Rodler Severin, Schott Melanie, Tamalunas Alexander, Marcon Julian, Graser Annabel, Mumm Jan-Niclas, Casuscelli Jozefina, Stief Christian G, Fürweger Christoph, Muacevic Alexander, Staehler Michael
Department of Urology, University Hospital of Munich, 80333 Munich, Germany.
European CyberKnife® Center, 81377 Munich, Germany.
Cancers (Basel). 2021 Feb 8;13(4):680. doi: 10.3390/cancers13040680.
Despite rapid advances of systemic therapy options in renal cell carcinoma (RCC), local tumor or metastases treatment remains important in selected patients. Here, we assess the safety and efficacy of robotic radiosurgery (RRS) as an ablative therapy for visceral and lymph node metastases of RCC. Patients with histologically confirmed RCC and radiologically confirmed progression of visceral or lymph node metastases underwent RRS and were retrospectively analyzed. Overall survival and progression free survival were calculated by the Kaplan-Meier method and log-rank test. Sixty patients underwent RRS and were included in the analysis. Patients presented for RRS treatment with a median age at RRS treatment of 64 years (range 42-83), clear cell histology (88.3%) and favorable international metastatic renal cell carcinoma database (IMDC) risk score (58.3%). Treatment parameters differed for the number of fractions (median visceral metastases: 1, range 1-5; median lymph node metastases: 1, range 0-5; = 0.003) and prescription dose (median visceral metastases 24 Gy, range 8-26; median lymph node metastases 18 Gy, range 7-26, < 0.001). The median overall survival was 65.7 months (range: 2.9-108.6), the median progression free survival was 17.4 months (range: 2.7-70.0) and local tumor control was achieved in 96.7% of patients. Adverse events were limited to 8.3% of patients, with one grade 4 toxicity within 6 weeks after RRS therapy. RRS is a safe and effective treatment option in selected patients with metastatic RCC in a multimodal approach. Further research is warranted to confirm our findings prospectively.
尽管肾细胞癌（RCC）全身治疗方案取得了快速进展，但局部肿瘤或转移灶的治疗在部分患者中仍然很重要。在此，我们评估机器人放射外科手术（RRS）作为RCC内脏和淋巴结转移灶消融治疗的安全性和有效性。对组织学确诊为RCC且经影像学证实有内脏或淋巴结转移进展的患者进行了RRS治疗，并进行回顾性分析。采用Kaplan-Meier法和对数秩检验计算总生存期和无进展生存期。60例患者接受了RRS治疗并纳入分析。接受RRS治疗的患者中位年龄为64岁（范围42 - 83岁），组织学类型为透明细胞癌（88.3%），国际转移性肾细胞癌数据库（IMDC）风险评分良好（58.3%）。治疗参数在分次剂量（中位内脏转移灶：1次，范围1 - 5次；中位淋巴结转移灶：1次，范围0 - 5次；P = 0.003）和处方剂量方面存在差异（中位内脏转移灶24 Gy，范围8 - 26 Gy；中位淋巴结转移灶18 Gy，范围7 - 26 Gy，P < 0.001）。中位总生存期为65.7个月（范围：2.9 - 108.6个月），中位无进展生存期为17.4个月（范围：2.7 - 70.0个月），96.7%的患者实现了局部肿瘤控制。不良事件仅限于8.3%的患者，RRS治疗后6周内有1例4级毒性反应。RRS是以多模式方法治疗部分转移性RCC患者的一种安全有效的治疗选择。有必要进行进一步研究以前瞻性地证实我们的发现。
