免疫疗法和立体定向体放疗用于不适合手术或肾切除术的非转移性肾癌老年患者:国际老年放疗小组的实用建议

Nam P. Nguyen, Monica-Emilia Chirila, Brandi R. Page, Vincent Vinh-Hung, O. Gorobets, Mohammad Mohammadianpanah, Huan Giap, Meritxell Arenas, Marta Bonet, Pedro Carlos Lara, Lyndon Kim, Fabien Dutheil, David Lehrman, Luis Zegarra Montes, Ghassen Tlili, Z. Dahbi, G. Loganadane, Sergio Calleja Blanco, S. Bose, Elena Natoli, Eric Li, Abba Mallum, A. G. Morganti
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摘要

非转移性肾癌的标准治疗方法是手术切除,然后对复发风险高的患者进行辅助治疗。然而,对于老年患者来说,由于并发症风险高,可能导致死亡,因此可能无法选择手术治疗。过去,肾癌被认为对放射线有抵抗力,需要更高的放射剂量,从而导致癌症周围正常器官受损,继而引发更多并发症。立体定向体放射治疗(SBRT)等放射治疗技术的进步,使放射治疗的杀瘤剂量和对正常组织的损伤降到最低。有报道称,选择性小肿瘤患者在接受 SBRT 治疗后,局部控制和生存率都非常好。然而,对于具有不良预后因素(如肿瘤体积大和侵袭性组织学)的患者,局部区域复发和远处转移的发生率较高。这些肿瘤经常携带程序死亡配体1(PD-L1),这使它们成为使用检查点抑制剂(CPI)进行免疫治疗的理想靶点。鉴于放疗和免疫疗法之间的协同作用,我们提出了一种结合 CPI 和 SBRT 的算法,用于不适合手术切除或肾切除术的非转移性老年肾癌患者。
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Immunotherapy and stereotactic body radiotherapy for older patients with non-metastatic renal cancer unfit for surgery or decline nephrectomy: practical proposal by the International Geriatric Radiotherapy Group
The standard of care for non-metastatic renal cancer is surgical resection followed by adjuvant therapy for those at high risk for recurrences. However, for older patients, surgery may not be an option due to the high risk of complications which may result in death. In the past renal cancer was considered to be radio-resistant, and required a higher dose of radiation leading to excessive complications secondary to damage of the normal organs surrounding the cancer. Advances in radiotherapy technique such as stereotactic body radiotherapy (SBRT) has led to the delivery of a tumoricidal dose of radiation with minimal damage to the normal tissue. Excellent local control and survival have been reported for selective patients with small tumors following SBRT. However, for patients with poor prognostic factors such as large tumor size and aggressive histology, there was a higher rate of loco-regional recurrences and distant metastases. Those tumors frequently carry program death ligand 1 (PD-L1) which makes them an ideal target for immunotherapy with check point inhibitors (CPI). Given the synergy between radiotherapy and immunotherapy, we propose an algorithm combining CPI and SBRT for older patients with non-metastatic renal cancer who are not candidates for surgical resection or decline nephrectomy.
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