Stereotactic ablative radiotherapy (SABR)
Topic Status Complete
Stereotactic ablative radiotherapy (SABR) for the treatment of renal cell carcinoma
Outcome of the appraisal
The evidence supports the routine adoption of stereotactic ablative radiotherapy (SABR) to treat people with primary kidney cancer who are not suitable for surgery or other ablative techniques.
The use of SABR provides a treatment option that may improve survival in patients who would otherwise have no other treatment options available. Patient selection for SABR should be undertaken by a cancer multidisciplinary team.
Economic modelling estimates that the use of SABR is cost effective when compared with clinical surveillance, with a cost per quality-adjusted life year (QALY) of £1,675.
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.
Plain language summary
Kidney cancer, also called renal cancer, is one of the most common types of cancer in the UK. It usually affects adults between 60 and 70 years of age, although it can sometimes occur in adults under 50. There are several different types of kidney cancer. For this review, Health Technology Wales considered people with primary kidney cancer, which is cancer that has not yet spread outside of the kidneys.
Kidney cancer is usually treated with surgery to remove the tumour. However, not everyone can undergo such a major surgery. Alternative treatments can use methods that aren’t as intrusive as surgery, such as using ‘ablative’ techniques that use hot and cold to destroy the tumour. Stereotactic ablative radiotherapy (SABR) is a type of external radiotherapy that uses many smaller, thinner beams of radiation than standard radiotherapy. SABR delivers precise beams of radiation that are guided by imaging systems that track the exact three-dimensional location of a tumour. This allows high doses of radiation to be delivered to the tumour while minimising damage to healthy tissue. SABR can be given with fewer treatments than standard radiotherapy and can be given in the outpatient setting without general anaesthetic, meaning that the patient might not need to need to stay in hospital.
Health Technology Wales looked for evidence on the use of stereotactic ablative radiotherapy (SABR) to treat people with primary kidney cancer. The evidence supports the routine adoption of SABR to treat people with primary kidney cancer who are not suitable for surgery or other ablative techniques.
Topic Exploration Report
Evidence Appraisal Review
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