Salvage stereotactic ablative body radiotherapy after thermal ablation of primary kidney cancer.

IF 3.7 2区 医学 Q1 UROLOGY & NEPHROLOGY
Muhammad Ali, Young Suk Kwon, Kendrick Koo, Anna Bruynzeel, David Pryor, Daniel G Schep, Michael Huo, Maggie Stein, Anand Swaminath, Raquibul Hannan, Shankar Siva
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引用次数: 0

Abstract

Objective: To evaluate the effectiveness and safety of salvage stereotactic ablative body radiotherapy (SABR) for recurrent renal cell carcinoma (RCC) after thermal ablation (TA).

Materials and methods: This study was a multi-institutional retrospective analysis of patients with recurrent RCC following TA who received SABR between 2016 and 2020. The primary study outcome was freedom from local failure, evaluated radiographically based on Response Evaluation Criteria in Solid Tumours (RECIST) v1.1. Distant failure, cancer-specific survival (CSS), overall survival (OS), treatment-related toxicity and renal function changes following SABR were the secondary outcomes. The Kaplan-Meier method was used to estimate freedom from local and distant failure, CSS and OS.

Results: Seventeen patients with 18 biopsy-confirmed RCCs were included, with a median (interquartile range [IQR]) age at time of SABR of 75.2 (72.6-68.7) years, a median (IQR) tumour size of 3.5 (1.9-4.1) cm and follow-up (reverse Kaplan-Meier method) of 3.36 (95% confidence interval [CI] 1.6-4.1) years. Six of the 17 patients had a solitary kidney. Five patients had failed repeat TA prior to SABR. The median (IQR) time from TA procedure to SABR was 3.03 (1.5-5.1) years. No patient experienced local progression, with a local control rate of 100%. Four patients, two with baseline metastatic disease, experienced distant progression. The distant progression-free survival, CSS and OS at 3 years were 72.1% (95% CI 51.9%-100%), 92.3% (95% CI 78.9%-100%) and 82.1% (95% CI 62.1%-100%), respectively. The median (IQR) glomerular filtration rate before SABR was 58 (40-71) mL/min, and at last follow-up, it was 48 (33-57) mL/min. No patient experienced grade 3+ toxicity or went on to develop end-stage renal disease.

Conclusion: The results showed that SABR appears to be an effective and safe salvage strategy in patients with recurrent RCC following TA.

原发性肾癌热消融术后的挽救性立体定向消融体放射治疗。
摘要评估热消融(TA)后复发肾细胞癌(RCC)的挽救性立体定向消融体放疗(SABR)的有效性和安全性:本研究是一项多机构回顾性分析,研究对象为2016年至2020年间接受SABR治疗的TA后复发RCC患者。主要研究结果为无局部失败,根据实体瘤反应评估标准(RECIST)v1.1进行放射学评估。远处失败、癌症特异性生存率(CSS)、总生存率(OS)、治疗相关毒性和SABR后的肾功能变化是次要结果。采用 Kaplan-Meier 法估算局部和远处失败、CSS 和 OS 的自由度:17名患者中有18名经活检确诊为RCC,SABR时的中位(四分位距[IQR])年龄为75.2(72.6-68.7)岁,中位(IQR)肿瘤大小为3.5(1.9-4.1)厘米,随访(反向卡普兰-梅耶法)时间为3.36(95%置信区间[CI]1.6-4.1)年。17 名患者中有 6 名是单肾患者。五名患者在 SABR 之前重复 TA 失败。从TA手术到SABR的中位(IQR)时间为3.03(1.5-5.1)年。没有患者出现局部进展,局部控制率为 100%。四名患者出现远处进展,其中两名患者有基线转移性疾病。3年的无远处进展生存率、CSS和OS分别为72.1%(95% CI 51.9%-100%)、92.3%(95% CI 78.9%-100%)和82.1%(95% CI 62.1%-100%)。SABR前的肾小球滤过率中位数(IQR)为58(40-71)毫升/分钟,最后一次随访时为48(33-57)毫升/分钟。没有患者出现 3+ 级毒性或发展为终末期肾病:结果表明,SABR似乎是治疗TA后复发RCC患者的一种有效而安全的挽救策略。
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来源期刊
BJU International
BJU International 医学-泌尿学与肾脏学
CiteScore
9.10
自引率
4.40%
发文量
262
审稿时长
1 months
期刊介绍: BJUI is one of the most highly respected medical journals in the world, with a truly international range of published papers and appeal. Every issue gives invaluable practical information in the form of original articles, reviews, comments, surgical education articles, and translational science articles in the field of urology. BJUI employs topical sections, and is in full colour, making it easier to browse or search for something specific.
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