Suleja Agata, Bilski Mateusz, Laukhtina Ekaterina, Fazekas Tamás, Matsukawa Akihiro, Tsuboi Ichiro, Mancon Stefano, Schulz Robert, Soeterik Timo F W, Przydacz Mikołaj, Nyk Łukasz, Rajwa Paweł, Majewski Wojciech, Campi Riccardo, Shariat Shahrokh F, Miszczyk Marcin
III Department of Radiotherapy and Chemotherapy, Maria Skłodowska-Curie National Research Institute of Oncology (MSCNRIO), 44-102 Gliwice, Poland.
Department of Radiotherapy, Medical University of Lublin, 20-059 Lublin, Poland.
Cancers (Basel). 2024 Sep 26;16(19):3276. doi: 10.3390/cancers16193276.
Surgery is the gold standard for the local treatment of primary renal cell carcinoma (RCC), but alternatives are emerging. We conducted a systematic review and meta-analysis to assess the results of prospective studies using definitive stereotactic body radiotherapy (SBRT) to treat primary localised RCC.
This review was prospectively registered in PROSPERO (CRD42023447274). We searched PubMed, Embase, Scopus, and Google Scholar for reports of prospective studies published since 2003, describing the outcomes of SBRT for localised RCC. Meta-analyses were performed for local control (LC), overall survival (OS), and rates of adverse events (AEs) using generalised linear mixed models (GLMMs). Outcomes were presented as rates with corresponding 95% confidence intervals (95% CIs). Risk-of-bias was assessed using the ROBINS-I tool.
Of the 2983 records, 13 prospective studies ( = 308) were included in the meta-analysis. The median diameter of the irradiated tumours ranged between 1.9 and 5.5 cm in individual studies. Grade ≥ 3 AEs were reported in 15 patients, and their estimated rate was 0.03 (95%CI: 0.01-0.11; = 291). One- and two-year LC rates were 0.98 (95%CI: 0.95-0.99; = 293) and 0.97 (95%CI: 0.93-0.99; = 253), while one- and two-year OS rates were 0.95 (95%CI: 0.88-0.98; = 294) and 0.86 (95%CI: 0.77-0.91; = 224). There was no statistically significant heterogeneity, and the estimations were consistent after excluding studies at a high risk of bias in a sensitivity analysis. Major limitations include a relatively short follow-up, inhomogeneous reporting of renal function deterioration, and a lack of prospective comparative evidence.
The short-term results suggest that SBRT is a valuable treatment method for selected inoperable patients (or those who refuse surgery) with localised RCC associated with low rates of high-grade AEs and excellent LC. However, until the long-term data from randomised controlled trials are available, surgical management remains a standard of care in operable patients.
手术是原发性肾细胞癌（RCC）局部治疗的金标准，但其他替代方法也在不断涌现。我们进行了一项系统评价和荟萃分析，以评估使用立体定向体部放疗（SBRT）治疗原发性局限性RCC的前瞻性研究结果。
本评价已在PROSPERO（CRD42023447274）上进行前瞻性注册。我们在PubMed、Embase、Scopus和谷歌学术上搜索了自2003年以来发表的前瞻性研究报告，这些报告描述了SBRT治疗局限性RCC的结果。使用广义线性混合模型（GLMMs）对局部控制（LC）、总生存期（OS）和不良事件（AE）发生率进行荟萃分析。结果以率和相应的95%置信区间（95%CI）表示。使用ROBINS-I工具评估偏倚风险。
在2983条记录中，13项前瞻性研究（n = 308）纳入了荟萃分析。各研究中照射肿瘤的中位直径在1.9至5.5 cm之间。15例患者报告了≥3级AE，其估计发生率为0.03（95%CI：0.01 - 0.11；n = 291）。1年和2年的LC率分别为0.98（95%CI：0.95 - 0.99；n = 293）和0.97（95%CI：0.93 - 0.99；n = 253），而1年和2年的OS率分别为0.95（95%CI：0.88 - 0.98；n = 294）和0.86（95%CI：0.77 - 0.91；n = 224）。没有统计学上的显著异质性，在敏感性分析中排除高偏倚风险的研究后，估计结果一致。主要局限性包括随访相对较短、肾功能恶化报告不一致以及缺乏前瞻性比较证据。
短期结果表明，SBRT是一种有价值的治疗方法，适用于选定的无法手术的患者（或拒绝手术的患者），这些患者患有局限性RCC，高级别AE发生率低且LC良好。然而，在获得随机对照试验的长期数据之前，手术治疗仍然是可手术患者的标准治疗方法。
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