Radiation’s Evolving Role in Kidney Cancer: From Resistance to Relevance

Shankar first explains the original historical studies that provided evidence of the limited efficacy of low dose conventional radiation therapy (RT) in treating kidney cancer. However, he and Rana discuss how stereotactic body radiation therapy (SBRT), a newer technology which delivers a higher dose per fraction more accurately, has shown better outcomes in clinical trials than conventional RT. They also explain the associated risks with SBRT and how neoadjuvant therapies can be combined with radiation. They also consider the use of SBRT in bulky tumors and those with IVC thrombus. All three doctors agree that radiation therapy needs to be incorporated into a multimodal approach to kidney cancer. They also discuss the potential of radiation therapy in the cytoreductive setting and its role in delaying systemic therapy in patients with oligometastases.

Finally, they explore the possibility of using PET imaging to detect oligometastatic disease. Although prostate-specific membrane antigen positron emission tomography (PSMA PET/CT) imaging is mostly used to stage prostate cancer, other solid tumors like renal cell carcinoma (RCC) may also express PSMA. For this reason, they agree that a next generation PSMA PET/CT equivalent for RCC could be revolutionary. Lastly, they predict what the future of RCC could hold by examining newer therapies, such as radioligand therapy and cyberknife.