Neoplasma. 2016;63(1):99-106. doi: 10.4149/neo_2016_012.
Our purpose was to evaluate the efficacy of stereotactic radiotherapy (SRT) for intracranial and extracranial metastases in patients with renal cell carcinoma. The retrospective analysis of 85 patients (151 tumors) treated with SRT was performed. SRT was the sole treatment in 35% of tumors, the other 65% had received additional treatment such as surgery, palliative radiotherapy, immunotherapy or chemotherapy. In 60% and 40% of patients SRT was delivered to brain and extracranial lesions, respectively. The assessment of the efficacy of SRT was based on a radiological imaging (Computed Tomography or Magnetic Resonance Imaging) and estimation of Local Control (LC) as well as Overall Survival (OS). Single fraction was used for 104 tumors and fractionated treatment for 47 tumors. The crude LC for evaluable lesions was 81%, stratified by tumor location: brain LC=94%, extracranial tumors LC=70% (p=0.049). The median OS was 9.4 months; 1-year and 2-year OS were 40% and 29%, respectively. The additional treatment did not lead to a better local response (p=0,543), but resulted in a benefit in OS (7 vs 13 months, p=0,01). A positive relationship between the biologically effective dose (BED) and local response was noted, but the BED was influenced by a tumor volume (R=-0,38; p<0,00001). The presence of multi-organ metastases reduced the OS rate (8.7 vs 19.1 months; p=0,01). The interval between the diagnosis of the metastasis and its treatment with SRT was inversely related to OS (P=0.0001). SRT results in a good local response, which is more beneficial for brain than extracranial lesions. The local efficacy of the SRT depends on the radiation dose. Multidisciplinary treatment and earlier application of SRT improves the prognosis of patients.
我们的目的是评估立体定向放疗（SRT）治疗肾细胞癌患者颅内和颅外转移的疗效。对 85 例（151 个肿瘤）接受 SRT 治疗的患者进行了回顾性分析。35%的肿瘤仅接受 SRT 治疗，其余 65%的肿瘤接受了手术、姑息性放疗、免疫治疗或化疗等其他治疗。60%和 40%的患者分别接受 SRT 治疗脑内和颅外病变。SRT 疗效评估基于影像学（计算机断层扫描或磁共振成像）和局部控制（LC）及总生存（OS）的估计。104 个肿瘤采用单次分割，47 个肿瘤采用分次治疗。可评价病灶的粗 LC 为 81%，按肿瘤部位分层：脑 LC=94%，颅外肿瘤 LC=70%（p=0.049）。中位 OS 为 9.4 个月；1 年和 2 年 OS 分别为 40%和 29%。辅助治疗并未导致更好的局部反应（p=0.543），但在 OS 方面有获益（7 个月与 13 个月，p=0.01）。观察到生物有效剂量（BED）与局部反应之间存在正相关，但 BED 受肿瘤体积影响（R=-0.38；p<0.00001）。多器官转移的存在降低了 OS 率（8.7 个月与 19.1 个月；p=0.01）。转移诊断与 SRT 治疗之间的间隔时间与 OS 呈负相关（P=0.0001）。SRT 可获得良好的局部反应，对脑转移瘤的疗效优于颅外转移瘤。SRT 的局部疗效取决于辐射剂量。多学科治疗和尽早应用 SRT 可改善患者预后。
