Stereotactic ablative radiotherapy (SABR)

Why was this topic appraised?

Kidney cancer develops when abnormal cells in either of the kidneys start to divide and grow in an uncontrolled way. This appraisal focuses on cancer that has not spread outside of the kidney.

Surgery is currently the standard of care for the treatment of kidney cancer. However, many older patients have comorbidities, which may make them unsuitable for major surgery. Minimally invasive ablative therapies, involving extreme cold or heat to remove the tumour (such as cryotherapy, radiofrequency ablation and microwave ablation), are potential treatment options for patients who are unsuitable for or decline surgery. However, these therapies are limited to smaller kidney tumours distant from vascular structures. Active surveillance (observation) is commonly utilised in elderly, frail people with kidney cancer, with small tumours less than four centimetres. However, active surveillance may require delayed intervention, often triggered by tumour growth.

SABR is a type of external radiotherapy, which uses smaller, thinner beams of radiation than standard radiotherapy. It delivers precise beams of radiation at various intensities guided by sophisticated imaging systems that track the exact three-dimensional location of a tumour. Such precision allows high doses of radiation to be delivered to the tumour while minimising damage to surrounding healthy tissue. SABR can be given with fewer treatments than standard radiotherapy and isa non-invasive treatment option, delivered in the outpatient setting without the need for general anaesthetic, meaning that the patient usually does not need to need to stay in hospital.

This topic was proposed by Dr Jacob Tanguay, Consultant Oncologist, Velindre University NHS Trust.