Zarkar Anjali, Henderson Dan, Carver Antony, Heyes Geoff, Harrop Victoria, Tutill Sarah, Kilkenny Julie, Marshall Andrea, Elbeltagi Nada, Howard Helen
University Hospitals Birmingham NHS Foundation Trust Birmingham UK.
Warwick Clinical Trials Unit Warwick UK.
BJUI Compass. 2023 Apr 13;4(4):464-472. doi: 10.1002/bco2.199. eCollection 2023 Jul.
Stereotactic ablative radiotherapy (SABR) for primary renal cell carcinoma (RCC) is a promising non-invasive ablative treatment option. A prospective interventional clinical trial published showed that treatment was feasible and well tolerated. We present the first single-institution UK cohort of patients with primary RCC receiving protocol-based SABR with prospective follow-up. We also present a protocol that could be used to facilitate more widespread use of the treatment.
Nineteen biopsy-proven primary RCC patients were treated with either 42 Gy in three fractions on alternate days or 26 Gy in a single fraction based on predefined eligibility criteria using either Linear Accelerator or CyberKnife platform. Prospective toxicity data using CTCAE V4.0 and outcome data such as estimated glomerular filtration rate (eGFR) and tumour response using CT thorax, abdomen and pelvis (CT-TAP) were collected at 6 weeks, 3, 6, 12, 18 and 24 months post treatment.
The 19 patients had a median age of 76 years (interquartile range [IQR] 64-82 years) and 47.4% were males, and they had a median tumour size of 4.5 cm (IQR 3.8-5.2 cm). Single and fractionated treatment was well tolerated and there were no significant acute side effects. The mean drop from baseline in eGFR at 6 months was 5.4 ml/min and that at 12 months was 8.7 ml/min. The overall local control rate at both 6 and 12 months was 94.4%. Overall survival at 6 and 12 months was 94.7% and 78.3%, respectively. After a median follow-up of 17 months, three patients experienced a Grade 3 toxicity, which was resolved with conservative management.
SABR for primary RCC is a safe and feasible treatment for medically unfit patients, which can be delivered in most UK cancer centres using standard Linear Accelerator as well as CyberKnife platforms.
立体定向消融放疗（SABR）用于原发性肾细胞癌（RCC）是一种很有前景的非侵入性消融治疗选择。一项已发表的前瞻性介入性临床试验表明该治疗是可行的且耐受性良好。我们展示了英国首个单机构队列中接受基于方案的SABR并进行前瞻性随访的原发性RCC患者。我们还展示了一个可用于促进该治疗更广泛应用的方案。
19例经活检证实的原发性RCC患者，根据预定义的入选标准，使用直线加速器或射波刀平台，隔日分三次给予42 Gy或单次给予26 Gy治疗。在治疗后6周、3个月、6个月、12个月、18个月和24个月收集使用CTCAE V4.0的前瞻性毒性数据以及诸如估计肾小球滤过率（eGFR）等结局数据，并用胸部、腹部和盆腔CT（CT-TAP）评估肿瘤反应。
19例患者的中位年龄为76岁（四分位间距[IQR]64 - 82岁），47.4%为男性，中位肿瘤大小为4.5 cm（IQR 3.8 - 5.2 cm）。单次和分次治疗耐受性良好，无明显急性副作用。6个月时eGFR较基线的平均下降值为5.4 ml/min，12个月时为8.7 ml/min。6个月和12个月时的总体局部控制率均为94.4%。6个月和12个月时的总生存率分别为94.7%和78.3%。中位随访17个月后，3例患者出现3级毒性反应，经保守治疗后缓解。
SABR治疗原发性RCC对于身体状况不佳的患者是一种安全可行的治疗方法，在英国大多数癌症中心使用标准直线加速器以及射波刀平台均可实施。
