Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium.
Department of Clinical Oncology, Royal Marsden NHS Foundation Trust, London, UK.
Lancet Oncol. 2014 Apr;15(4):e170-7. doi: 10.1016/S1470-2045(13)70569-2.
Renal-cell carcinoma is considered to be a radioresistant tumour, but this notion might be wrong. If given in a few (even single) fractions, but at a high fraction dose, stereotactic body radiotherapy becomes increasingly important in the management of renal-cell carcinoma, both in primary settings and in treatment of oligometastatic disease. There is an established biological rationale for the radiosensitivity of renal-cell carcinoma to stereotactic body radiotherapy based on the ceramide pathway, which is activated only when a high dose per fraction is given. Apart from the direct effect of stereotactic body radiotherapy on renal-cell carcinoma, stereotactic body radiotherapy can also induce an abscopal effect. This effect, caused by immunological processes, might be enhanced when targeted drugs and stereotactic body radiotherapy are combined. Therefore, rigorous, prospective randomised trials involving a multidisciplinary scientific panel are needed urgently.
肾细胞癌被认为是一种放射抗拒肿瘤，但这种观点可能是错误的。如果采用立体定向体部放射治疗，在较少（甚至单次）分割的情况下给予高分割剂量，那么立体定向体部放射治疗在肾细胞癌的治疗中变得越来越重要，无论是在原发性疾病还是治疗寡转移疾病中。基于神经酰胺通路，立体定向体部放射治疗对肾细胞癌具有放射敏感性，这一生物学原理已经得到确立，只有在给予高剂量/分数时才会被激活。除了立体定向体部放射治疗对肾细胞癌的直接作用外，立体定向体部放射治疗还可以诱导远隔效应。这种由免疫过程引起的效应在靶向药物和立体定向体部放射治疗联合使用时可能会增强。因此，迫切需要涉及多学科科学小组的严格、前瞻性随机试验。
