Aoyama Takahiro, Koide Yutaro, Shimizu Hidetoshi, Kitagawa Tomoki, Iwata Tohru, Hashimoto Shingo, Tachibana Hiroyuki, Kodaira Takeshi
Department of Radiation Oncology, Aichi Cancer Center, 1-1 Kanokoden, Chikusa-Ku, Nagoya, Aichi 464-8681, Japan.
J Radiat Res. 2025 Jul 22;66(4):429-435. doi: 10.1093/jrr/rraf028.
Stereotactic body radiation therapy (SBRT) has emerged as a promising and minimally invasive treatment option for patients with renal cell carcinoma (RCC). This study presents our initial clinical experiences with treatments following our center's protocol, which was formulated based on both national and international evidence. Six patients who had undergone renal SBRT at our center from January 2021 to December 2023 were included. Treatment planning used computed tomography (CT) and magnetic resonance imaging, with respiratory management conducted through breath-hold or free-breathing techniques. The prescribed dose was primarily 48 Gy in three fractions, with increased fractionations when dose constraints were challenging to achieve. Dose constraints were met for all patients, and treatment planning adhered to protocol guidelines. After the confirmation of cone-beam CT (CBCT) images by physicians, radiation was delivered. Five out of six patients completed the planned treatment, whereas one discontinued the treatment midway (the causal relationship to radiation therapy was unclear). Dose-volume histogram analysis revealed that doses to organs at risk depended on the position and size of the planning target volume but remained within acceptable limits for all cases. The intrafractional patient motion was 2.7 mm, as calculated from the pre- and post-CBCT images, confirming the appropriateness of a 3-mm setup margin. Although this study provides initial insights, further clinical trials are warranted to establish standardized protocols and optimize treatment strategies for RCC. In the future, it is also necessary to generate evidence that is tailored to the current situation in Japan.
立体定向体部放射治疗（SBRT）已成为肾细胞癌（RCC）患者一种有前景的微创治疗选择。本研究介绍了我们按照本中心方案进行治疗的初步临床经验，该方案是基于国内外证据制定的。纳入了2021年1月至2023年12月在本中心接受肾脏SBRT的6例患者。治疗计划采用计算机断层扫描（CT）和磁共振成像，通过屏气或自由呼吸技术进行呼吸管理。处方剂量主要为48 Gy分3次给予，当剂量限制难以实现时增加分次剂量。所有患者均满足剂量限制，治疗计划符合方案指南。经医生确认锥形束CT（CBCT）图像后进行放射治疗。6例患者中有5例完成了计划治疗，1例中途停止治疗（与放射治疗的因果关系不明）。剂量体积直方图分析显示，危及器官的剂量取决于计划靶区的位置和大小，但所有病例均在可接受范围内。根据CBCT图像前后计算得出，分次治疗期间患者的运动为2.7 mm，证实了3 mm设置边界的合理性。尽管本研究提供了初步见解，但仍需进一步开展临床试验以建立标准化方案并优化RCC的治疗策略。未来，还需要生成针对日本当前情况的证据。
