Editor’s Note: Hosted jointly by the Chinese Society of Clinical Oncology (CSCO) and the Beijing Hisco Clinical Oncology Research Foundation, the 2024 CSCO Guidelines Conference was held in Jinan on April 26-27. It is understood that updates to the CSCO guidelines for kidney cancer treatment are currently under discussion. “Oncology Frontier” interviewed Professor Pei Dong from the Sun Yat-sen University Cancer Center at the venue to interpret the upcoming updates to the new CSCO guidelines for kidney cancer treatment.
Oncology Frontier: Could you share, based on relevant studies, the role and status of Stereotactic Body Radiotherapy (SBRT) in the treatment of kidney cancer?
Professor Pei Dong: Although kidney cancer has traditionally been considered radio-resistant, in the 2023 CSCO kidney cancer guidelines, we have included Stereotactic Body Radiotherapy as a separate chapter and as one of the recommended treatment options. With the latest clinical advancements, the two-year disease control rate for kidney cancer with SBRT can reach 96%. For patients who cannot undergo surgical removal of the primary lesion, have a solitary kidney, complex tumor locations, or cannot tolerate surgery, SBRT can significantly reduce the tumor size. Additionally, for certain metastatic lesions, particularly bone metastases and in patients who are inoperable or for whom surgery is challenging, SBRT can achieve very good tumor control effects, and even complete tumor remission.
Oncology Frontier: What are the significant updates in the surgical treatment section of this year’s CSCO kidney cancer treatment guidelines?
Professor Pei Dong: We are currently compiling the surgical treatment updates for the 2024 edition of the CSCO kidney cancer guidelines. Personally, I am particularly focused on neoadjuvant treatment for kidney cancer. For some complex or large tumors, targeted therapy combined with immunotherapy has shown good efficacy. Whether nephron-sparing treatment can be applied after using this neoadjuvant treatment to reduce the tumor size is a key focus of my current research. The results of the NeoAvAx study presented at the 2022 ASCO-GU meeting showed that about 30% of patients could achieve significant tumor reduction and significantly lower the postoperative recurrence risk for these locally advanced patients. Therefore, the use of neoadjuvant treatment may not only be for reducing the difficulty of surgery but more importantly, it might also reduce the risk of postoperative recurrence and improve long-term survival. This is something we look forward to observing further.
Oncology Frontier: Cytoreductive surgery is one of the hotly debated topics in the field of metastatic renal cell carcinoma. How do you think we should choose the timing and plan of the surgery to further improve patient prognosis?
Professor Pei Dong: The results of the CARMENA study might lead people to believe that late-stage kidney cancer patients do not benefit from cytoreductive nephrectomy in terms of survival. However, we find that performing cytoreductive nephrectomy after neoadjuvant treatment can further improve efficacy. It is worth noting that the CARMENA study was conducted during the era of targeted drug therapy. As targeted therapy combined with immunotherapy significantly enhances overall treatment outcomes, whether this combined approach can significantly reduce tumor size, and then performing cytoreductive nephrectomy could further enhance patient outcomes, is a question worth exploring. According to some of our retrospective data, for these patients, cytoreductive nephrectomy combined with targeted immunotherapy can indeed significantly improve treatment outcomes. Of course, whether different patients need to first undergo neoadjuvant treatment before cytoreductive surgery to further improve overall outcomes requires personalized treatment strategies.
Oncology Frontier: Robot-assisted partial nephrectomy is one of the most challenging surgeries in urology. How should we leverage its advantages to achieve better kidney cancer removal outcomes and long-term benefits?
Professor Pei Dong: In kidney cancer treatment, the primary goal is to ensure complete tumor removal and minimize post-surgical complications. With the advent of the robotic era, we are able to perform minimally invasive surgery for more complex cases. For patients who would have undergone traditional open surgery and could not have fine nephron-sparing tumor removal, robotic surgery might offer better outcomes. However, it is important to note that for some complex or large tumors, we need to strictly control the indications when using minimally invasive robotic surgery. For example, for stage T3 tumors, when the tumor significantly breaches the capsule, we need to consider whether nephron-sparing surgery in such cases could truly benefit the patient. Additionally, for certain special types of patients, such as those with cystic-solid tumors, we need to pay special attention to the protection of the surgical margin. In the era of robotic surgery, surgeons need to more accurately assess indications to expand the scope of nephron-sparing treatment for complex cases, thus improving treatment outcomes. At the same time, we are more focused on evidence of long-term tumor-free survival to ensure patients achieve better survival benefits and quality of life.
