Bora Hima, Sarma Gautam, Medhi Partha Pratim
Department of Radiation Oncology, Tezpur Medical College and Hospital, Tezpur, Assam, India.
Department of Radiation Oncology, All India Institute of Medical Sciences, Guwahati, Assam, India.
Acta Med Litu. 2025;32(1):22-36. doi: 10.15388/Amed.2025.32.1.18. Epub 2025 Feb 18.
Because of its remarkable precision in providing targeted radiation, recent evidence supports (SABR) as a promising non-invasive treatment approach for metastatic renal cell carcinoma, minimizing harm to adjacent healthy tissues. With regards to its heterogeneous nature with diverse clinical presentations, rapid progression and metastatic potential, (RCC) is known to make therapy more challenging, and also to reduce the survival rates. Even though (ICIs) remain the gold standard for treating metastatic RCC (mRCC), certain patients with one or a few distant metastases seem to have a longer survival period if the metastases are surgically removed. However, complete responses are not always the case, with radiation being increasingly incorporated as a component of multidisciplinary care. Moreover, studies proving the immunogenic qualities of hypofractionated SABR and the safety and potential of combining SABR with immune-based and surgical therapy for mRCC are becoming more prevalent in the literature. SABR helps induce local inflammation with the tumour, promoting T cell activation and antigen presentation. Multiple retrospective and prospective reports have also demonstrated that SABR assigned to the metastatic locations of mRCC, while using ablative dosages, achieves high local control rates with a good toxicity profile, thus disproving earlier theories of RCC radioresistance. This review outlines the key evidence favouring SABR being administered to metastatic tumours, including the results of recent prospective phase 2 trials in patients with oligometastatic, oligoprogressive, and unselected mRCC. The body of data that has been gathered points to SABR as a promising indicator that is being utilized more and more in the multidisciplinary management of mRCC.
由于其在提供靶向辐射方面具有卓越的精准度，近期证据支持立体定向消融放疗（SABR）作为转移性肾细胞癌一种有前景的非侵入性治疗方法，可将对相邻健康组织的损害降至最低。鉴于肾细胞癌（RCC）具有异质性，临床表现多样、进展迅速且有转移潜能，已知其会使治疗更具挑战性，还会降低生存率。尽管免疫检查点抑制剂（ICIs）仍是治疗转移性肾细胞癌（mRCC）的金标准，但某些有一处或几处远处转移的患者，若手术切除转移灶，似乎生存期更长。然而，并非总能实现完全缓解，放疗越来越多地被纳入多学科治疗方案。此外，证明低分割SABR的免疫原性以及SABR与基于免疫和手术治疗联合用于mRCC的安全性和潜力的研究在文献中越来越普遍。SABR有助于诱导肿瘤局部炎症，促进T细胞活化和抗原呈递。多项回顾性和前瞻性报告也表明，将SABR应用于mRCC的转移部位，采用消融剂量时，可实现较高的局部控制率，且毒性反应良好，从而推翻了早期关于RCC放射抗性的理论。本综述概述了支持对转移性肿瘤进行SABR治疗的关键证据，包括近期针对寡转移、寡进展和未选择的mRCC患者进行前瞻性2期试验的结果。已收集的数据表明SABR是一个有前景的指标，在mRCC的多学科管理中越来越多地被使用。
