Authors' objectives: We identified and summarised evidence addressing the following review question: what is the clinical and cost effectiveness of stereotactic ablative radiotherapy (SABR) for primary kidney cancer compared to standard care?

Authors' results and conclusions: We identified two systematic reviews and one meta-analysis investigating the use of SABR in renal cell carcinoma, but we were unable to use the pooled results from the meta-analysis as some of the included patients had metastatic disease. The vast majority of the evidence we identified comes from single-arm studies. Local control rates ranged from 75% to 100% with SABR. The only studies we found involving a comparator came from two retrospective analyses of the same American cancer database. SABR was associated with an increased overall survival compared with observation, but a worse overall survival compared to partial nephrectomy or thermal ablation. The majority of reported adverse events with SABR were mild. Serious adverse events were reported as occurring in between 0 to 19% of patients. Tumour recurrence rates with SABR were reported as being between 0% and 8.1%. There were mixed findings for post-SABR estimated glomerular filtration rate. Quality of life appeared to be well-preserved at six-months following SABR. No relevant health economic studies were identified in the literature review. An economic analysis developed by HTW considering the cost-effectiveness of SABR in people who cannot be managed using surgery or invasive ablation techniques found SABR to be more effective but more costly than standard care. The resulting incremental cost-effectiveness ratio (ICER) of £1,675 per quality-adjusted life year (QALY) indicates that SABR is cost effective.

Authors' recommendations: The evidence supports the routine adoption of stereotactic ablative radiotherapy (SABR) to treat people with primary kidney cancer who are not suitable for surgery or other ablative techniques. The use of SABR provides a treatment option that may improve survival in patients who would otherwise have no other treatment options available. Patient selection for SABR should be undertaken by a cancer multidisciplinary team. Economic modelling estimates that the use of SABR is cost effective when compared with clinical surveillance, with a cost per quality-adjusted life year (QALY) of £1,675.

Authors' methods: The Evidence Appraisal Report is based on a literature search (strategy available on request) for published clinical and economic evidence on the health technology of interest. It is not a full systematic review but aims to identify the best available evidence on the health technology of interest. Researchers critically evaluate and synthesise this evidence. We include the following clinical evidence in order of priority: systematic reviews; randomised trials; non-randomised trials. We only include evidence for “lower priority” evidence where outcomes are not reported by a “higher priority” source. We also search for economic evaluations or original research that can form the basis of an assessment of costs/cost comparison. We carry out various levels of economic evaluation, according to the evidence that is available to inform this.

Authors' identified further research: The Appraisal Panel recommended the collection of real-world evidence on cancer-related and survival outcomes in people with localised kidney cancer treated with SABR in Wales, for example with a registry or audit.

Project Status: Completed

Year Published: 2022

URL for published report: https://healthtechnology.wales/reports-guidance/stereotactic-ablative-radiotherapy-sabr/

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Wales, United Kingdom

Organisation Name: Health Technology Wales

Contact Address: c/o Digital Health Care Wales, 21 Cowbridge Road East Cardiff CF11 9AD

Contact Name: Susan Myles, PhD

Contact Email: healthtechnology@wales.nhs.uk

Copyright: Health Technology Wales