Cheung Patrick, Patel Samir, North Scott A, Sahgal Arjun, Chu William, Soliman Hany, Ahmad Belal, Winquist Eric, Niazi Tamim, Patenaude Francois, Lim Gerald, Heng Daniel Yick Chin, Dubey Arbind, Czaykowski Piotr, Wong Rebecca K S, Swaminath Anand, Morgan Scott C, Mangat Rupi, Keshavarzi Sareh, Bjarnason Georg A
Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada.
Division of Radiation Oncology, Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada.
Eur Urol. 2021 Dec;80(6):693-700. doi: 10.1016/j.eururo.2021.07.026. Epub 2021 Aug 13.
Despite the paucity of prospective evidence, stereotactic radiotherapy (SRT) is increasingly being considered in the setting of oligoprogression to delay the need to change systemic therapy.
To determine the local control (LC), progression-free survival (PFS), cumulative incidence of changing systemic therapy, and overall survival (OS) after SRT to oligoprogressive metastatic renal cell carcinoma (mRCC) lesions in patients who are on tyrosine kinase inhibitor (TKI) therapy.
DESIGN, SETTING, AND PARTICIPANTS: A prospective multicenter study was performed to evaluate the use of SRT in oligoprogressive mRCC patients. Patients with mRCC who had previous stability or response after ≥3 mo of TKI therapy were eligible if they developed progression of five of fewer metastases. Thirty-seven patients with 57 oligoprogressive tumors were enrolled.
Oligoprogressive tumors were treated with SRT, and the same TKI therapy was continued afterward.
Competing risk analyses and the Kaplan-Meir methodology were used to report the outcomes of interest.
The median duration of TKI therapy prior to study entry was 18.6 mo; 1-yr LC of the irradiated tumors was 93% (95% confidence interval [CI] 71-98%). The median PFS after SRT was 9.3 mo (95% CI 7.5-15.7 mo). The cumulative incidence of changing systemic therapy was 47% (95% CI 32-68%) at 1 yr, with a median time to change in systemic therapy of 12.6 mo (95% CI 9.6-17.4 mo). One-year OS was 92% (95% CI 82-100%). There were no grade 3-5 SRT-related toxicities.
LC of irradiated oligoprogressive mRCC tumors was high, and the need to change systemic therapy was delayed for a median of >1 yr.
The use of stereotactic radiotherapy in metastatic kidney cancer patients, who develop growth of a few tumors while on oral targeted therapy, can significantly delay the need to change to the next line of drug therapy.
尽管前瞻性证据匮乏，但在寡进展情况下，立体定向放射治疗（SRT）越来越多地被考虑用于延迟更换全身治疗的需求。
确定接受酪氨酸激酶抑制剂（TKI）治疗的寡进展性转移性肾细胞癌（mRCC）患者在接受SRT治疗后，局部控制（LC）、无进展生存期（PFS）、更换全身治疗的累积发生率以及总生存期（OS）。
设计、地点和参与者：进行了一项前瞻性多中心研究，以评估SRT在寡进展性mRCC患者中的应用。接受TKI治疗≥3个月后病情曾稳定或有反应的mRCC患者，如果出现5个或更少转移灶进展，则符合入选条件。37例患者共57个寡进展性肿瘤被纳入研究。
对寡进展性肿瘤进行SRT治疗，之后继续使用相同的TKI治疗。
采用竞争风险分析和Kaplan-Meir方法报告感兴趣的结果。
入组研究前TKI治疗的中位持续时间为18.6个月；照射肿瘤的1年局部控制率为93%（95%置信区间[CI]71%-98%）。SRT后的中位无进展生存期为9.3个月（95%CI 7.5-15.7个月）。1年时更换全身治疗的累积发生率为47%（95%CI 32%-68%），更换全身治疗的中位时间为12.6个月（95%CI 9.6-17.4个月）。1年总生存率为92%（95%CI 82%-100%）。没有3-5级与SRT相关的毒性反应。
照射的寡进展性mRCC肿瘤的局部控制率较高，更换全身治疗的需求延迟了中位时间>1年。
对于在口服靶向治疗期间出现少数肿瘤生长的转移性肾癌患者，使用立体定向放射治疗可显著延迟更换至下一线药物治疗的需求。
