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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) - Beyond the Abstract

Renal cell carcinoma (RCC) ranks as the 14th most common cancer globally, with incidence steadily rising—often due to incidental findings during imaging for unrelated conditions.1 As a result, RCC is now frequently diagnosed in older, frail patients who present with multiple comorbidities. The majority of RCC cases (about 80%) are of the clear cell subtype, followed by papillary tumors.

Surgery remains the standard treatment for localized RCC, typically through partial nephrectomy for smaller (T1) tumors or radical nephrectomy for larger (T2) ones.2 However, surgery isn’t always feasible, particularly for patients with poor overall health or impaired kidney function. For these individuals, alternative approaches such as thermal ablation or active surveillance have emerged. Thermal ablation uses extreme heat or cold to treat the tumor, but remains invasive and less effective for larger or deeper lesions.3

More recently, stereotactic body radiotherapy (SBRT) — also known as stereotactic ablative body radiotherapy (SABR) — has gained attention as a promising noninvasive option. This technique delivers highly targeted radiation beams to precisely mapped tumors, offering a well-tolerated and effective solution. The recent publication of the FASTRACK II prospective single-arm trial raised the level of evidence, demonstrating excellent outcomes in terms of both LCR, DPFS, and CSS, with minimal toxicity, particularly for T1a and T1b tumors in patients who are not surgical candidates.4

Combined with ongoing innovations like liquid biopsies for early detection, these advances reflect a broader shift toward personalized, noninvasive cancer care—expanding options and improving outcomes for patients once considered inoperable.

In France, the Société Française de Radiothérapie Oncologique (SFRO) has published new guidelines outlining the use of radiotherapy in managing localized RCC. These recommendations include detailed protocols for treatment planning, target volume definition, follow-up, and strategies to preserve kidney function through strict dosimetric constraints.

Written by: Nicolas Benziane-Ouaritini,1 & Paul Sargos,2

  1. Department of Radiotherapy, Centre Azuréen de Cancérologie, Mougins, France.
  2. Department of Radiotherapy, Institut Bergonié, Bordeaux, France; Amethyst Radiotherapy Group, Paris, France.
References:

  1. Bukavina L, Bensalah K, Bray F, Carlo M, Challacombe B, Karam JA, et al. Epidemiology of Renal Cell Carcinoma: 2022 Update. Eur Urol. nov 2022;82(5):529‑42.
  2. Bigot P, Barthelemy P, Boissier R, Khene ZE, Pettenati C, Bernhard JC, et al. French AFU Cancer Committee Guidelines - Update 2022-2024: management of kidney cancer. Prog En Urol. nov 2022;32(15):1195‑274.
  3. Escudier B, Porta C, Schmidinger M, Rioux-Leclercq N, Bex A, Khoo V, et al. Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. mai 2019;30(5):706‑20.
  4. Siva S, Bressel M, Sidhom M, Sridharan S, Vanneste BGL, Davey R, et al. Stereotactic ablative body radiotherapy for primary kidney cancer (TROG 15.03 FASTRACK II): a non-randomised phase 2 trial. Lancet Oncol. mars 2024;25(3):308‑16.
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