Onal Cem, Oymak Ezgi, Guler Ozan Cem, Tilki Burak, Yavas Guler, Hurmuz Pervin, Yavas Cagdas, Ozyigit Gokhan
Department of Radiation Oncology, Adana Dr. Turgut Noyan Research and Treatment Center, Baskent University Faculty of Medicine, 01120, Adana, Turkey.
Division of Radiation Oncology, Iskenderun Gelisim Hospital, Hatay, Turkey.
Strahlenther Onkol. 2023 May;199(5):456-464. doi: 10.1007/s00066-022-02026-w. Epub 2022 Nov 30.
Few studies have determined the viability of stereotactic body radiotherapy (SBRT) and tyrosine kinase inhibitors (TKIs) in the treatment of metastatic renal cell carcinoma (mRCC). We examined the results of RCC patients who had five or fewer lesions and were treated with TKI and SBRT.
The clinical data of 42 patients with 96 metastases treated between 2011 and 2020 were retrospectively evaluated. The prognostic factors predicting overall survival (OS) and progression-free survival (PFS) were assessed in uni- and multivariable analyses.
Median follow-up and time between TKI therapy and SBRT were 62.3 and 3.7 months, respectively. The 2‑year OS and PFS rates were 58.0% and 51.3%, respectively, and 2‑year local control rate was 94.1% per SBRT-treated lesion. In univariable analysis, the time between TKI therapy and SBRT and treatment response were significant prognostic factors for OS and PFS. In multivariable analysis, a time between TKI therapy and SBRT of less than 3 months and complete response were significant predictors of better OS and PFS. Only 12 patients (28.6%) had a systemic treatment change at a median of 18.2 months after SBRT, mostly in patients with a non-complete treatment response after this therapy. Two patients (4.8%) experienced grade III toxicity, and all side effects observed during metastasis-directed therapy subsided over time.
We demonstrated that SBRT in combination with TKIs is an effective and safe treatment option for RCC patients with ≤ 5 metastases. However, distant metastasis was observed in 60% of the patients, indicating that distant disease control still has room for improvement.
很少有研究确定立体定向体部放射治疗（SBRT）和酪氨酸激酶抑制剂（TKIs）在治疗转移性肾细胞癌（mRCC）中的可行性。我们研究了接受TKI和SBRT治疗且病灶数为5个或更少的RCC患者的治疗结果。
回顾性评估2011年至2020年间接受治疗的42例有96处转移灶的患者的临床资料。在单变量和多变量分析中评估预测总生存期（OS）和无进展生存期（PFS）的预后因素。
TKI治疗与SBRT之间的中位随访时间和间隔时间分别为62.3个月和3.7个月。2年OS率和PFS率分别为58.0%和51.3%，每个接受SBRT治疗的病灶的2年局部控制率为94.1%。在单变量分析中，TKI治疗与SBRT之间的时间间隔和治疗反应是OS和PFS的显著预后因素。在多变量分析中，TKI治疗与SBRT之间的时间间隔小于3个月和完全缓解是OS和PFS更佳的显著预测因素。仅12例患者（28.6%）在SBRT后中位18.2个月时进行了全身治疗调整，大多数是在该治疗后未获得完全治疗反应的患者中。2例患者（4.8%）出现3级毒性反应，在转移灶定向治疗期间观察到的所有副作用均随时间消退。
我们证明，SBRT联合TKIs是治疗转移灶≤5个的RCC患者的一种有效且安全的治疗选择。然而，60%的患者出现了远处转移，表明远处疾病控制仍有改善空间。
