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Patients with primary <jats:styled-content style=\"fixed-case\">RCC<\/jats:styled-content> were treated with 12 or 16\u2010fraction <jats:styled-content style=\"fixed-case\">CIRT<\/jats:styled-content> at The Hospital of the National Institute of Radiological Sciences outside of clinical trials. Outcome data were pooled and retrospectively analyzed for toxicity, local control, and disease\u2010free, cancer\u2010specific, and overall survival. From 1997 to 2014, 19 <jats:styled-content style=\"fixed-case\">RCC<\/jats:styled-content> patients (11 with T1aN0M0, 4 with T1bN0M0, and 4 with inoperable advanced stage [T4N0M0, T3aN1M0, and T1aN0M1]) were treated with <jats:styled-content style=\"fixed-case\">CIRT<\/jats:styled-content> and followed up for a median of 6.6 (range, 0.7\u201016.5) years; 9 of these patients were inoperable because of comorbidities or advanced\u2010stage disease. Diagnoses were confirmed by imaging in 11 patients and by biopsy in the remaining 8. In 4 of 5 patients with definitive renal comorbidities, including diabetic nephropathy, sclerotic kidney or solitary kidney pre\u2010<jats:styled-content style=\"fixed-case\">CIRT<\/jats:styled-content> progressed to grade 4 chronic kidney disease (<jats:styled-content style=\"fixed-case\">CKD<\/jats:styled-content>). In contrast, the remaining 14 patients without definitive renal comorbidities did not progress to grade 3 or higher <jats:styled-content style=\"fixed-case\">CKD<\/jats:styled-content>. Furthermore, although 1 case of grade 4 dermatitis was observed, there were no other grade 3 or higher non\u2010renal adverse events. Local control rate, and disease\u2010free, cancer\u2010specific, and overall survival rates at 5 years of all 19 patients were 94.1%, 68.9%, 100%, and 89.2%, respectively. This updated retrospective analysis based on long\u2010term follow\u2010up data suggests that <jats:styled-content style=\"fixed-case\">CIRT<\/jats:styled-content> is a safe treatment for primary <jats:styled-content style=\"fixed-case\">RCC<\/jats:styled-content> patients without definitive renal comorbidities pre\u2010<jats:styled-content style=\"fixed-case\">CIRT<\/jats:styled-content>, and yield favorable treatment outcomes, even in inoperable cases.<\/jats:p>","DOI":"10.1111\/cas.13727","type":"journal-article","created":{"date-parts":[[2018,7,7]],"date-time":"2018-07-07T09:38:35Z","timestamp":1530956315000},"page":"2873-2880","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Updated long\u2010term outcomes after carbon\u2010ion radiotherapy for primary renal cell 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