Prins Fieke M, Kerkmeijer Linda G W, Pronk Anne A, Vonken Evert-Jan P A, Meijer Richard P, Bex Axel, Barendrecht Maurits M
1 Department of Radiation Oncology, University Medical Center Utrecht , Utrecht, The Netherlands .
2 Department of Urology, Tergooi Hospital , Hilversum, The Netherlands .
J Endourol. 2017 Oct;31(10):963-975. doi: 10.1089/end.2017.0382. Epub 2017 Aug 22.
The standard treatment of T1 renal cell carcinoma (RCC) is (partial) nephrectomy. For patients where surgery is not the treatment of choice, for example in the elderly, in case of severe comorbidity, inoperability, or refusal of surgery, alternative treatment options are available. These treatment options include active surveillance (AS), radiofrequency ablation (RFA), cryoablation (CA), microwave ablation (MWA), or stereotactic body radiotherapy (SBRT). In the present overview, the efficacy, safety, and outcome of these different options are summarized, particularly focusing on recent developments.
Databases of MEDLINE (through PubMed), EMBASE, and the Cochrane Library were systematically searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. The search was performed in December 2016, and included a search period from 2010 to 2016. The terms and synonyms used were renal cell carcinoma, active surveillance, radiofrequency ablation, microwave ablation, cryoablation and stereotactic body radiotherapy.
The database search identified 2806 records, in total 73 articles were included to assess the rationale and clinical evidence of alternative treatment modalities for small renal masses. The methodological quality of the included articles varied between level 2b and level 4.
Alternative treatment modalities, such as AS, RFA, CA, MWA, and SBRT, are treatment options especially for those patients who are unfit to undergo an invasive treatment. There are no randomized controlled trials available comparing surgery and less invasive modalities, leading to a low quality on the reported articles. A case-controlled registry might be an alternative to compare outcomes of noninvasive treatment modalities in the future.
T1期肾细胞癌（RCC）的标准治疗方法是（部分）肾切除术。对于那些手术并非首选治疗方式的患者，例如老年人、存在严重合并症、无法手术或拒绝手术的患者，有其他替代治疗方案可供选择。这些治疗方案包括主动监测（AS）、射频消融（RFA）、冷冻消融（CA）、微波消融（MWA）或立体定向体部放疗（SBRT）。在本综述中，总结了这些不同方案的疗效、安全性和结果，尤其关注了近期的进展。
根据系统评价和Meta分析的首选报告项目（PRISMA）标准，系统检索了MEDLINE（通过PubMed）、EMBASE和Cochrane图书馆的数据库。检索于2016年12月进行，纳入的检索时间段为2010年至2016年。使用的检索词及同义词包括肾细胞癌、主动监测、射频消融、微波消融、冷冻消融和立体定向体部放疗。
数据库检索共识别出2806条记录，总共纳入73篇文章以评估小肾肿块替代治疗方式的理论依据和临床证据。纳入文章的方法学质量在2b级至4级之间有所不同。
替代治疗方式，如AS、RFA、CA、MWA和SBRT，尤其适用于那些不适合接受侵入性治疗的患者。目前尚无比较手术和侵入性较小治疗方式的随机对照试验，导致所报道文章的质量较低。病例对照登记可能是未来比较非侵入性治疗方式结果的一种替代方法。
