Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy.
Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono, Milan, Italy.
Clin Transl Oncol. 2021 Aug;23(8):1717-1726. doi: 10.1007/s12094-021-02574-0. Epub 2021 Mar 9.
Renal cell carcinoma (RCC) has traditionally been considered radioresistant with a limited role for conventional fractionation as a local approach. Nevertheless, since the appearance of stereotactic body radiation therapy (SBRT), radiotherapy (RT) has been increasingly employed in the management of metastatic RCC (mRCC). The aim of this study was to evaluate the role of SBRT for synchronous and metachronous oligo metastatic RCC patients in terms of local control, delay of systemic treatment, overall survival and toxicity.
A Monocentric single institution retrospective data collection was performed. Inclusion criteria were: (1) oligo-recurrent or oligo-progressive disease (less than 5 metastases) in mRCC patients after radical/partial nephrectomy or during systemic therapy, (2) metastasectomy or other metastasis-directed, rather than SBRT not feasible, (3) any contraindication to receive systemic therapy (such as comorbidities), (4) all the histologies were included, (5) available signed informed consent form for treatment. Tumor response and toxicity were evaluated using the response evaluation criteria in solid tumors and the Common Terminology Criteria for Adverse Events version 4.03, respectively. Progression-free survival in-field and out-field (in-field and out-field PFS) and overall survival (OS) were calculated via the Kaplan-Meier method. The drug treatment-free interval was calculated from the start of SBRT to the beginning of any systemic therapy.
From 2010 to December 2018, 61 patients with extracranial and intracranial metastatic RCC underwent SBRT on 83 lesions. Intracranial and extracranial lesions were included. Forty-five (74%) patients were treated for a solitary metastatic lesion. Median RT dose was 25 Gy (range 10-52) in 5-10 fractions. With a median follow-up of 2.3 years (range 0-7.15), 1-year in-field PFS was 70%, 2-year in-field PFS was 55%. One year out-field PFS was 39% and 1-year OS was 78%. Concomitant systemic therapy was employed for only 11 (18%) patients, for the others 50 (82%) the drug treatment-free rate was 70% and 50% at 1 and 2 years, respectively. No > G1 acute and late toxicities were reported.
The pattern of failure was pre-dominantly out-of-field, even if the population was negatively selected and the used RT dose could be considered palliative. Therefore, SBRT appears to be a well-tolerated, feasible and safe approach in oligo metastatic RCC patients with an excellent in-field PFS. SBRT might play a role in the management of selected RCC patients allowing for a delay systemic therapy begin (one out of two patients were free from new systemic therapy at 2 years after SBRT). Further research on SBRT dose escalation is warranted.
肾细胞癌（RCC）传统上被认为对放射线具有抗性，常规分割放疗作为局部治疗方法的作用有限。然而，自从立体定向体部放射治疗（SBRT）出现以来，放射治疗（RT）在转移性肾细胞癌（mRCC）的治疗中得到了越来越多的应用。本研究旨在评估 SBRT 在同步和异时寡转移 RCC 患者中的作用，包括局部控制、延迟全身治疗、总生存和毒性。
进行了一项单中心回顾性数据收集。纳入标准为：（1）根治性/部分肾切除术或全身治疗期间 mRCC 患者出现寡复发或寡进展性疾病（少于 5 个转移灶）；（2）转移灶切除术或其他转移灶导向治疗不可行，而 SBRT 可行；（3）存在接受全身治疗的任何禁忌症（如合并症）；（4）包括所有组织学类型；（5）有治疗同意书。使用实体瘤反应评价标准和不良事件通用术语标准 4.03 分别评估肿瘤反应和毒性。通过 Kaplan-Meier 方法计算无进展生存的靶区和靶外区（靶区 PFS 和靶外区 PFS）和总生存（OS）。从 SBRT 开始到开始任何全身治疗的药物治疗无进展间隔时间。
2010 年至 2018 年 12 月，83 个病灶的 61 例颅外和颅内转移性 RCC 患者接受了 SBRT。包括颅内和颅外病变。45（74％）例患者接受了单一转移病灶治疗。中位放疗剂量为 25 Gy（范围 10-52），分 5-10 次。中位随访 2.3 年（范围 0-7.15），1 年靶区 PFS 为 70％，2 年靶区 PFS 为 55％。1 年靶外 PFS 为 39％，1 年 OS 为 78％。仅有 11（18％）例患者同时接受了全身治疗，对于其余 50（82％）例患者，药物治疗无进展率为 70％，1 年和 2 年分别为 50％。未报告任何> G1 级急性和迟发性毒性。
失败模式主要是靶外区，即使该人群为负选择，且使用的 RT 剂量可被认为是姑息性的。因此，SBRT 似乎是一种耐受性良好、可行且安全的方法，在寡转移 RCC 患者中具有出色的靶区 PFS。SBRT 可能在管理选定的 RCC 患者中发挥作用，从而延迟全身治疗开始（在 SBRT 后 2 年，有 1/2 的患者无需新的全身治疗）。需要进一步研究 SBRT 剂量递增。
