The role of radiation therapy in renal cell carcinoma

Although renal cell carcinoma (RCC) is traditionally considered to be a radioresistant neoplasm, there is in vitro and clinical evidence that it does respond to radiation therapy (RT). There are both retrospective and randomized data in the literature describing outcomes and toxicity of RT in the adjuvant setting and for distant metastases. In general, the available randomized trials have found that RT in the adjuvant setting does not provide any survival benefit and is associated with unacceptable toxicity. Retrospective data suggest that radiation in the form of whole-brain radiotherapy or stereotactic radiosurgery can provide symptomatic relief and local control of brain metastases. In addition, RT has been found to be effective in palliation for symptomatic bone metastases. In this chapter, we review the methods of RT delivery and the relevant evidence regarding its role in the treatment of RCC and conclude that RT does not have a major role in the management of localized RCC in the adjuvant setting, but is effective for palliation and local control of distant sites of metastasis to bone and brain in particular.