Shout out to the SAMURAI protocol for looking at what we should’ve been doing 20 years ago.
Treating the primary w/ SABR in metastatic RCC is such a no-brainer. No downtime and no seeding like CARMENA.
Many of these tumors have vascular involvement and are obvious seeders.
This is a young KPS 100 gentleman with newly diagnosed RCC with a few brain mets, a few small lung mets, and a 9cm primary.
He got postop fSRS to brain met cavity with treatment of two intact lesions w/in 2 wks surgery.
He’ll get 4500/5fx SABR (w/ GTV SIB to 5500) to the primary completed w/in 3 wks.
All this completed before insurance has even finished authing his initial dose of keytruda/lenvima.
Small lung nodules will be systemic therapy index, and can be SBRT’d to NED if they don’t respond.