Dr Tang on Unanswered Questions About the Role of Radiation Therapy in RCC

Chad Tang, MD, associate professor, Department of Genitourinary Radiation Oncology, Division of Radiation Oncology, associate professor, Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, 

 surrounding the role of radiation therapy in patients with renal cell carcinoma (RCC).

Ongoing research in this arena is exploring the potential of upfront or sequenced radiation therapy for primary tumors in patients with metastatic disease, Tang begins. Currently, there are at least 3 significant trials of interest investigating this approach, he notes. These include the phase 2 CYTOSHRINK trial (NCT04090710) based in Canada, the phase 2 SAMURAI study (NCT05327686) conducted in the United States, and a newly initiated Italy-based trial called ITALIC-RCC (EudraCT 2024-517789-41-00), he explains. Radiation therapy is of particular interest because it offers the advantage of shorter recovery periods and less interruption of systemic therapy compared with surgical interventions, Tang states.

In addition, there is growing interest in using radiation therapy as an alternative to systemic treatment for patients with indolent, oligometastatic RCC, he expands, adding that the phase 3 SOAR trial (NCT05863351) has recently opened and will randomly assign patients with kidney cancer with limited metastases to receive either a radiation-based strategy or the standard of care, which typically involves systemic therapy. Another area of active investigation is the use of adjuvant radiation therapy in combination with immunotherapy, Tang notes. The phase 2 ASTROs study (NCT06004336), for which Tang serves as the principal investigator, is examining the efficacy of pembrolizumab (Keytruda) administered as adjuvant therapy following radiation for patients with oligometastatic RCC, he explains.

These trials represent exciting opportunities to further understand how radiation therapy can be integrated into RCC management, potentially offering new strategies for managing metastatic disease with fewer effects on systemic treatment schedules and overall patient recovery, Tang concludes.

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Chad Tang, MD, discusses unanswered questions surrounding the role of radiation therapy in renal cell carcinoma.

Dr Tang on the Current Role for Radiation Therapy in Advanced RCC

Chad Tang, MD, associate professor, Department of Genitourinary Radiation Oncology, Division of Radiation Oncology, associate professor, Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses the current role of radiation therapy in advanced renal cell carcinoma (RCC) and how medical oncologists and radiation oncologists can collaborate to effectively advance the management of this disease.

Stereotactic body radiation therapy (SBRT) is the most common form of radiation therapy utilized in the treatment of patients with RCC, Tang begins. SBRT delivers high doses of radiation over a shortnumber of fractionations and can serve multiple purposes in RCC management, he explains. For patients with primary RCC, radiation therapy can be employed as an alternative to nephrectomy to control localized tumors, Tang states. Additionally, for those with metastatic RCC, SBRT offers control over indolent disease by targeting a few specific sites of progression, he says. Beyond these applications, radiation therapy remains a palliative tool, particularly for managing metastatic complications, such as bone metastases, brain tumors, or inferior vena cava thromboses, which are becoming more frequently treated with radiation, Tang adds.

There is a critical need for better communication between medical oncologists and radiation oncologists regarding the evolving role of radiation in RCC, Tang continues. Historically, radiation has been viewed as ineffective for this cancer type; however, that perception is changing, he notes. Medical oncologists are encouraged to explore the potential of radiation therapy in cases where it might help extend the efficacy of systemic therapy, provide a break from it, or alleviate specific symptoms, Tang states. Open discussions between these specialties can foster innovative treatment strategies and improve patient outcomes, according to Tang. By working together, medical and radiation oncologists can better integrate radiation into RCC treatment plans, where it can provide patients with significant benefits, Tang concludes.

Chad Tang, MD, discusses the potential role for radiation therapy in advanced renal cell carcinoma.

Chad Tang, MD

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Dr Tang on Unanswered Questions About the Role of Radiation Therapy in RCC

Dr Tang on the Current Role for Radiation Therapy in Advanced RCC