Top Line: Blockbuster results with non-surgical management of localized renal cell carcinoma (RCC) via SBRT were presented in abstract form at ASTRO 2023.
The Study: We now have the eagerly-anticipated full pub. As a reminder, FASTRACK II was a prospective, phase 2 trial in which 70 patients with unifocal RCC (<10 cm) who weren’t eligible for or declined surgery were treated with SBRT. Given that some RCCs can be safely observed in older patients, it’s important to not the majority of enrollees had serial progression on surveillance imaging. Tumors ≤4 cm were treated with 26 Gy in 1 fraction, and tumors >4 cm were treated with 42 Gy in 3 fractions, and the median tumor size was 4.6 cm. . Again, at a median follow-up of just over 3.5 years, there were zero local recurrences and one distant recurrence. The rate of grade 3 toxicity was 10% and included pain, nausea, bowel obstruction, and diarrhea. Finally, the authors note: “the observed mean decline in eGFR of 10·8 mL/min per at 1 year in FASTRACK II is similar to the expected decline with partial nephrectomy.”
TBL: Analogous to patients with early-stage lung cancer, patients who are not candidates for or simply decline surgery for localized RCC now have a readily-available, safe, non-invasive curative treatment alternative in SBRT. | Sive, Lancet Oncol 2024
The Study: We now have the eagerly-anticipated full pub. As a reminder, FASTRACK II was a prospective, phase 2 trial in which 70 patients with unifocal RCC (<10 cm) who weren’t eligible for or declined surgery were treated with SBRT. Given that some RCCs can be safely observed in older patients, it’s important to not the majority of enrollees had serial progression on surveillance imaging. Tumors ≤4 cm were treated with 26 Gy in 1 fraction, and tumors >4 cm were treated with 42 Gy in 3 fractions, and the median tumor size was 4.6 cm. . Again, at a median follow-up of just over 3.5 years, there were zero local recurrences and one distant recurrence. The rate of grade 3 toxicity was 10% and included pain, nausea, bowel obstruction, and diarrhea. Finally, the authors note: “the observed mean decline in eGFR of 10·8 mL/min per at 1 year in FASTRACK II is similar to the expected decline with partial nephrectomy.”
TBL: Analogous to patients with early-stage lung cancer, patients who are not candidates for or simply decline surgery for localized RCC now have a readily-available, safe, non-invasive curative treatment alternative in SBRT. | Sive, Lancet Oncol 2024