Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada.
Department of Radiation Oncology, Sunnybrook Health Sciences Centre and the University of Toronto, Toronto, Ontario, Canada.
Eur Urol Focus. 2019 Nov;5(6):958-969. doi: 10.1016/j.euf.2019.06.002. Epub 2019 Jun 24.
Stereotactic ablative radiotherapy (SABR) is an emerging treatment option for primary renal cell carcinoma (RCC).
To systematically review the literature on SABR for primary RCC and perform a meta-analysis evaluating local control (LC), toxicity, and renal function.
A PROSPERO-registered (#115573), Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA)-based systematic review of the literature was conducted (1995-2019). Studies of SABR targeting primary RCC tumors were included, while those targeting only metastases were excluded. The primary outcome was LC defined as tumor size reduction and/or absence of local progression. Secondary outcomes included toxicity (Common Terminology Criteria for Adverse Events) and renal function (change in estimated glomerular filtration rate [eGFR]). Weighted random-effect meta-analyses using the DerSimonian and Laird method were conducted for primary and secondary outcomes. The I statistic and Cochran's Q test were used to assess heterogeneity.
From 2386 PubMed entries and 924 meeting abstracts, 26 studies were identified (11 prospective trials), including 383 tumors in 372 patients, most of whom were deemed inoperable. Weighted averages (ranges) of median follow-up, median age, and mean tumor size were 28.0 (5.8-79.2)mo, 70.4 (62-83)yr, and 4.6 (2.3-9.5)cm, respectively. RCC histology was confirmed in 78.9% of patients who underwent pretreatment biopsy. Dose fractionation varied, but 26Gy in one fraction and 40Gy in five fractions were most common. The random-effect estimates for LC, grade 3-4 toxicity, and post-SABR eGFR change were 97.2% (95% confidence interval [CI]: 93.9-99.5%, I=20%), 1.5% (95% CI: 0-4.3%, I=0%), and -7.7ml/min (95% CI: -12.5 to -2.8, I=2%), respectively, and heterogeneity was minimal. Six patients with pre-existing renal dysfunction (2.9%) required dialysis.
Renal SABR is locally effective and associated with low toxicity rates for primary RCC, despite treatment of larger tumors in older, mostly medically inoperable patients.
Stereotactic ablative radiotherapy is a high-precision, noninvasive radiation treatment requiring few outpatient visits, and represents a safe and effective management option for primary renal cell carcinoma.
立体定向消融放疗（SABR）是治疗原发性肾细胞癌（RCC）的一种新兴治疗选择。
系统地回顾 SABR 治疗原发性 RCC 的文献，并进行荟萃分析评估局部控制（LC）、毒性和肾功能。
在 PROSPERO 注册（#115573）下，进行了基于首选报告项目的系统综述和荟萃分析（PRISMA）文献系统回顾（1995-2019 年）。纳入了针对原发性 RCC 肿瘤的 SABR 研究，而排除了仅针对转移灶的研究。主要结局是肿瘤大小缩小和/或无局部进展的 LC。次要结局包括毒性（不良事件通用术语标准）和肾功能（估算肾小球滤过率[eGFR]变化）。使用 DerSimonian 和 Laird 方法进行主要和次要结局的加权随机效应荟萃分析。使用 I 统计量和 Cochran's Q 检验评估异质性。
从 2386 篇 PubMed 条目和 924 篇会议摘要中，确定了 26 项研究（11 项前瞻性试验），包括 372 名患者的 383 个肿瘤，大多数患者被认为无法手术。加权平均值（范围）的中位随访时间、中位年龄和平均肿瘤大小分别为 28.0（5.8-79.2）mo、70.4（62-83）yr 和 4.6（2.3-9.5）cm。78.9%的接受术前活检的患者证实了 RCC 组织学。剂量分割方式不同，但 26Gy 单次分割和 40Gy 五次分割最为常见。LC、3-4 级毒性和 SABR 后 eGFR 变化的随机效应估计值分别为 97.2%（95%置信区间[CI]：93.9-99.5%，I=20%）、1.5%（95% CI：0-4.3%，I=0%）和-7.7ml/min（95% CI：-12.5 至-2.8，I=2%），异质性最小。6 名（2.9%）有预先存在的肾功能不全的患者需要透析。
尽管治疗的是更大的肿瘤，而且患者年龄较大，大多无法手术，但肾 SABR 对原发性 RCC 是有效的，且毒性发生率低。
立体定向消融放疗是一种高精度、无创的放射治疗方法，需要很少的门诊就诊，是治疗原发性肾细胞癌的一种安全有效的治疗选择。
