Stereotactic Body Radiation Therapy in Treating Patients With Metastatic or Recurrent Kidney Cancer

Inclusion Criteria:

- Patients must have histologically or cytologically confirmed metastatic or recurrent
RCC (any histologic subtype)

- Patients must have between 1 to 5 new or recurrent lesions suspicious for metastatic
RCC on diagnostic imaging

- Each extracranial lesion must be =< 6 cm and amenable to SBRT or surgical
excision

- Patients must have 3 or fewer brain metastases, of size =< 4 cm

- Brain metastases must be treated prior to enrollment in the study; the
modality of treatment of brain metastases can include surgical resection,
whole brain radiotherapy, stereotactic radiosurgery, or any combination of
the above

- Patients who have an intact unresected primary tumor should be considered for
radical nephrectomy and primary resection prior to enrollment in the study; if
the patient is not eligible for surgical resection, the primary tumor must be
amenable to SBRT or request for applications (RFA); generally, this will be
defined as a primary tumor < 10 cm in size or a primary lesion which can be
treated to a dose of >= 8 Gy x 5 without excessive perceived risk of toxicity

- Patients must have had at least a computed tomography (CT) of the chest, abdomen, and
pelvis within 4 weeks of registration in the trial; CT or magnetic resonance imaging
(MRI) of the brain is only required in the presence of neurologic symptoms

- Patients must have had no radiotherapy, immunotherapy, chemotherapy or therapy with
targeted agents within the last 1 month

- Patients may not have had prior bevacizumab, based on case reports of
tracheoesophageal fistula in patients treated with bevacizumab and radiotherapy

- Eastern Cooperative Oncology Group (ECOG) performance status =<2

- Age 18 years or older

- Life expectancy of >= 3 months

- Patients must have normal organ and marrow function within 30 days of registration, as
defined below:

- Absolute neutrophil count >= 500/mcL

- Hemoglobin >= 8.0 g/dL

- Platelets >= 50,000/mcL

- Total bilirubin within normal institutional limits

- Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase
[SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase
[SGPT]) =< 3 X institutional upper limit of normal if liver metastases are
present

- Women of childbearing potential must have a negative pregnancy test within 14 days of
registration

- Patients must have the ability to understand and the willingness to sign a written
informed consent document

Exclusion Criteria:

- Patients who have had prior chemotherapy, immunotherapy, targeted therapy, or
radiotherapy within 1 month of enrollment

- Patients who have had any prior bevacizumab, due to case reports suggesting a possible
risk of severe toxicity in combination with radiotherapy

- Patients with radiographic or clinical findings of spinal cord compression or cauda
equina syndrome with neurologic deficit thought to be due to malignancy

- Patients may not be receiving any systemic anti-cancer agents or other investigational
agents during radiation therapy

- Patients may not have received prior radiation therapy to a site of recurrence which
would require overlap of appreciable radiation dose

- Known active invasive malignancy except for renal cell carcinoma and/or non-melanoma
skin cancer

- Severe, active co-morbidity, defined as follows:

- Unstable angina and/or congestive heart failure requiring hospitalization within
the last 6 months prior to registration;

- Transmural myocardial infarction within the last 6 months prior to registration;

- Acute bacterial or fungal infection requiring intravenous antibiotics at the time
of registration;

- Chronic obstructive pulmonary disease exacerbation or other respiratory illness
requiring hospitalization or precluding study therapy within 30 days prior to
registration;

- Severe hepatic disease, defined as a diagnosis of Child-Pugh class B or C hepatic
disease if the liver is involved with metastatic disease;

- Human immunodeficiency virus (HIV) positive with cluster of differentiation (CD)4
count < 200 cells/microliter; note that patients who are HIV positive are
eligible, provided they are under treatment with highly active antiretroviral
therapy (HAART) and have a CD4 count >= 200 cells/microliter within 30 days prior
to registration; note also that HIV testing is not required for eligibility for
this protocol

- Pregnancy or women of childbearing potential who are sexually active and not
willing/able to use medically acceptable forms of contraception during protocol
treatment or for at least 6 months following treatment