AUTHOR=Nguyen Nam P. , Chirila Monica-Emilia , Page Brandi R. , Vinh-Hung Vincent , Gorobets Olena , Mohammadianpanah Mohammad , Giap Huan , Arenas Meritxell , Bonet Marta , Lara Pedro Carlos , Kim Lyndon , Dutheil Fabien , Lehrman David , Montes Luis Zegarra , Tlili Ghassen , Dahbi Zineb , Loganadane Gokoulakrichenane , Blanco Sergio Calleja , Bose Satya , Natoli Elena , Li Eric , Mallum Abba , Morganti Alessio G. TITLE=Immunotherapy and stereotactic body radiotherapy for older patients with non-metastatic renal cancer unfit for surgery or decline nephrectomy: practical proposal by the International Geriatric Radiotherapy Group JOURNAL=Frontiers in Oncology VOLUME=14 YEAR=2024 URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2024.1391464 DOI=10.3389/fonc.2024.1391464 ISSN=2234-943X ABSTRACT=

The standard of care for non-metastatic renal cancer is surgical resection followed by adjuvant therapy for those at high risk for recurrences. However, for older patients, surgery may not be an option due to the high risk of complications which may result in death. In the past renal cancer was considered to be radio-resistant, and required a higher dose of radiation leading to excessive complications secondary to damage of the normal organs surrounding the cancer. Advances in radiotherapy technique such as stereotactic body radiotherapy (SBRT) has led to the delivery of a tumoricidal dose of radiation with minimal damage to the normal tissue. Excellent local control and survival have been reported for selective patients with small tumors following SBRT. However, for patients with poor prognostic factors such as large tumor size and aggressive histology, there was a higher rate of loco-regional recurrences and distant metastases. Those tumors frequently carry program death ligand 1 (PD-L1) which makes them an ideal target for immunotherapy with check point inhibitors (CPI). Given the synergy between radiotherapy and immunotherapy, we propose an algorithm combining CPI and SBRT for older patients with non-metastatic renal cancer who are not candidates for surgical resection or decline nephrectomy.