Schoenhals Jonathan E, Mohamad Osama, Christie Alana, Zhang Yuanyuan, Li Daniel, Singla Nirmish, Bowman Isaac, Arafat Waddah, Hammers Hans, Courtney Kevin, Cole Suzanne, Bagrodia Aditya, Margulis Vitaly, Desai Neil, Garant Aurelie, Choy Hak, Timmerman Robert, Brugarolas James, Hannan Raquibul
Kidney Cancer Program, Simmons Comprehensive Cancer Center, Dallas, Texas.
Department of Radiation Oncology, University of California San Francisco, San Francisco, California.
Adv Radiat Oncol. 2021 May 26;6(5):100692. doi: 10.1016/j.adro.2021.100692. eCollection 2021 Sep-Oct.
Oligoprogression, defined as limited sites of progression on systemic therapy, in patients with metastatic renal cell carcinoma (mRCC) is not uncommon, possibly because of inter- and intratumoral heterogeneity. We evaluated the effect of stereotactic ablative radiation therapy (SAbR) for longitudinal control of oligoprogressive mRCC.
Patients with extracranial mRCC were included in this retrospective analysis if they progressed in ≤3 sites on systemic therapy while demonstrating response/stability at other sites and received SAbR to all progressing sites without switching systemic therapy. Our primary endpoint was modified progression-free survival (mPFS), which we calculated from the start of SAbR to the start of a subsequent systemic therapy, death, or loss to follow-up.
We identified 36 patients with a median follow-up of 20.4 months (interquartile range, 10.9-29.4). Forty-three sites were treated with SAbR with a median dose of 36 Gy (range, 18-50) in 3 fractions (range, 1-5). Median time to SAbR from the start of systemic therapy was 11.4 months (interquartile range, 6.1-17.1). Median mPFS was 9.2 months (95% confidence interval [CI], 5.9-13.2). Patients receiving SAbR while on immunotherapy exhibited a longer median mPFS (>28.4 months, log-rank = .0001) than patients not on immunotherapy (9.2 months). Median overall survival from SAbR administration was 43.4 months (95% CI, 21.5-not Reached). The 1-year local control rate was 93% (95% CI, 78.7-97.5). Most SAbR-related toxicities were grade 1 to 2 (33% of patients), with one grade 5 hemoptysis event possibly related to SAbR or disease progression.
SAbR has the potential to extend the the duration of current systemic therapy for selected patients with mRCC, preserving subsequent therapies for later administration possibly enabling longer treatment duration.
寡进展定义为转移性肾细胞癌（mRCC）患者在全身治疗过程中进展部位有限，这种情况并不少见，可能是由于肿瘤间和肿瘤内的异质性。我们评估了立体定向消融放疗（SAbR）对寡进展性mRCC进行纵向控制的效果。
如果颅外mRCC患者在全身治疗中进展部位≤3个，而在其他部位表现出缓解/稳定，并且在不更换全身治疗的情况下对所有进展部位接受SAbR，则纳入本回顾性分析。我们的主要终点是改良无进展生存期（mPFS），计算从SAbR开始至后续全身治疗开始、死亡或失访的时间。
我们纳入了36例患者，中位随访时间为20.4个月（四分位间距，10.9 - 29.4个月）。43个部位接受了SAbR治疗，中位剂量为36 Gy（范围，18 - 50 Gy），分3次给予（范围，1 - 5次）。从全身治疗开始至接受SAbR的中位时间为11.4个月（四分位间距，6.1 - 17.1个月）。中位mPFS为9.2个月（95%置信区间[CI]，5.9 - 13.2个月）。接受免疫治疗时接受SAbR的患者中位mPFS（>28.4个月，对数秩检验 = 0.0001）长于未接受免疫治疗的患者（9.2个月）。从给予SAbR开始的中位总生存期为43.4个月（95% CI，21.5 - 未达到）。1年局部控制率为93%（95% CI，78.7 - 97.5%）。大多数与SAbR相关的毒性为1至2级（33%的患者），有1例5级咯血事件可能与SAbR或疾病进展有关。
SAbR有可能延长部分mRCC患者当前全身治疗的持续时间，保留后续治疗以便后期使用，可能使治疗持续时间更长。
