背景:在70岁及以上的人群中,局限性肾细胞癌(RCC)的发病率呈上升趋势。虽然治疗的黄金标准仍然是手术切除,一些患有合并症的老年和体弱患者不符合此程序的条件。在某些情况下,经皮热消融,比如冷冻疗法,微波和射频,提供侵入性较小的选择。这种治疗有时需要全身麻醉,但大多数程序可以使用轻度或深度清醒镇静进行。这种方法优选推荐用于位于距肾门和/或输尿管一定距离处的小cT1a肿瘤。主动监测仍然是小的低级别RCC的替代方案,尽管它可能会引起某些患者的焦虑。最近的研究强调了立体定向消融体放射治疗(SABR)作为一种非侵入性,耐受性良好,对肾脏小肿瘤的有效治疗。这篇叙述性综述旨在探讨SABR在局部RCC中的最新进展,包括适当的患者选择,治疗方式和管理,以及疗效和耐受性评估。
方法:我们使用术语[肾癌]进行了文献综述,[肾细胞癌],[立体定向放射治疗],[SBRT],和[SABR]在Medline,PubMed,和Embase数据库,重点关注英文发表的前瞻性和相关回顾性研究。
结果:研究报告SABR的局部控制率从70%到100%不等,强调其治疗RCC的疗效。在SABR后的几年中,肾小球滤过率(GFR)的下降约为-5至-17mL/min。常见的毒性很少见,主要是CTCAE1级,包括疲劳,恶心,胸部或背部疼痛,腹泻,或胃炎。
结论:立体定向消融体放疗(SABR)可被认为是局部RCC患者的可行选择,这些患者不适合手术,局部控制率高,安全性好。.应该在多学科会议上讨论这种方法,并等待正在进行的临床试验的结果。
BACKGROUND: The incidence of localized renal cell carcinoma (RCC) is on the rise among individuals aged 70 and older. While the gold standard for treatment remains surgical resection, some elderly and frail patients with comorbidities are not eligible for this procedure. In selected cases, percutaneous thermal ablation, such as cryotherapy, microwave and radiofrequency, offers less invasive options. General anesthesia is sometimes necessary for such treatments, but most of the procedures can be conducted using mild or deep conscious sedation. This approach is preferably recommended for small cT1a tumors situated at a distance from the renal hilum and/or ureter. Active surveillance remains an alternative in the case of small low grade RCC although it may induce anxiety in certain patients. Recent research has highlighted the potentials of stereotactic ablative body radiotherapy (SABR) as a noninvasive, well-tolerated, and effective treatment for small renal tumors. This narrative review aims to explore recent advances in SABR for localized RCC, including appropriate patient selection, treatment modalities and administration, as well as efficacy and tolerance assessment.
METHODS: We conducted a literature review using the terms [kidney cancer], [renal cell carcinoma], [stereotactic radiotherapy], [SBRT], and [SABR] in the Medline, PubMed, and Embase databases, focusing on prospective and relevant retrospective studies published in English.
RESULTS: Studies report local control rates ranging from 70% to 100% with SABR, highlighting its efficacy in treating RCC. The decline in glomerular filtration rate (GFR) is approximately -5 to -17mL/min over the years following SABR. Common toxicities are rare, primarily CTCAE grade 1, include fatigue, nausea, chest or back pain, diarrhea, or gastritis.
CONCLUSIONS: Stereotactic ablative body radiotherapy (SABR) may be considered as a viable option for patients with localized RCC who are not suitable candidates for surgery with a high local control rate and a favorable safety profile. This approach should be discussed in a multidisciplinary meeting and results from ongoing clinical trials are awaited.
METHODS: