The emerging roles of stereotactic ablative radiotherapy for metastatic renal cell carcinoma

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Abstract
To discuss the emerging roles of stereotactic ablative radiotherapy (SABR) in patients with metastatic renal cell carcinoma (RCC). RCC tumours are not as radio-resistant as previously thought, as local control rates of tumours treated with SABR are high. Therefore, SABR is an attractive treatment option for RCC tumours in which effective long-term palliation of symptoms or local control is desired. Like surgical resection of metastatic tumours, SABR can also be used as a method of eradicating oligometastases to potentially 'cure' or offer prolonged disease-free survival in patients with low-volume metastatic disease. In patients who develop progression of a solitary or few tumours (termed oligoprogression), SABR to the progressing 'rogue' tumours may delay the need to start or change systemic therapy. Finally, there is the potential for SABR to improve the efficacy of immunotherapy for metastatic RCC, given the known immune-modulated abscopal effect of radiotherapy. SABR is increasingly being used in metastatic RCC patients, given the great potential to improve various outcomes. More prospective clinical trials are needed to identify and quantify the clinical benefits.

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