Singh Raj, Ansinelli Hayden, Sharma Dana, Jenkins Jan, Davis Joanne, Sharma Sanjeev, Vargo John Austin
Department of Radiation Oncology, Virginia Commonwealth University Health System, Richmond, VA 23298, USA.
Department of Radiation Oncology, University of Arizona, Tucson, AZ 85719, USA.
J Radiosurg SBRT. 2020;7(1):29-37.
Examine local control(LC), overall survival(OS), and toxicity following stereotactic body radiation therapy(SBRT) for patients with metastatic renal cell carcinoma(mRCC). A multi-institutional registry was queried. Potential predictive factors of LC and OS were evaluated with a Cox-proportional hazards model for multivariate analysis(MVA). We identified 115 mRCC patients with 181 lesions. Median biologically effective dose (BED) was 72.9 Gy (range: 42.9-231.4 Gy) with a median dose/fraction of 10 Gy (range: 5-24 Gy). Utilizing both Karnofsky Performance Score (KPS) and presence of osseous metastatic disease as prognostic indicators, estimated 2-year OS rates were 67.7% (95% CI: 49.9-89.5%), 31.8% (95% CI: 19.0-45.3%), and 20% (95% CI: 1.4-54.7%; p=0.0012). One- and 2-year LC rates were 88.2% and 82.7%, respectively, with no prognostic factors identified. Roughly 13% of patients reported toxicities with one Grade 3-5 toxicity. SBRT was well-tolerated with promising LC. Both KPS and osseous metastatic disease should be considered in determining which patients with mRCC may preferentially benefit from SBRT.
研究立体定向体部放射治疗（SBRT）用于转移性肾细胞癌（mRCC）患者后的局部控制（LC）、总生存期（OS）及毒性反应。查询了一个多机构登记数据库。采用Cox比例风险模型进行多变量分析（MVA），评估LC和OS的潜在预测因素。我们纳入了115例mRCC患者的181个病灶。生物等效剂量（BED）中位数为72.9 Gy（范围：42.9 - 231.4 Gy），中位分次剂量为10 Gy（范围：5 - 24 Gy）。以卡诺夫斯基功能状态评分（KPS）和骨转移疾病的存在作为预后指标，估计2年总生存率分别为67.7%（95%CI：49.9 - 89.5%）、31.8%（95%CI：19.0 - 45.3%）和20%（95%CI：1.4 - 54.7%；p = 0.0012）。1年和2年局部控制率分别为88.2%和82.7%，未发现预后因素。约13%的患者报告有不良反应，其中1例为3 - 5级毒性反应。SBRT耐受性良好，局部控制效果良好。在确定哪些mRCC患者可能优先从SBRT中获益时，应同时考虑KPS和骨转移疾病。
