Stage I renal cell carcinoma. Resection or stereotactic radiotherapy?

The aim of the study: evaluation of the treatment results for stage I renal cell carcinoma (RCC) using stereotactic radiotherapy (SBRT) and partial nephrectomy, taking into account survival rates, local control, and renal function. Material and methods. From 2011 to 2024, 143 patients underwent local treatment for stage I RCC. The first group included 85 patients who underwent partial nephrectomy, the second group included 58 patients with verified T1N0M0 RCC who underwent SBRT up to 30–45 Gy in 3 fractions using the CyberKnife device. SBRT was used to treat the primary tumor, and in 9 cases, for recurrent kidney cancer. The average age in the first group was 72 years, in the second group – 70 years. The average tumor diameter in the surgery group was 3.8 cm, in the SBRT group – 3.5 cm. Results. The median overall survival (OS) in the first group was 100 months. The median OS in the 2nd group was not reached, the average life expectancy was 127 months. 1-year OS after partial nephrectomy was 98.9% and 96.4% with SBRT, 1-year progression-free survival (PFS) in the surgery group was 97%, in the radiotherapy group – 93%. 5-year OS in the surgery group was higher – 83% versus 66% in the SBRT group (p=0.06). In the first group, 7 out of 85 patients (8.2%) developed a relapse in the resected tumor bed. In group 2, 8.3% (5 cases) had progression of the process, 7 patients (11.6%) had a complete response according to RECIST 1.1 criteria, half of the patients (31 patients (51.7%) had stabilization of the process, and 28.4% of cases (17 patients) had a partial response. A decrease in the glomerular filtration rate by more than 10 ml/min/1.73 m2 was recorded in 11 patients (13%) in the first group and in 10 patients (17%) in the second group 12 months after treatment. Dialysis was not required after treatment in any case. Conclusion. Kidney resection makes it possible to achieve better indicators of OS and PFS in comparison with CTT with comparable local control, however, if the patient is inoperable or refuses surgery, CTT can be used in the treatment of stage I RCC.