Division of Urology, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois.
Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Cancer. 2018 Sep 15;124(18):3641-3655. doi: 10.1002/cncr.31341. Epub 2018 Apr 24.
Despite the rapid elaboration of multiple, novel systemic agents introduced for metastatic renal cell carcinoma (mRCC) in recent years, a durable complete response remains elusive with systemic therapy alone. Definitive treatment of the metastatic deposit remains the sole potentially curative option and is a cornerstone of mRCC therapy, offering potential for both local control and palliation of tumor-related symptoms. In this review, the evidence supporting the definitive treatment of mRCC is examined and summarized, including the use of surgical metastasectomy, thermal ablation, radiotherapy, and other minimally invasive options. Multimodal approaches, including the combination of metastasectomy with novel systemic agents, are discussed. Finally, the authors review considerations for patient selection for this type of therapy and summarize available risk-stratification tools that may help guide shared decision making.
尽管近年来针对转移性肾细胞癌 (mRCC) 引入了多种新型系统药物，但单独采用系统治疗仍难以实现持久的完全缓解。明确治疗转移性病灶仍然是唯一潜在的治愈选择，也是 mRCC 治疗的基石，为局部控制和缓解肿瘤相关症状提供了可能。在这篇综述中，检查并总结了支持 mRCC 确定性治疗的证据，包括手术转移灶切除术、热消融、放疗和其他微创选择的应用。讨论了包括转移灶切除术与新型系统药物联合应用的多模式方法。最后，作者回顾了此类治疗患者选择的考虑因素，并总结了可能有助于指导共同决策的现有风险分层工具。
