Simple Summary Renal cancer is the eighth most frequent cancer in Europe, and its
prevalence is increasing. Surgery is the treatment of choice for localised renal cell
carcinoma requiring interventional management, but less invasive treatment methods
are emerging. Stereotactic body radiotherapy (SBRT) utilises precise delivery of high
doses of radiation to ablate the primary cancer. In our systematic review and meta-analysis,
we pooled data from available prospective trials, including 13 studies involving 308
patients. The results of the meta-analysis show that SBRT for localised renal cell
carcinoma is highly effective in controlling local diseases and has low complication
rates. In the second year, 97% of patients were free from local recurrence. Only 3%
experienced severe adverse events, which included abdominal pain and fatigue. SBRT
presents a valuable treatment for patients who require treatment but cannot undergo
surgery; however, it has not been yet confirmed to be equieffective to surgery as
trials directly comparing these methods are missing.Abstract Context: Surgery is the
gold standard for the local treatment of primary renal cell carcinoma (RCC), but alternatives
are emerging. We conducted a systematic review and meta-analysis to assess the results
of prospective studies using definitive stereotactic body radiotherapy (SBRT) to treat
primary localised RCC. Evidence acquisition: This review was prospectively registered
in PROSPERO (CRD42023447274). We searched PubMed, Embase, Scopus, and Google Scholar
for reports of prospective studies published since 2003, describing the outcomes of
SBRT for localised RCC. Meta-analyses were performed for local control (LC), overall
survival (OS), and rates of adverse events (AEs) using generalised linear mixed models
(GLMMs). Outcomes were presented as rates with corresponding 95% confidence intervals
(95% CIs). Risk-of-bias was assessed using the ROBINS-I tool. Evidence synthesis:
Of the 2983 records, 13 prospective studies (n = 308) were included in the meta-analysis.
The median diameter of the irradiated tumours ranged between 1.9 and 5.5 cm in individual
studies. Grade >= 3 AEs were reported in 15 patients, and their estimated rate was
0.03 (95%CI: 0.01-0.11; n = 291). One- and two-year LC rates were 0.98 (95%CI: 0.95-0.99;
n = 293) and 0.97 (95%CI: 0.93-0.99; n = 253), while one- and two-year OS rates were
0.95 (95%CI: 0.88-0.98; n = 294) and 0.86 (95%CI: 0.77-0.91; n = 224). There was no
statistically significant heterogeneity, and the estimations were consistent after
excluding studies at a high risk of bias in a sensitivity analysis. Major limitations
include a relatively short follow-up, inhomogeneous reporting of renal function deterioration,
and a lack of prospective comparative evidence. Conclusions: The short-term results
suggest that SBRT is a valuable treatment method for selected inoperable patients
(or those who refuse surgery) with localised RCC associated with low rates of high-grade
AEs and excellent LC. However, until the long-term data from randomised controlled
trials are available, surgical management remains a standard of care in operable patients.
