A Pilot Study of SBRT With Adjuvant Pazopanib for Renal Cell Cancer

Inclusion Criteria

• •Patient is considered a poor surgical candidate for removal of a renal mass as determined by pre-operative assessment due to the following factors or various combinations thereof:
• •* Significant comorbidity precluding ability to deliver anesthesia, without compromised ability to undergo systemic chemotherapy with pazopanib as deemed by the Urologist and Medical Oncologist
• •* Medically documented contraindication for surgery due to religion or risk of blood transfusion
• •* Size or location of tumor deemed high risk for surgical intervention by Urologist
• •* Unacceptable risk for anesthesia, such as history of malignant hyperthermia
• •* Any one of these factors may or may not constitute unresectability, but for consideration for this trial, the surgical and medical oncologist must agree that the particular constellation of findings for the patient under consideration would likely entail a low probability (\< 50%) that the tumor would be resectable (with negative margins) or that the potential morbidity associated with an attempt at surgical resection would not be clinically acceptable
• •* The numerical thresholds noted above are only a guideline and the clinical judgment of the surgeon and medical oncologist will determine unresectability or if patient refuses surgery or other forms of local therapy; the histopathology for this cohort is limited to clear cell carcinoma of the kidney
• •Patient is able to give and sign study specific informed consent
• •Negative serum or urine pregnancy test within 72 hours prior to registration for women of childbearing potential and agrees to use contraception for the duration of the treatment cycle and for a minimum of 30-days following the end of therapy (a minimum estimate 95 days)
• •Patient has a pathologically confirmed diagnosis of clear cell RCC
• •Karnofsky status of ≥ 70%
• •Subject has no contraindication for computed tomography (CT) and/or magnetic resonance imaging (MRI) during screening and is able to complete a screening examination; CT and/or MRI within 6 months of screening is required
• •Patient has inadequate organ function as defined by:
• •* Serum aspartate transaminase (AST; serum glutamic oxaloacetic transaminase \[SGOT\]) and serum alanine transaminase (ALT; serum glutamic pyruvic transaminase \[SGPT\]) =\< 2.5 x laboratory upper limit of normal (ULN)
• •* Total serum bilirubin \< 1.5 x ULN
• •* Absolute neutrophil count (ANC) \> 1500/uL
• •* Platelets \> 100,000/uL
• •* Hemoglobin \> 9.0 g/dL (no transfusion permitted within 1 week)
• •* Serum creatinine \< 2.5 mg/dL
• •* Urine to protein to creatinine (UPC) ratio \< 1; if UPC \> 1, then a 24-hour urine protein must be assessed; subjects must have a 24-hour urine protein value \< 1 g to be eligible
• •* Prothrombin time (PT) or international normalized ratio (INR) and partial thromboplastin time (PTT) \< 1.2 X upper limit of normal (ULN)