局部、复发和转移性肾细胞癌的原位立体定向烧蚀体放射治疗

IF 2.7 3区医学 Q3 ONCOLOGY Clinical and Translational Radiation Oncology Pub Date : 2024-10-28 DOI:10.1016/j.ctro.2024.100879

Daniel Huang , Connor Lynch , Lucas M. Serra , Randy F. Sweis , Paul J. Chang , Walter M. Stadler , Russell Z. Szmulewitz , Peter H. O’Donnell , Abhinav Sidana , Scott E. Eggener , Arieh L. Shalhav , Stanley L. Liauw , Sean P. Pitroda

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引用次数: 0

摘要

背景和目的立体定向烧蚀体放射治疗（SABR）是治疗局部性肾细胞癌（RCC）的有效方法。然而，原位 SABR 对局部复发或转移性 RCC 的作用尚不明确。在此，我们报告了在我院接受治疗的不同队列的局部、复发和转移性 RCC 患者的原发部位 SABR 治疗结果。材料和方法纳入在我院接受肾脏病变或肾切除床 SABR 治疗且随访至少 6 个月的 RCC 患者进行分析。采用 Kaplan-Meier 法估算局部控制率、总生存率和无远处衰竭率。结果53名患者接受了原发部位SABR。37例（70%）患者为局部RCC，16例（30%）为转移性RCC。7名患者（13%）在接受过手术或消融治疗后局部复发。肿瘤大小中位数为 4.5 厘米（IQR 3.7-6.3）。中位随访时间为23个月（IQR 12-35），2年的局部控制率为100%，3年的局部控制率为94.4%（95% CI 84.4%-100%）。在最初局部病变的患者中，2年无远处转移的比例为94.6%（95% CI 87.6%-100%），2年总生存率为66.5%（95% CI 51.9%-85.2%）。12名患者（23%）出现了急性1-2级治疗相关毒性（恶心、呕吐或小肠）。没有出现急性 3-4 级毒性反应。两名患者（3.8%）出现了晚期3级胃肠道毒性。基线 eGFR 中位数为 51 mL/min/1.73 m2（IQR 38-77）。SABR 术后 1 年，eGFR 下降的中位数为 5 mL/min/1.73 m2（IQR -3-9）。结论这项分析表明，接受 SABR 治疗的局部、复发和转移性 RCC 患者的局部控制率非常高。治疗与 eGFR 的下降关系不大。

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Primary site stereotactic ablative body radiotherapy in localized, recurrent, and metastatic renal cell carcinoma

Background and purpose

Stereotactic ablative body radiotherapy (SABR) is an effective treatment for localized renal cell carcinoma (RCC). However, the role of primary site SABR for locally recurrent or metastatic RCC is unclear. Here, we report outcomes of primary SABR across a diverse cohort of localized, recurrent, and metastatic RCC patients treated at our institution.

Materials and methods

RCC patients treated with SABR to lesions of the kidney or nephrectomy bed at our institution with at least 6 months of follow-up were included for analysis. Local control, overall survival, and freedom from distant failure were estimated using the Kaplan-Meier method. Estimated glomerular filtration rate (eGFR) was assessed at baseline and following SABR.

Results

Fifty-three patients received primary site SABR. Thirty-seven (70 %) patients had localized RCC, and 16 (30 %) had metastatic RCC. Seven (13 %) had locally recurrent RCC after prior surgery or ablation. The median tumor size was 4.5 cm (IQR 3.7–6.3). At a median follow-up of 23 months (IQR 12–35), 2-year local control was 100 %, and 3-year local control was 94.4 % (95 % CI 84.4 %–100 %). Among patients with initially localized disease, the 2-year freedom from distant failure was 94.6 % (95 % CI 87.6 %–100 %), and the 2-year overall survival was 66.5 % (95 % CI 51.9 %–85.2 %). Twelve (23 %) patients experienced acute grade 1–2 treatment-related toxicity (nausea, vomiting, or small bowel). There were no acute grade 3–4 toxicities. Two (3.8 %) patients developed late grade 3 gastrointestinal toxicity. The median baseline eGFR was 51 mL/min/1.73 m² (IQR 38–77). At 1-year post-SABR, the median eGFR decline was 5 mL/min/1.73 m² (IQR −3 to 9). One patient required dialysis following SABR.

Conclusion

This analysis demonstrates excellent local control rates across patients with localized, recurrent, and metastatic RCC treated with SABR. Treatment was associated with minimal eGFR decline.

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