Optimising image-guided radiotherapy in extracranial renal cell carcinoma
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Embargo End Date
2026-01-29
ICR Authors
Authors
Green, H
Document Type
Thesis or Dissertation
Date
2025-07-29
Date Accepted
Abstract
Curative-intent stereotactic body radiotherapy (SBRT) for primary inoperable renal cell carcinoma (RCC) has world-wide recognition following a proliferation of clinical studies demonstrating excellent clinical outcomes. Patients are often older, frail or have comorbidities precluding them from gold-standard invasive intervention. Although severe toxicity rates from SBRT are low, moderate toxicity is common. Cancer-specific survival decreases with increasing tumour size. Immunotherapy and targeted treatments have transformed the treatment landscape of metastatic RCC (mRCC). Patterns of failure are changing with often one or a few problematic areas requiring local control.
This thesis evaluates SBRT dosimetry with Volume-Modulated Arc Therapy, CyberKnife and Proton Beam Therapy. In smaller tumours, dosimetric feasibility is demonstrated using all 3 techniques, however protons significantly reduced organ at risk (OAR) doses. In larger tumours, protons maintained prescription dose in more cases and resulted in a significant reduction in OAR doses compared to photons. Real-time tracking using CyberKnife may be beneficial in very mobile tumours. This work aims to lead to a clinical feasibility study of stereotactic protons in primary RCC. For large cases with significant bowel overlap, no techniques met bowel constraints. Carbon-ion therapy is thought to be more radiobiologically effective than photons. Through international collaboration, a radical hypofractionated approach is investigated in such cases and shows dosimetric feasibility.
A systematic review is undertaken to evaluate metastasis-directed ablative therapies in mRCC. This leads to the development of a single-centre randomised feasibility study of high-dose hypofractionated radiotherapy versus palliative radiotherapy for local control. Interim results meet feasibility criteria.
This work aims to lead to a collaborative programme of clinical research, incorporating both translationally-rich studies and real-world data. My hope is that future work will aid development of patient-selection tools, to encourage equity of access and prioritisation of advanced technology when it is most likely to lead to improved patient outcomes.
Citation
2025
DOI
Source Title
Publisher
Institute of Cancer Research (University Of London)
ISSN
eISSN
Collections
Research Team
RT Gynaecological Cancer