Phase 2 trial: neoadjuvant radiation before IVC thrombectomy for RCC appears feasible

Phase 1-2 · JAMA Oncol · 2026-10-16. Number 2 in the UrologyWatch Top 5 for October 22, 2026.

Single-center prospective phase 2 nonrandomized trial gave neoadjuvant stereotactic ablative radiotherapy to IVC tumor thrombus before nephrectomy/thrombectomy in 23 patients with RCC; 22 completed surgery and 21 were evaluable for the primary 1-year recurrence-free survival endpoint, compared with a prespecified historical surgery-alone benchmark of 55.7%.

Why it matters: Offers a potential neoadjuvant strategy for a high-risk, technically challenging RCC subgroup with IVC tumor thrombus lacking established local therapies, pending larger confirmatory studies.

Limitation: Single-center, nonrandomized, small sample (21 evaluable), compared against a historical rather than concurrent control.

Source: JAMA Oncol · PubMed 42879162 · DOI 10.1001/jamaoncol.2026.4172

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