Long-term SABR outcomes reported in selected patients with primary renal cell carcinoma.
Shankar Siva, MBBS PhD; Muhammad Ali, MBBS; Nicholas Hardcastle, PhD; Tomas Kron, PhD; Braden Higgs, MBBS; Farshad Foroudi, MBBS DMedSc; et al.
May 17, 2026
- The Lancet Oncology
- The Lancet Oncology, Volume 27, Issue 6, Pages 721–728
- 10.1016/S1470-2045(26)00170-1
Evidence before this study
We searched PubMed and Embase for studies of SABR for primary renal cell carcinoma (restricted to publications in English from Jan 1, 1995, to Dec 5, 2025) with the search string: (“radiotherapy” OR “radiation therapy” OR “stereotactic” OR “cyberknife” OR “sabr” OR “sbrt”) AND (“Kidney neoplasms” OR “kidney neoplasm” OR “renal neoplasms” OR “kidney cancer” OR “renal cell carcinoma” OR ““Carcinoma, Renal Cell” OR “renal cell cancer” OR “renal adenocarcinoma”) and identified that prospective clinical trial evidence has largely been limited to small, single-institution cohorts, with limited long-term follow-up.
Added value of this study
This pooled analysis of two prospective clinical trials using a shared ultra-hypofractionated SABR protocol provides long-term outcomes in a cohort with larger tumours who were at high risk or unsuitable for surgery. With a median follow-up of 5·0 years, local control remained high (98% at 3 and 5 years), and cancer-specific survival was also high (98% at 3 and 5 years). Severe adverse events were uncommon (8% of patients had grade 3 adverse events; no grade 4–5 adverse events). As no late safety signals were observed beyond 2 years, and renal function stabilised over time, these results confirm the long-term safety and efficacy of this technique. Renal function decline was modest and stabilised over time, with a low rate of dialysis.
Implications of all the available evidence
Our long-term, prospective data support SABR as an efficacious, convenient, non-invasive curative option for patients with primary renal cell carcinoma who are medically inoperable, high risk for surgery, or decline surgery, including those with larger tumours. The findings provide clinically useful benchmarks for patient counselling regarding durability of tumour control, late adverse events, and renal function trajectories after ultra-hypofractionated SABR. The results also strengthen the rationale for randomised trials comparing SABR with surgery in carefully selected operable patients.
Source: The Lancet Oncology
