One-third of renal cell carcinomas (RCCs) without metastases develop metastatic disease after extirpative surgery for the primary tumors. The majority of metastatic RCC cases, along with treated primary lesions, involve limited lesions termed “oligo-recurrent” disease. The role of metastasis-directed therapy (MDT), including stereotactic body radiation therapy (SBRT) and metastasectomy, in the treatment of oligo-recurrent RCC has evolved. Although the surgical resection of all lesions alone can have a curative intent, SBRT is a valuable treatment option, especially for patients concurrently receiving systemic therapy. Contemporary immune checkpoint inhibitor (ICI) combination therapies remain central to the management of metastatic RCC. However, one objective of MDT is to delay the initiation of systemic therapies, thereby sparing patients from potentially unnecessary burdens. Undertaking MDT for cases showing progression under systemic therapies, known as “oligo-progression”, can be complex in considering the treatment approach. Its efficacy may be diminished compared to patients with stable disease. SBRT combined with ICI can be a promising treatment for these cases because radiation therapy has been shown to affect the tumor microenvironment and areas beyond the irradiated sites. This may enhance the efficacy of ICIs, although their efficacy has only been demonstrated in clinical trials.
肾细胞癌（RCC）患者中，约三分之一在原发性肿瘤切除术后无转移者最终会发展为转移性疾病。大多数转移性RCC病例，连同已治疗的原发病灶，涉及被称为“寡复发”的有限病灶。针对寡复发RCC的转移定向治疗（MDT），包括立体定向体部放疗（SBRT）和转移灶切除术，其作用已逐渐演变。尽管单纯手术切除所有病灶可能具有治愈意图，但SBRT是一种有价值的治疗选择，特别是对于同时接受全身治疗的患者。当代免疫检查点抑制剂（ICI）联合疗法仍然是转移性RCC管理的核心。然而，MDT的目标之一是延迟全身治疗的启动，从而使患者免于可能不必要的负担。对于在全身治疗下出现进展的病例（称为“寡进展”），实施MDT在考虑治疗方法时可能较为复杂。与疾病稳定的患者相比，其疗效可能有所降低。SBRT联合ICI可能是这些病例的一种有前景的治疗方法，因为放疗已被证明会影响肿瘤微环境和照射区域以外的部位。这可能会增强ICI的疗效，尽管其疗效仅在临床试验中得到证实。
The Diagnosis and Treatment Approach for Oligo-Recurrent and Oligo-Progressive Renal Cell Carcinoma
肿瘤(癌症)患者之家