Role of radiotherapy in the management of primary renal cell carcinoma: Recommendations from the Société française de radiothérapie oncologique (SFRO, the French society for radiation oncology)

Abstract

Renal cell carcinoma represents the 14th most frequent tumour worldwide, but its incidence is increasing partly due to incidental diagnoses. As a result, these tumours are diagnosed in patients at an increasingly advanced age, often frail and with comorbidities. Most renal cell carcinoma cases are clear cell carcinoma (80 %), with papillary tumours being the second most frequent histological subtype. The standard of care for localized RCC is surgery, with partial nephrectomy or radical nephrectomy being recommended for T1 and T2 tumours, respectively. Thermoablative strategies have been developed over the past decade for patients who are not amenable to surgery and/or with impaired renal function. Active surveillance remains an alternative in the case of small low-grade renal cell carcinoma. Recent research has evaluated stereotactic ablative body radiotherapy as a well-tolerated and effective treatment for small renal tumours essentially for the management of both T1a and T1b tumours. This article aims to report the recommendations of the Société française de radiothérapie oncologique (SFRO, the French society for radiation oncology) on the role of radiotherapy in the management of localized renal cell carcinoma. These guidelines describe both treatment planning modalities, target volumes, and follow-up procedures. They also focus on the impact of radiotherapy on renal function, and the specific dosimetric constraints to be implemented.