Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX.
Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA.
Clin Genitourin Cancer. 2018 Aug;16(4):e935-e943. doi: 10.1016/j.clgc.2018.03.015. Epub 2018 Apr 3.
Because renal cell carcinoma (RCC) has been traditionally considered a "radioresistant" histology, it may be advantageous to treat brain metastases (BMs) with ablative dosing by means of stereotactic radiosurgery (SRS). This is the first known analysis evaluating utilization of SRS for RCC BMs in the United States.
The National Cancer Data Base was queried (2005-2014) for metastatic RCC and delivery of intracranial radiotherapy. Patients were stratified into groups receiving either SRS or non-SRS treatment. Multivariable logistic regression ascertained factors associated with SRS administration. Secondary exploratory Kaplan-Meier overall survival (OS) analysis without and with propensity matching, along with Cox proportional hazards modeling evaluated predictors of OS.
Of 2312 patients, 813 (35%) received SRS, whereas 1499 (65%) received non-SRS radiotherapy. Use of SRS increased from 27% in 2005 to 44% in 2014. Patients receiving SRS tended to reside farther from the treating facility, received therapy at academic centers, and underwent chemotherapy and/or nephrectomy (P < .05). SRS was less often given to persons with lower income and who were uninsured/had Medicaid (P < .05). Higher OS was observed in the SRS cohort both before and following propensity matching; on subset analysis, differences persisted when stratifying for nephrectomy and lack thereof (P < .001 for all). Treatment at an academic center independently predicted for higher OS.
SRS for RCC BMs is rising; this is driven by multiple socioeconomic disparities, which needs to be better addressed to ensure high-quality care for all patients. Treatment with SRS was associated with higher survival; further prospective studies are warranted to confirm these findings.
由于肾细胞癌（RCC）传统上被认为是一种“放射抗拒”的组织学类型，因此用立体定向放射外科（SRS）进行消融剂量治疗脑转移瘤（BMs）可能是有利的。这是首次在美国评估 SRS 治疗 RCC BMs 的应用的分析。
国家癌症数据库（2005-2014 年）查询转移性 RCC 和颅内放疗的应用情况。患者分为接受 SRS 或非 SRS 治疗的组。多变量逻辑回归确定了与 SRS 给药相关的因素。无和有倾向匹配的二次探索性 Kaplan-Meier 总体生存（OS）分析，以及 Cox 比例风险模型评估 OS 的预测因素。
在 2312 名患者中，813 名（35%）接受了 SRS，1499 名（65%）接受了非 SRS 放疗。2005 年 SRS 的使用率为 27%，2014 年增加到 44%。接受 SRS 的患者倾向于居住在离治疗中心更远的地方，在学术中心接受治疗，并且接受化疗和/或肾切除术（P<0.05）。SRS 较少用于收入较低、没有保险/拥有医疗补助的人群（P<0.05）。SRS 组在进行倾向匹配之前和之后均观察到更高的 OS；在亚组分析中，当对肾切除术和无肾切除术进行分层时，差异仍然存在（所有 P<0.001）。在学术中心治疗独立预测更高的 OS。
RCC BMs 的 SRS 应用正在增加；这是由多种社会经济差异驱动的，需要更好地解决这些差异，以确保为所有患者提供高质量的护理。SRS 治疗与更高的生存率相关；需要进一步的前瞻性研究来证实这些发现。
