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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
Authors: Nguyen, Nam P.
Chirila, Monica Emilia
Page, Brandi R.
Vinh-Hung, Vincent
Gorobets, Olena
Mohammadianpanah, Mohammad
Giap, Huan
Arenas, Meritxell
Bonet, Marta
Lara Jiménez, Pedro Carlos 
Kim, Lyndon
Dutheil, Fabien
Lehrman, David
Zegarra Montes, Luis
Tlili, Ghassen
Dahbi, Zineb
Loganadane, Gokoulakrichenane
Calleja Blanco, Sergio
Bose, Satya
Natoli, Elena
Li, Eric
Mallum, Abba
Morganti, Alessio G.
UNESCO Clasification: 32 Ciencias médicas
320713 Oncología
320107 Geriatría
320112 Radioterapia
Keywords: Cpi
Renal Cancer
Issue Date: 2024
Journal: Frontiers in Oncology 
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.
DOI: 10.3389/fonc.2024.1391464
Source: Frontiers in Oncology[EISSN 2234-943X],v. 14, (Enero 2024)
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