Wei Qinghong, He Hongmei, Lv Long, Xu Xiaoying, Sun Weibing
Department of Radiation Oncology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China.
Department of medical Oncology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China.
Transl Androl Urol. 2020 Dec;9(6):2821-2830. doi: 10.21037/tau-20-1466.
Traditionally, renal cell carcinoma (RCC) has been regarded to be "radioresistant". Conventional fractionated radiation (CFRT) has played a limited role in RCC as a palliative treatment to relieve pain and bleeding. Succeed to the rapid development of precise radiotherapy techniques, realizing safe delivery of high-dose radiotherapy, an increasing amount of convincing data suggests that the delivery of high-dose-per-fraction radiation through stereotactic radiosurgery (SRS) or stereotactic body radiation therapy (SBRT), also known as stereotactic ablative radiotherapy (SABR) can help to overcome resistance to radiotherapy. Herein, we summarized and analyzed the data from randomized controlled trials, retrospective and prospective studies, and meta-analyses relating to the treatment of advanced and metastatic RCC (mRCC) with CFRT, SBRT, or SBRT combined with systemic therapy. CFRT has a limited effect on local control (LC) of advanced RCC and mRCC, but it is a major palliative treatment which could obviously relieve pain caused by cancer. SBRT and SRS have the significant advantage of being able to precisely deliver a high dose of radiation to the target tissues. SBRT could cause a higher LC for advanced and metastatic RCC and could be used as an alternative to surgery for patients with oligometastatic RCC. The combination of SBRT with systemic therapy, such as targeted therapy or immunotherapy, is safe and tolerable. Concurrent immunotherapy and SBRT is a promising treatment strategy for patients with advanced or metastatic RCC. However, research on radiotherapy combined with systemic therapy is still limited and further studies to explore this treatment for RCC are urgently needed.
传统上，肾细胞癌（RCC）被认为是“放射抗拒性的”。常规分割放疗（CFRT）在RCC作为缓解疼痛和出血的姑息性治疗中作用有限。随着精确放疗技术的迅速发展，实现了高剂量放疗的安全实施，越来越多有说服力的数据表明，通过立体定向放射外科（SRS）或立体定向体部放疗（SBRT，也称为立体定向消融放疗[SABR]）进行高剂量单次分割放疗有助于克服放疗抵抗。在此，我们总结并分析了来自随机对照试验、回顾性和前瞻性研究以及荟萃分析的数据，这些数据与CFRT、SBRT或SBRT联合全身治疗晚期和转移性RCC（mRCC）的治疗有关。CFRT对晚期RCC和mRCC的局部控制（LC）效果有限，但它是一种主要的姑息性治疗方法，可明显缓解癌症引起的疼痛。SBRT和SRS具有能够将高剂量辐射精确地传递到靶组织的显著优势。SBRT可使晚期和转移性RCC获得更高的LC，可作为寡转移RCC患者手术的替代方法。SBRT与全身治疗（如靶向治疗或免疫治疗）联合使用是安全且可耐受的。同步免疫治疗和SBRT是晚期或转移性RCC患者一种有前景的治疗策略。然而，放疗联合全身治疗的研究仍然有限，迫切需要进一步研究探索RCC的这种治疗方法。
