From the Departments of Radiation Oncology.
Medical Oncology, UT Southwestern Medical Center, Dallas, TX.
Cancer J. 2020 Sep/Oct;26(5):448-459. doi: 10.1097/PPO.0000000000000475.
The incidence of renal cell carcinoma (RCC) has been increasing, with a moderate subgroup of individuals who later develop metastatic disease. Historically, metastatic RCC has been managed with systemic therapy because RCC was believed to be radioresistant. Local therapies, such as stereotactic body radiation therapy, also known as stereotactic ablative radiotherapy, which utilize focused high-dose-rate radiation delivered over a limited number of treatments, have been successful in controlling local disease and, in some cases, extending survival in patients with intracranial and extracranial metastatic RCC. Stereotactic ablative radiotherapy is highly effective in treating intact disease when patients are not surgical candidates. Stereotactic ablative radiotherapy is well tolerated when used in conjunction with systemic therapy such as tyrosine kinase inhibitors and immune checkpoint inhibitors. These successes have prompted investigators to evaluate the efficacy of stereotactic body radiation therapy in novel settings such as neoadjuvant treatment of advanced RCC with tumor thrombus and oligometastatic/oligoprogressive disease states.
肾细胞癌 (RCC) 的发病率一直在增加，其中有一部分人会发展为转移性疾病。历史上，转移性 RCC 一直采用系统治疗，因为 RCC 被认为对放疗具有抗性。局部治疗，如立体定向体部放射治疗（也称为立体定向消融放疗），利用聚焦高剂量率放射治疗，在有限的几次治疗中完成，已经成功地控制了局部疾病，并在某些情况下延长了颅内和颅外转移性 RCC 患者的生存期。对于不能手术的患者，立体定向消融放疗在治疗完整的疾病时非常有效。当与系统治疗（如酪氨酸激酶抑制剂和免疫检查点抑制剂）联合使用时，立体定向消融放疗具有良好的耐受性。这些成功促使研究人员在新的治疗环境中评估立体定向体部放射治疗的疗效，例如在伴有肿瘤血栓的晚期 RCC 的新辅助治疗中，以及在寡转移/寡进展性疾病状态中。
