Marvaso Giulia, Jereczek-Fossa Barbara Alicja, Zaffaroni Mattia, Vincini Maria Giulia, Corrao Giulia, Andratschke Nicolaus, Balagamwala Ehsan H, Bedke Jens, Blanck Oliver, Capitanio Umberto, Correa Rohann J M, De Meerleer Gert, Franzese Ciro, Gaeta Aurora, Gandini Sara, Garibaldi Cristina, Gerszten Peter C, Gillessen Silke, Grubb William R, Guckenberger Matthias, Hannan Raquibul, Jhaveri Pavan M, Josipovic Mirjana, Kerkmeijer Linda G W, Lehrer Eric J, Lindskog Magnus, Louie Alexander V, Nguyen Quynh-Nhu, Ost Piet, Palma David A, Procopio Giuseppe, Rossi Maddalena, Staehler Michael, Tree Alison C, Tsang Yat Man, Van As Nicholas, Zaorsky Nicholas G, Zilli Thomas, Pasquier David, Siva Shankar
Division of Radiation Oncology, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.
Division of Radiation Oncology, European Institute of Oncology, IRCCS, Milan, Italy.
Lancet Oncol. 2024 May;25(5):e193-e204. doi: 10.1016/S1470-2045(24)00023-8.
The purpose of this European Society for Radiotherapy and Oncology (ESTRO) project, endorsed by the European Association of Urology, is to explore expert opinion on the management of patients with oligometastatic and oligoprogressive renal cell carcinoma by means of stereotactic ablative radiotherapy (SABR) on extracranial metastases, with the aim of developing consensus recommendations for patient selection, treatment doses, and concurrent systemic therapy. A questionnaire on SABR in oligometastatic renal cell carcinoma was prepared by a core group and reviewed by a panel of ten prominent experts in the field. The Delphi consensus methodology was applied, sending three rounds of questionnaires to clinicians identified as key opinion leaders in the field. At the end of the third round, participants were able to find consensus on eight of the 37 questions. Specifically, panellists agreed to apply no restrictions regarding age (25 [100%) of 25) and primary renal cell carcinoma histology (23 [92%] of 25) for SABR candidates, on the upper threshold of three lesions to offer ablative treatment in patients with oligoprogression, and on the concomitant administration of immune checkpoint inhibitor. SABR was indicated as the treatment modality of choice for renal cell carcinoma bone oligometatasis (20 [80%] of 25) and for adrenal oligometastases 22 (88%). No consensus or major agreement was reached regarding the appropriate schedule, but the majority of the poll (54%-58%) retained the every-other-day schedule as the optimal choice for all the investigated sites. The current ESTRO Delphi consensus might provide useful direction for the application of SABR in oligometastatic renal cell carcinoma and highlight the key areas of ongoing debate, perhaps directing future research efforts to close knowledge gaps.
本项目由欧洲放射治疗与肿瘤学会（ESTRO）发起，并得到了欧洲泌尿外科学会的认可，旨在通过立体定向消融放疗（SABR）治疗颅外转移灶，探讨寡转移和寡进展性肾细胞癌患者管理的专家意见，目的是就患者选择、治疗剂量和同步全身治疗制定共识性建议。一个核心小组编制了一份关于寡转移肾细胞癌SABR的调查问卷，并由该领域的十位知名专家组成的小组进行了审核。采用德尔菲共识方法，向被确定为该领域关键意见领袖的临床医生发送三轮调查问卷。在第三轮结束时，参与者能够就37个问题中的8个达成共识。具体而言，小组成员同意，对于SABR候选者，在年龄（25人中有25人[100%]）和原发性肾细胞癌组织学（25人中有23人[92%]）方面不设限制；对于寡进展患者，提供消融治疗的病灶上限为3个；以及同意同时给予免疫检查点抑制剂。SABR被指定为肾细胞癌骨寡转移（25人中有20人[80%]）和肾上腺寡转移（22人中有88%）的首选治疗方式。关于合适的治疗方案未达成共识或主要一致意见，但大多数投票者（54%-58%）认为隔日治疗方案是所有研究部位的最佳选择。当前的ESTRO德尔菲共识可能为SABR在寡转移肾细胞癌中的应用提供有用的指导，并突出正在进行辩论的关键领域，也许能指导未来的研究工作以填补知识空白。
