Don’t hate, ablate.

Early-stage renal cell carcinoma (RCC) is the new early-stage non-small cell lung cancer (NSCLC). And by that we mean the emerging—what has become classic—turf war between surgery and stereotactic body radiation (SBRT). Currently, just as in NSCLC, SBRT is reserved only for cases of medically-inoperable early-stage RCC. With that segue, here comes another classic: a retrospective NCDB analysis comparing outcomes between partial nephrectomy, SBRT, “ablation” (cryo- or thermal), and observation. Most predictable is the conclusion that SBRT with a biologically effective dose, assuming a tumor α/β value of 10, (BED10) of over 100 is associated with better survival than observation (HR 0.34). Not so when BED10 was <100. This was compared to similar survival advantages seen with surgery (HR 0.25) and ablation (HR 0.36). Wait, there was something else... Oh yeah, the cohort numbers: surgery (n=65,298), ablation (n=17,196), observation (n=18,241)...and SBRT with a BED10 >100 (n=62). TBL: If nothing else, this further supports the maxim, if you’re treating RCC with SBRT, go ablative or go home. | Grant, Adv Radiat Oncol 2020