靶向药物联合立体定向放疗治疗转移性肾癌初步临床观察

Preliminary clinical observation of efficacy and safety of stereotactic body radiation therapy in combination with targeted therapy for metastatic renal cell carcinoma

目的初步评估靶向药物联合体部立体定向放疗(SBRT)治疗转移性肾癌的疗效和安全性。方法回顾性分析2013-2018年间中山大学肿瘤防治中心接受靶向药物联合SBRT治疗的58例转移性肾癌患者资料,79.3%患者根据国际转移性肾细胞癌联合数据库评分为中高危,中位生物有效剂量为147 Gy(67~238 Gy)。结果分别有32、13、7、5、1例患者接受了1、2、3、4和6处共105个病灶的SBRT治疗,71%为骨转移灶,放疗期间未停用靶向药。SBRT治疗后中位随访9.4个月(2.7~40.1个月),18例患者死亡。1年局控率为97.4%,1年无进展生存率为50.3%,1、2年总生存率分别为72%、53%。85%患者放疗后疼痛减轻。放疗后肿瘤退缩患者1年总生存优于放疗后疾病稳定或进展患者(83%∶48%,P=0.021)。全组患者共6例发生3级不良反应,4例为3级骨髓抑制,1例为放射性神经炎,1例为放射性皮肤损伤。结论初步显示靶向治疗基础上联合局部转移病灶的SBRT治疗晚期转移性肾癌安全有效。

Objective To evaluate the preliminary clinical efficacy and safety of stereotactic body radiation therapy(SBRT)in combination with targeted therapy for metastatic renal cell carcinoma(mRCC).Methods Clinical data of 58 patients with mRCC who were treated with SBRT in combination with targeted therapy in Sun Yat-sen University Cancer Center from June 2013 to December 2018 were retrospectively analyzed.Among them,79.3%patients were classified as intermediate or high risk according to International Metastatic Renal Cell Carcinoma Database Consortium Criteria.The median biologically equivalent dose(BED)was 147 Gy(67 to 238 Gy).Results Overall,32,13,7,5 and 1 patients received SBRT for 1,2,3,4 and 6 metastatic sites(105 lesions)and 71.4%of them were bone lesions.Targeted therapy was continued during SBRT.With a median follow-up of 9.4 months(range 2.7 to 40.1 months),18 patients died.The 1-year local control rate was 97.4%.The 1-year progression-free survival was 50.3%.The 1-and 2-year overall survival was 72%and 53%.Approximately 85%patients experienced pain relief after SBRT.Patients who achieved complete or partial response after SBRT obtained better overall survival than those with stable disease or disease progression(1-year overall survival:83%vs.48%,P=0.021).In the whole cohort,6 cases developed GradeⅢadverse events,4 of which were GradeⅢmyelosuppression,1 case of GradeⅢneuropathy and 1 case of radiation-induced skin injury.Conclusion Preliminary study reveals that combined use of targeted therapy and SBRT is an efficacious and safe treatment of advanced mRCC.