Miljanic Mihailo, Song Tidie, Christie Alana, Yen Allen, Kwon Young Suk, Garant Aurelie, Aguilera Todd A, Wardak Zabihullah, Hammers Hans, Courtney Kevin, Cole Suzanne, Brugarolas James, Timmerman Robert, Hannan Raquibul
Department of Radiation Oncology 2280 Inwood Road, Dallas, TX 75390-9303.
UT Southwestern Medical School 5323 Harry Hines Blvd, Dallas, TX 75390.
Adv Radiat Oncol. 2025 Jun 13;10(9):101835. doi: 10.1016/j.adro.2025.101835. eCollection 2025 Sep.
The optimal management strategies for glandular metastases in patients with metastatic renal cell carcinoma (mRCC) are currently unknown. While local therapy may be effective, there is a paucity of data on Stereotactic Ablative Body Radiation (SABR) particularly considering the risks of duodenal injury and adrenal insufficiency with high-dose radiation in these locations.
We conducted an institutional review board-approved, single-institution, retrospective study of patients with RCC metastases to the adrenal and pancreas treated with SABR. Data on patient characteristics, therapies, toxicities, and outcomes were collected and analyzed. Outcome of patient with SABR-treated mRCC was compared between those with and without glandular metastasis.
A total of 46 patients with a median follow-up of 20 months with mRCC were included with 36 adrenal and 19 pancreatic metastases treated with SABR with a median dose of 40 Gray (Gy) delivered in 5 treatments. One-year overall survival was 82.2%, progression-free survival was 48.2%, and local control was 95.9%. Acute grade 2 and 3 toxicity related to SABR was 7.4%. One patient experienced a grade 3 duodenal bleed as a result of pancreatic SABR, whereas 6.1% of patients experienced adrenal insufficiency with a median time to onset of 4 months following adrenal SABR.
SABR for RCC metastases to the pancreas and adrenal gland is feasible, safe, and effective at achieving high rates of local control with a small risk of duodenal injury and adrenal insufficiency, respectively. Oncological outcomes of patients with SABR-treated mRCC with glandular metastasis were comparable to those without glandular metastasis.
目前，转移性肾细胞癌（mRCC）患者发生腺转移的最佳管理策略尚不清楚。虽然局部治疗可能有效，但关于立体定向消融体部放疗（SABR）的数据较少，尤其是考虑到在这些部位进行高剂量放疗会有十二指肠损伤和肾上腺功能不全的风险。
我们进行了一项经机构审查委员会批准的单机构回顾性研究，研究对象为接受SABR治疗的肾细胞癌转移至肾上腺和胰腺的患者。收集并分析了患者特征、治疗方法、毒性反应和治疗结果的数据。比较了接受SABR治疗的mRCC患者中有无腺转移患者的治疗结果。
共纳入46例mRCC患者，中位随访时间为20个月，其中36例肾上腺转移和19例胰腺转移接受了SABR治疗，中位剂量为40格雷（Gy），分5次给予。1年总生存率为82.2%，无进展生存率为48.2%，局部控制率为95.9%。与SABR相关的急性2级和3级毒性反应为7.4%。1例患者因胰腺SABR出现3级十二指肠出血，而6.1%的患者出现肾上腺功能不全，肾上腺SABR后中位发病时间为4个月。
SABR治疗肾细胞癌转移至胰腺和肾上腺是可行、安全且有效的，分别具有较低的十二指肠损伤和肾上腺功能不全风险，能够实现较高的局部控制率。接受SABR治疗的有腺转移的mRCC患者的肿瘤学结局与无腺转移的患者相当。
