PDF(Pubmed)
Abstract：
Renal cell cancer (RCC) has traditionally been considered radioresistant. Because of this, conventional radiotherapy (RT) has been predominantly relegated to the palliation of symptomatic metastatic disease. The implementation of stereotactic ablative radiotherapy (SABR) has made it possible to deliver higher ablative doses safely, shifting the renal radioresistance paradigm. SABR has increasingly been adopted into the multidisciplinary framework for the treatment of locally recurrent, oligoprogressive, and oligometastatic disease. Furthermore, there is growing evidence of SABR as a non-invasive definitive therapy in patients with primary RCC who are medically inoperable or who decline surgery, unsuited to invasive ablation (surgery or percutaneous techniques), or at high-risk of requiring post-operative dialysis. Encouraging outcomes have even been reported in cases of solitary kidney or pre-existing chronic disease (poor eGFR), with a high likelihood of preserving renal function. A review of clinical evidence supporting the use of ablative radiotherapy (SABR) in primary, recurrent, and metastatic RCC has been conducted. Given the potential immunogenic effect of the high RT doses, we also explore emerging opportunities to combine SABR with systemic treatments. In addition, we explore future directions and ongoing clinical trials in the evolving landscape of this disease.
摘要：
肾细胞癌(RCC)传统上被认为是耐放射性的。正因为如此,常规放疗(RT)主要是缓解有症状的转移性疾病.立体定向消融放射治疗（SABR）的实施使安全地提供更高的消融剂量成为可能，改变肾脏放射抗性范式。SABR越来越多地被纳入治疗局部复发的多学科框架，寡进,和寡转移疾病。此外，越来越多的证据表明，SABR作为一种非侵入性的确定性治疗，适用于医学上无法手术或拒绝手术的原发性RCC患者，不适合侵入性消融（手术或经皮技术），或需要术后透析的高风险。在孤立肾或预先存在的慢性疾病（eGFR差）的病例中，甚至有令人鼓舞的结果。保留肾功能的可能性很高。对支持消融性放疗（SABR）在原发性，经常性,已进行转移性肾癌。鉴于高RT剂量的潜在免疫原性作用，我们还探索了将SABR与系统治疗相结合的新机会.此外,我们探讨了这种疾病的未来发展方向和正在进行的临床试验。
