SBRT compared with other ablative therapies for localised renal cell carcinoma.

Evidence before this study

Ablative therapies such as radiofrequency ablation, microwave ablation, and cryoablation have been integrated within clinical guidelines as evidence-based interventions for primary renal cell carcinoma. Previous non-randomised investigations have generally indicated no substantial differences in outcomes across these methods, with the selection of treatment often contingent on the availability of the method and the expertise of the operator. Stereotactic body radiotherapy (SBRT), an emergent ablative therapy distinguished by its delivery of highly focused radiation doses across multiple sessions, is a novel approach but lacks comparative data, especially in direct evaluations against other established ablative methods. We did a systematic search on PubMed (MEDLINE), Embase, and the Cochrane Library from Jan 1, 2000, to March 1, 2024, for meta-analyses comparing the clinical efficacy or adverse events of SBRT with radiofrequency ablation, microwave ablation, and cryoablation and identified no previous meta-analyses on this topic.

Added value of this study

To our knowledge, this large-scale meta-analysis is the first to compare the clinical outcomes of SBRT with other established ablative methods to treat localised renal cell carcinoma, including radiofrequency ablation, microwave ablation, and cryoablation and specifically addresses gaps in the literature concerning the absence of comparative efficacy data on SBRT. The study provides a comprehensive overview of the clinical profiles of patients with localised renal cell carcinoma undergoing these ablative therapies.

Implications of all the available evidence

Our findings suggest that SBRT might offer a particularly advantageous option for treating larger renal cell carcinoma tumours, yielding the highest local control rates among ablative options with comparatively low rates of severe complications. Conversely, for smaller, peripheral tumours, all methods continue to represent effective choices with robust safety profiles. The evidence advocates for multi-disciplinary treatment approaches, ensuring that therapeutic decisions are precisely tailored to the individual patient's clinical condition and treatment objectives. Future research should aim to conduct randomised controlled trials across larger patient populations to further elucidate the long-term oncological and survival outcomes associated with these treatments.

Source: The Lancet Oncology