
^ah The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
^ai Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
^aj The Institute of Cancer Research, London, UK
^ak University Hospitals Seidman Cancer Center and Case Western Reserve University, Cleveland, OH, USA
^al Academic Department of Radiation Oncology, Centre O Lambret, Lille, France
^am University of Lille, Centrale Lille, CNRS, UMR 9189—CRIStAL, Lille, France
^an Peter MacCallum Cancer Centre, Department of Radiation Oncology, University of Melbourne, Parkville, VIC, Australia
^ao Faculty of Medicine, University of Melbourne, Parkville, VIC, Australia

^*Correspondence to: Mattia Zaffaroni, Division of Radiation Oncology, European Institute of Oncology, IRCCS, 20141 Milan, ItalyDivision of Radiation OncologyEuropean Institute of OncologyIRCCSMilan20141Italy

Summary

The purpose of this European Society for Radiotherapy and Oncology (ESTRO) project, endorsed by the European Association of Urology, is to explore expert opinion on the management of patients with oligometastatic and oligoprogressive renal cell carcinoma by means of stereotactic ablative radiotherapy (SABR) on extracranial metastases, with the aim of developing consensus recommendations for patient selection, treatment doses, and concurrent systemic therapy. A questionnaire on SABR in oligometastatic renal cell carcinoma was prepared by a core group and reviewed by a panel of ten prominent experts in the field. The Delphi consensus methodology was applied, sending three rounds of questionnaires to clinicians identified as key opinion leaders in the field. At the end of the third round, participants were able to find consensus on eight of the 37 questions. Specifically, panellists agreed to apply no restrictions regarding age (25 [100%) of 25) and primary renal cell carcinoma histology (23 [92%] of 25) for SABR candidates, on the upper threshold of three lesions to offer ablative treatment in patients with oligoprogression, and on the concomitant administration of immune checkpoint inhibitor. SABR was indicated as the treatment modality of choice for renal cell carcinoma bone oligometatasis (20 [80%] of 25) and for adrenal oligometastases 22 (88%). No consensus or major agreement was reached regarding the appropriate schedule, but the majority of the poll (54%–58%) retained the every-other-day schedule as the optimal choice for all the investigated sites. The current ESTRO Delphi consensus might provide useful direction for the application of SABR in oligometastatic renal cell carcinoma and highlight the key areas of ongoing debate, perhaps directing future research efforts to close knowledge gaps.

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Plan

Introduction

Committees and participants

Questionnaire structure

Study design

Analysis

Results

Section 1: SABR eligibility for oligometastatic renal cell carcinoma

Section 2: SABR treatment

Discussion

Search strategy and selection criteria

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Vol 25 - N° 5

P. e193-e204 - mai 2024 Retour au numéro

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Delphi consensus on stereotactic ablative radiotherapy for oligometastatic and oligoprogressive renal cell carcinoma—a European Society for Radiotherapy and Oncology study endorsed by the European Association of Urology - 30/04/24

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