Ponsky Lee E, Mahadevan Arul, Gill Indebir S, Djemil Toufik, Novick Andrew C
Center for Urologic Oncology and Minimally Invasive Therapies, University Hospitals Case Medical Center, Cleveland, OH 44106, USA.
Surg Innov. 2007 Dec;14(4):265-9. doi: 10.1177/1553350607310546.
The purpose of this study was to determine whether radiosurgical technology can be safely applied to renal tumors. Patients received radiosurgical treatment of renal lesions. At 8 weeks after radiosurgical treatment, patients underwent a partial or radical nephrectomy and histologic evaluation. The patients received a radiation dose of 4 Gy per fraction for 4 fractions. Patients were followed, and radiation-induced toxicities were noted. Three patients were treated for a minimum of 1 year of follow-up. All patients completed the treatments, tolerating each of the 4 fractions with no adverse events. No acute toxicities or changes in renal function were noted. None of the patients had any evidence of acute radiation injury or toxicity noted at the time of surgery or within the subsequent 12 months after the radiosurgical treatment. The last patient treated was found to have a cavity with no microscopic evidence of viable tumor after radiosurgical treatment; pathology was consistent with necrotic renal cell carcinoma, papillary type. The other 2 tumors demonstrated pathologic evidence of viable renal cell carcinoma (grade I and grade II). Tumor size remained relatively unchanged for 8 weeks after the radiosurgical treatment in all patients. The authors are extremely encouraged and cautiously optimistic with the initial results. Radiosurgery for renal tumors appears to be safe at this initial dose level.
本研究的目的是确定放射外科技术是否能安全应用于肾肿瘤。患者接受了肾病变的放射外科治疗。在放射外科治疗8周后，患者接受了部分或根治性肾切除术及组织学评估。患者每次接受4 Gy的辐射剂量，共4次。对患者进行随访，并记录辐射诱发的毒性反应。3例患者接受了至少1年的随访。所有患者均完成治疗，耐受了4次治疗中的每一次，未出现不良事件。未观察到急性毒性反应或肾功能变化。在手术时或放射外科治疗后的随后12个月内，没有患者有任何急性放射损伤或毒性反应的证据。最后一名接受治疗的患者在放射外科治疗后发现有一个空洞，没有显微镜下可见的存活肿瘤证据；病理结果与坏死性肾细胞癌（乳头状型）一致。另外2个肿瘤显示有存活肾细胞癌的病理证据（I级和II级）。在所有患者中，放射外科治疗后8周肿瘤大小相对保持不变。作者对初步结果极为鼓舞并持谨慎乐观态度。在这个初始剂量水平下，肾肿瘤的放射外科治疗似乎是安全的。
