Comparative analysis of the results of surgical and radiation treatment of stage I kidney cancer

Malignant tumours Pub Date : 2024-05-24 DOI:10.18027/2224-5057-2024-009

Zh. E. Sabelnikova, М. М. Sarycheva, Е. Y. Mozerova, А. V. Vazhenin, А. А. Lozhkov

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Abstract

Purpose of the study. To conduct a comparative assessment of the results of surgical and radiation treatment of patients with stage I renal cell carcinoma (RCC) in terms of overall survival (OS), progression-free survival (PFS), local control and changes in renal function.Material and methods. From 2011 to 2022 170 patients with stage I RCC were treated at the Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine. We conducted a retrospective study of their treatment results. The first group - 115 patients who underwent surgical treatment of T1N0M0 kidney cancer (mainly in the amount of kidney resection - 85 people), the second group - 55 patients with verified T1N0M0 renal cell carcinoma who underwent stereotactic radiation therapy (SBRT) up to 30-45 Gy in 3 fractions using CyberKnife. SBRT was performed mainly for the treatment of a primary kidney tumor, in 7 cases - for a recurrence of kidney cancer, including 1 patient with recurrent tumors in both kidneys. The average age of patients in the surgery group was 73 years, in the SBRT group - 69.9 years. The average tumor diameter in the operation group was 4.3 cm, in the SBRT group it was 3.5 cm.Results. The median OS in the surgery group was 121 months, but it was not achieved in the SBRT group, since most patients are alive at the time of the study. 1-year OS in the surgery group and SBRT was comparable (98.9% and 95.1%, respectively), but 5-year OS in the surgery group was significantly higher - 90.2% vs. 70% in the SBRT group (p<0 .05). The same trend was noted in the assessment of PFS. In the surgery group, 4 patients out of 115 (3.5%) had a recurrence in the tumor bed, in all cases after kidney resection, after 28 months in average. In the SBRT group, 42 patients (75%) according to RECIST 1.1 criteria 6 months after SBRT showed stabilization of the process, in 20% of cases (11 patients) - a partial response, in 5% (3 patients) – progressed disease. 1-year local control was 96.4%, 1-year cancer-specific survival in both groups was 100%. Renal toxicity was recorded in 38 patients (33%) in the surgery group and in 10 patients (18%) in the radiotherapy group 6 months after treatment. On average, glomerular filtration rate decreased by 25% in the surgery group and by 18% in the radiotherapy group. We have not noted a single case of a pronounced decrease in GFR, which would require dialysis.Conclusion. Surgery remains the main treatment option for T1N0M0 kidney cancer, but if there are contraindications to surgery, SBRT may be the best option for inoperable patients.

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I 期肾癌手术和放射治疗效果对比分析

研究目的从总生存期（OS）、无进展生存期（PFS）、局部控制和肾功能变化等方面对I期肾细胞癌（RCC）患者的手术和放射治疗结果进行比较评估。2011 年至 2022 年，车里雅宾斯克地区肿瘤学与核医学临床中心治疗了 170 名 I 期肾癌患者。我们对他们的治疗结果进行了回顾性研究。第一组--115名T1N0M0肾癌患者接受了手术治疗（主要是肾脏切除术--85人），第二组--55名经证实的T1N0M0肾细胞癌患者接受了CyberKnife立体定向放射治疗（SBRT），治疗剂量达30-45 Gy，分3次进行。SBRT主要用于治疗原发性肾脏肿瘤，7例用于治疗肾癌复发，其中1例患者双肾肿瘤复发。手术组患者的平均年龄为 73 岁，SBRT 组患者的平均年龄为 69.9 岁。手术组的肿瘤平均直径为4.3厘米，SBRT组为3.5厘米。手术组的中位生存期为121个月，但SBRT组未达到这一目标，因为大多数患者在研究时还活着。手术组和SBRT组的1年生存率相当（分别为98.9%和95.1%），但手术组的5年生存率明显更高，为90.2%，而SBRT组为70%（P<0.05）。在 PFS 评估中也发现了同样的趋势。在手术组中，115 名患者中有 4 名（3.5%）在平均 28 个月后肿瘤床复发，所有病例都是在肾脏切除后复发。在 SBRT 组中，根据 RECIST 1.1 标准，42 名患者（75%）在 SBRT 6 个月后病情趋于稳定，20% 的病例（11 名患者）有部分反应，5% 的病例（3 名患者）病情有所进展。两组患者的1年局部控制率均为96.4%，1年癌症特异性生存率均为100%。治疗 6 个月后，手术组有 38 名患者（33%）出现肾毒性，放疗组有 10 名患者（18%）出现肾毒性。手术组患者的肾小球滤过率平均下降了 25%，放疗组患者的肾小球滤过率平均下降了 18%。我们没有发现一例因肾小球滤过率明显下降而需要透析的病例。手术仍是治疗T1N0M0肾癌的主要方法，但如果有手术禁忌症，SBRT可能是无法手术患者的最佳选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Malignant tumours

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