靶向药物联合立体定向放疗治疗肾癌骨转移的临床疗效分析

Clinical analysis of TKIs combined with SBRT in the treatment of renal cell carcinoma with bone metastasis

目的探讨靶向药物联合立体定向放疗(SBRT)治疗肾癌骨转移的疗效和安全性。方法回顾性分析2010年4月至2020年4月中山大学肿瘤防治中心80例肾癌骨转移患者的临床资料。24例接受单纯靶向药物治疗(A组),男19例,女5例。年龄17~73岁。病理诊断为透明细胞癌17例,非透明细胞癌7例。国际转移性肾细胞癌联合数据库(IMDC)预后评分低危2例,中危14例,高危8例。初诊骨转移21例。同期转移18例。行原发灶切除7例。56例接受靶向药物联合骨转移病灶SBRT治疗(B组),男45例,女11例。年龄21~86岁。病理诊断为透明细胞癌36例,非透明细胞癌20例。IMDC评分低危14例,中危32例,高危10例。初诊骨转移45例。同期转移31例。行原发灶切除56例。54例SBRT治疗前伴骨痛,疼痛数字评分法(NRS)中位评分6(2~9分)。一线治疗药物分别为舒尼替尼44例,索拉非尼10例,阿昔替尼22例,培唑帕尼4例。5例因无法耐受不良反应更换二线药物治疗,65例因肿瘤进展改二线及以上药物治疗。靶向药物治疗时间均>6个月。SBRT患者采用仰卧位,根据治疗目的、肿瘤位置、肿瘤大小以及危及器官的耐受性决定放疗剂量,常用SBRT处方为30~45 Gy/5F。比较两组的疗效及预后情况。结果本研究80例,中位随访时间20.7(4.8~115.7)个月。随访期间,A组和B组分别有3例和12例接受了靶向药物联合免疫治疗。B组中54例放疗前有骨痛症状,46例SBRT治疗后对止痛效果满意,12例骨病灶放疗后达完全缓解,32例达部分缓解。随访期间,40例因疾病进展死亡。A组和B组的中位总生存时间分别为20.7个月和未达,2年总生存率分别50%和62%,5年总生存率分别为19%和56%,差异均有统计学意义(P=0.006)。B组仅2例(3.6%)发生3度放疗相关不良反应。结论在靶向药物治疗基础上联合骨转移灶SBRT,可以有效提高肾癌骨转移患者的生活质量并延长生存时间。

Objective To evaluate the efficacy and safety of Tyrosine Kinase Inhibitors(TKIs)combined with stereotactic body radiation therapy(SBRT)in the treatment of renal cell carcinoma(RCC)patients with bone metastasis.Methods The clinical data of 80 RCC patients with bone metastasis in Sun Yat-sen University Cancer Center from April 2010 to April 2020 were analyzed retrospectively.Among them,64 patients were medium or high risk according to the International Metastatic Renal Cell Carcinoma Database Consortium(IMDC)score.Twenty-four patients received TKI therapy alone(Group A),and the other 56 cases received TKIs combined with SBRT to bone metastastic lesions(Group B).Results The median follow-up period was 20.7 months(4.8-115.6 months),70 patients received second or third-line targeted drug therapy,and 4 patients in group A and 15 patients in group B received TKI plus immunotherapy.Fifty-four patients had symptoms of bone pain before radiotherapy,46 patients were satisfied with the analgesic effect after SBRT treatment.Twelve patients got complete response(CR)after bone lesions,and 32 patients achieved partial response(PR).Forty patients died of disease progression during follow-up.The median OS was:20.7 months vs not reached(Group A vs.Group B),and the 2-y OS and 5-y OS were 50%vs.62%,and 19%vs.56%,respectively(P=0.006).There were only 2 patients(3.6%)had grade 3 SBRT related adverse events.Conclusions SBRT combined with TKIs improved the quality of life and prolonged the overall survival of RCC patients with bone metastasis.