Bentahila Rita, Bensalah Karim, Benziane-Ouaritini Nicolas, Barthelemy Philippe, Rioux-Leclerc Nathalie, Correas Jean-Michel, Belhomme Sarah, Bigot Pierre, Sargos Paul
Department of radiotherapy, Bergonié Institute, Bordeaux, France.
Urology Department, Rennes University Hospital, Rennes, France.
Fr J Urol. 2024 Jul;34(7-8):102660. doi: 10.1016/j.fjurol.2024.102660. Epub 2024 May 31.
The incidence of localized renal cell carcinoma (RCC) is on the rise among individuals aged 70 and older. While the gold standard for treatment remains surgical resection, some elderly and frail patients with comorbidities are not eligible for this procedure. In selected cases, percutaneous thermal ablation, such as cryotherapy, microwave and radiofrequency, offers less invasive options. General anesthesia is sometimes necessary for such treatments, but most of the procedures can be conducted using mild or deep conscious sedation. This approach is preferably recommended for small cT1a tumors situated at a distance from the renal hilum and/or ureter. Active surveillance remains an alternative in the case of small low grade RCC although it may induce anxiety in certain patients. Recent research has highlighted the potentials of stereotactic ablative body radiotherapy (SABR) as a noninvasive, well-tolerated, and effective treatment for small renal tumors. This narrative review aims to explore recent advances in SABR for localized RCC, including appropriate patient selection, treatment modalities and administration, as well as efficacy and tolerance assessment.
We conducted a literature review using the terms [kidney cancer], [renal cell carcinoma], [stereotactic radiotherapy], [SBRT], and [SABR] in the Medline, PubMed, and Embase databases, focusing on prospective and relevant retrospective studies published in English.
Studies report local control rates ranging from 70% to 100% with SABR, highlighting its efficacy in treating RCC. The decline in glomerular filtration rate (GFR) is approximately -5 to -17mL/min over the years following SABR. Common toxicities are rare, primarily CTCAE grade 1, include fatigue, nausea, chest or back pain, diarrhea, or gastritis.
Stereotactic ablative body radiotherapy (SABR) may be considered as a viable option for patients with localized RCC who are not suitable candidates for surgery with a high local control rate and a favorable safety profile. This approach should be discussed in a multidisciplinary meeting and results from ongoing clinical trials are awaited.
70岁及以上人群中局限性肾细胞癌（RCC）的发病率正在上升。虽然治疗的金标准仍然是手术切除，但一些患有合并症的老年体弱患者不适合进行该手术。在某些情况下，经皮热消融，如冷冻疗法、微波和射频，提供了侵入性较小的选择。此类治疗有时需要全身麻醉，但大多数手术可使用轻度或深度镇静进行。对于位于远离肾门和/或输尿管的小cT1a肿瘤，推荐采用这种方法。对于小的低级别RCC，主动监测仍是一种选择，尽管它可能会在某些患者中引起焦虑。最近的研究强调了立体定向体部放射治疗（SABR）作为一种对小肾肿瘤无创、耐受性良好且有效的治疗方法的潜力。本叙述性综述旨在探讨SABR治疗局限性RCC的最新进展，包括合适的患者选择、治疗方式和给药方法，以及疗效和耐受性评估。
我们在Medline、PubMed和Embase数据库中使用术语[肾癌]、[肾细胞癌]、[立体定向放射治疗]、[SBRT]和[SABR]进行文献综述，重点关注以英文发表的前瞻性和相关回顾性研究。
研究报告SABR的局部控制率在70%至100%之间，突出了其治疗RCC的疗效。SABR后的几年中，肾小球滤过率（GFR）下降约-5至-17mL/分钟。常见毒性罕见，主要为CTCAE 1级，包括疲劳、恶心、胸痛或背痛、腹泻或胃炎。
对于不适合手术的局限性RCC患者，立体定向体部放射治疗（SABR）可被视为一种可行的选择，具有较高的局部控制率和良好的安全性。应在多学科会议上讨论这种方法，并等待正在进行的临床试验结果。
