Prospective Study of Interstitial Brachytherapy for Unresectable/Unablatable T1b/T2a Renal Masses
This phase I/II trial investigates the side effects of interstitial brachytherapy and to see how well it works in limiting the growth of large kidney cancer masses in patients with kidney cancer that have refused or are unable to undergo surgery or ablation (unresectable/unablatable). Brachytherapy, also known as internal radiation therapy, temporarily introduces a radiation source into or near the tumor to eradicate the tumor cells. Giving brachytherapy may potentially reduce the size of the kidney cancer mass that would otherwise not be amenable to surgical management and translate into lower risk of spread.
⁃ Elected to undergo interstitial brachytherapy as part of conventional treatment for renal cell carcinoma
⁃ Biopsy proven renal cell carcinoma
⁃ No definitive evidence of locally advanced (nodal or tumor thrombus) or distant (metastatic) disease
⁃ Lesion size (maximal dimension) of 4 to 10 cm
⁃ Patient not a candidate for curative surgery (unwilling or unable to pursue surgery)
⁃ Lesion cannot be reliably treated with ablative techniques
⁃ Entire lesion able to be treated adequately by brachytherapy per radiation oncologist
⁃ Tumor predominantly solid (\
• \> 80%)
⁃ Lesion that has been observed for \>= 6 months with demonstrable growth rate anticipated to be \>= 4 mm/year by same imaging modality
⁃ Renal tumor that is amenable to percutaneous access for interstitial renal brachytherapy (Institutional Review Board \[IRB\])
⁃ Hemoglobin \> 9
⁃ Absolute neutrophil count (ANC) \>= 1500/uL (microliter)
⁃ Platelets \>= 100,000/uL
⁃ Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =\< 3.0 upper limit of normal (ULN)
⁃ Total bilirubin =\< ULN
⁃ A competent immune system
⁃ Estimated glomerular filtration rate (eGFR) \>= 30
⁃ Good performance status (Eastern Cooperative Oncology Group \[ECOG\]) \< 2
⁃ Understanding and willingness to provide consent
⁃ No prior systemic treatment for kidney cancer
⁃ Women of childbearing potential must have negative pregnancy test at start of therapy