背景:尽管转移性肾细胞癌(mRCC)的治疗由于新的全身性药物的出现而发生了革命性的变化,仍然很少有患者经历长期持久的反应。立体定向消融放疗(SABR)是目前常用的转移定向治疗(MDT),但是关于如何最好地实施这一战略作为多模式方法的一部分的数据有限。
目的:评估颅外SABR在mRCC中的潜在作用,并确定SABR在不同疾病环境中的未来治疗进展。
方法:根据PubMed数据库上的系统评价和荟萃分析(PRISMA)声明,于2022年5月进行了系统评价。选择了34项研究纳入本系统评价。
结果:SABR已用于四个主要目标:(1)根除同步和异时寡转移患者的全部转移负担,导致长期局部控制率(LC)>90%,中位无进展生存期(PFS)介于8和15个月之间;(2)根除少进病变,使全身治疗的持续时间延长约9个月;(3)改善多转移性患者对全身治疗的反应,导致总反应率从17%到56%;(4)多转移性mRCC患者的细胞减少,LC率在71%到100%之间,保护肾功能,但不清楚PFS和总体生存影响。总的来说,SABR和全身药物的组合与总体良好的耐受性相关,≥3级毒性范围为0%至13%。
结论:目前的数据强调了SABR作为一种新兴的MDT治疗选择在寡转移和寡进展的颅外mRCC中的作用,能够确保疾病的长期控制并延迟使用下一线系统治疗。SABR在从头转移疾病中用于细胞减少以及在多转移环境中作为免疫增强剂的用途仍在研究中,值得进一步研究。
结果:对于诊断为转移性肾细胞癌的患者,使用消融剂量(>6Gy/分数)进行放射治疗是一种有希望的治疗策略。在转移数量有限的患者中观察到了优异的结果,将无转移生存率提高几个月。对于在全身治疗下有少数转移进展的患者,放疗可以将正在进行的治疗的持续时间延长几个月.
Although the management of metastatic renal cell carcinoma (mRCC) has been revolutionized by the advent of new systemic agents, still few patients experience a long-term durable response. Stereotactic ablative radiotherapy (SABR) is nowadays commonly used as metastasis-directed therapy (MDT), but limited data exist on how best to implement this strategy as part of a multimodal approach.
To evaluate the potential role of extracranial SABR in mRCC and to identify future therapeutic developments of SABR in different disease settings.
A systematic review was conducted in May 2022 according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement on the PubMed database. Thirty-four studies were selected for inclusion in this systematic review.
SABR has been used with four main goals: (1) eradication of the whole metastatic burden in synchronous and metachronous oligometastatic patients, resulting in a long-term local control (LC) rate of >90% and median progression-free survival (PFS) ranging between 8 and 15 mo; (2) eradication of
oligoprogressive lesions, enabling an extension of the duration of the systemic therapy by approximately 9 mo; (3) improvement of the response to systemic therapy in polymetastatic patients, resulting in an overall response rate ranging from 17% to 56%; and (4) cytoreduction in polymetastatic mRCC patients, with LC rates ranging between 71% and 100%, and preservation of the renal function, but unclear PFS and overall survival impact. Overall, the combination of SABR and systemic agents has been associated with overall good tolerance, with grade ≥3 toxicity ranging from 0% to 13%.
Current data highlight the role of SABR as an emerging MDT treatment option in both oligometastatic and
oligoprogressive extracranial mRCC, able to ensure long-term disease control and delay the use of next-line systemic therapies. The use of SABR for cytoreduction in the de novo metastatic disease and as an immunological booster in the polymetastatic setting remains investigational and warrants further investigations.
Radiotherapy delivered with ablative doses (>6 Gy per fraction) is a promising treatment strategy for patients diagnosed with metastatic renal cell carcinoma. Excellent outcome results have been observed in patients with a limited number of metastases, improving metastasis-free survival by several months. For patients with a few metastases progressing under systemic therapy, radiotherapy allows an extension of the duration of the ongoing therapy by several months.