Department of Radiation Oncology, Peking University First Hospital, Beijing 100034, China.
Department of Health Science & Technology Strategy Information, Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100006, China.
Curr Oncol. 2022 Oct 17;29(10):7832-7841. doi: 10.3390/curroncol29100619.
Stereotactic ablative body radiotherapy (SABR) is one of the treatment options for oligometastatic renal cell carcinoma (RCC) but is limited by a lack of data to evaluate high-dose SABR to all/multiple sites.
This study retrospectively investigated the efficacy and prognostic factors of high-dose SABR for oligometastatic RCC patients.
DESIGN, SETTING, AND PARTICIPANTS: Patients with oligometastatic RCC on systemic therapy were retrospectively collected.
INTERVENTION(S): All patients were treated with SABR (40-50 Gy/5 fractions) for small tumors or partial-SABR (tumor center boosted with 6-8 Gy/3-5 fractions with 50-60 Gy/20-25 fractions to the whole tumor volume) for bulky tumors or tumors adjacent to critical organs.
Progression-free survival (PFS) and overall survival (OS) were calculated.
In total, 35 patients were enrolled, of which 88.5% had intermediate- or high-risk disease, with 60% on second- to fourth-line systemic therapy. The median follow-up time was 17 months. The median PFS and OS times were 11.3 and 29.7 months, respectively. Univariate analysis showed that an OS benefit was found in patients who received radiation before tyrosine kinase inhibitor (TKI) failure ( = 0.006) and where there was a short time interval (<six months) from being diagnosed with metastatic disease to undergoing radiotherapy ( = 0.046). Similar results were also found in PFS in patients who received radiation before TKI failure ( = 0.049) or within eight months ( = 0.047). There were certain differences in PFS ( = 0.033) between patients receiving radiotherapy with all lesions and those with selected tumors. In multivariate analysis, OS benefits were found in patients who received radiotherapy before TKI failure ( = 0.028). The limitations of this study include its retrospective design and the small patient cohort.
The early use of high-dose SABR to multi-lesions may improve survival. Partial-SABR for bulky lesions close to critical organs could be safely and effectively applied under certain circumstances.
立体定向消融体放射治疗（SABR）是治疗寡转移性肾细胞癌（RCC）的治疗方法之一，但由于缺乏评估高剂量 SABR 对所有/多个部位的资料，其应用受到限制。
本研究回顾性分析了高剂量 SABR 治疗寡转移性 RCC 患者的疗效和预后因素。
设计、地点和参与者：回顾性收集了接受系统治疗的寡转移性 RCC 患者。
所有患者均接受 SABR（40-50 Gy/5 个分次）治疗小肿瘤，或采用部分 SABR（肿瘤中心采用 6-8 Gy/3-5 个分次加 50-60 Gy/20-25 个分次全肿瘤容积）治疗大肿瘤或紧邻重要器官的肿瘤。
计算无进展生存期（PFS）和总生存期（OS）。
共纳入 35 例患者，其中 88.5%为中高危疾病患者，60%接受二线至四线系统治疗。中位随访时间为 17 个月。中位 PFS 和 OS 时间分别为 11.3 和 29.7 个月。单因素分析显示，在接受放疗前 TKI 失败（ = 0.006）和从诊断为转移性疾病到接受放疗的时间间隔较短（<6 个月）（ = 0.046）的患者中，OS 获益。在 PFS 中也观察到类似的结果，即接受放疗前 TKI 失败（ = 0.049）或 8 个月内（ = 0.047）的患者。在所有病变和选择肿瘤患者中，PFS 存在一定差异（ = 0.033）。多因素分析显示，在接受放疗前 TKI 失败的患者中，OS 获益（ = 0.028）。本研究的局限性在于其回顾性设计和小样本量。
早期多病灶高剂量 SABR 治疗可能提高生存率。对于紧邻重要器官的大肿瘤，在某些情况下可以安全有效地应用部分 SABR。
