A Phase I Evaluating Integration of HypofractionatedStudy Renal Ablative Radiotherapy

Inclusion Criteria: Eligibility Criteria

• Patients must have histologically confirmed carcinoma of the kidney
• Patients must be able to tolerate extended treatment time 30 minutes for MVCT andtreatment delivery) for radiation on the tomotherapy unit
• Patients must have confirmed metastatic disease, nodal or locally advanced diseaseeither by biopsy or imaging
• Informed consent performed and documented
• Patients must have one of a) unresectable local disease, b) be medically inoperable,or c) chosen against having a local surgical treatment
• Age ≥ 18
• Patients previously received any targeted therapy or immunotherapy for RCC, are alsoeligible. Patients must be off these agents for a minimum of 2 weeks prior toradiation therapy to be eligible

Exclusion Criteria:

• Patients without an adequate functioning contralateral kidney as seen on renalperfusion scan (>40% of total renal flow)
• Patients with poor baseline renal function, represented by a creatinine clearance < 50mL/minute based on the Cockcroft-Gault approximation method
• Patients with a creatinine clearance < 50 ml/minute are still eligible if theipsilateral kidney has <25% of the total renal flow on a renal perfusion scan. × constant Serum creatinine ( in µmol/L) constant =male is 1.23, women is 1.04)
• Previous abdominal radiotherapy
• Bilateral RCC
• Diagnosis of transitional cell carcinoma, squamous cell carcinoma, or a non epithelialcancer of the kidney
• Diagnosis of any other malignancy in previous 5 years, excluding non-melanoma skincancer -Known active malignancy other than RCC, excluding non-melanoma skin cancer
• Estimated (by treating radiation oncologist) life expectancy of less than 8 weeks
• Pregnant or breast-feeding women
• Concurrent illness in addition to RCC that would make radiotherapy delivery undulychallenging, including but not limited to, severe congestive heart failure or othercardiorespiratory conditions, severe neuromuscular disorders, ongoing or activeinfections, and psychiatric illness
• Medical conditions for which radiation is contraindicated, including but not limitedto, scleroderma, systemic lupus erythematosus and ataxia teleangiectasia - Patientswith excessive kidney motion on pre-planning 4D-CT scan that would prevent safedelivery of radiotherapy with gated or non-gated techniques
• Patients taking concurrent medication that can interfere with the safe delivery ofradiation (e.g. radiosensitizers)
• Urology opinion recommends partial nephrectomy as cytoreductive atment --Expected TKItherapy to be initiated during initial 2 weeks completion of radiotherapy.