Renal cell cancer (RCC) has traditionally been considered radioresistant. Because of this, conventional radiotherapy (RT) has been predominantly relegated to the palliation of symptomatic metastatic disease. The implementation of stereotactic ablative radiotherapy (SABR) has made it possible to deliver higher ablative doses safely, shifting the renal radioresistance paradigm. SABR has increasingly been adopted into the multidisciplinary framework for the treatment of locally recurrent, oligoprogressive, and oligometastatic disease. Furthermore, there is growing evidence of SABR as a non-invasive definitive therapy in patients with primary RCC who are medically inoperable or who decline surgery, unsuited to invasive ablation (surgery or percutaneous techniques), or at high-risk of requiring post-operative dialysis. Encouraging outcomes have even been reported in cases of solitary kidney or pre-existing chronic disease (poor eGFR), with a high likelihood of preserving renal function. A review of clinical evidence supporting the use of ablative radiotherapy (SABR) in primary, recurrent, and metastatic RCC has been conducted. Given the potential immunogenic effect of the high RT doses, we also explore emerging opportunities to combine SABR with systemic treatments. In addition, we explore future directions and ongoing clinical trials in the evolving landscape of this disease.
肾细胞癌（RCC）传统上被认为具有放射抵抗性。因此，常规放射治疗（RT）主要被用于缓解症状性转移性疾病。立体定向消融放射治疗（SABR）的实施使得安全地给予更高消融剂量成为可能，从而改变了肾癌放射抵抗的传统观念。SABR已越来越多地被纳入多学科治疗框架，用于治疗局部复发、寡进展和寡转移性疾病。此外，越来越多的证据表明，对于因医学原因无法手术、拒绝手术、不适合侵入性消融（手术或经皮技术）或术后需要透析风险较高的原发性RCC患者，SABR可作为一种非侵入性的根治性治疗。甚至在孤立肾或已有慢性肾病（eGFR较差）的病例中也报告了令人鼓舞的结果，且保留肾功能的概率较高。本文综述了支持在原发性、复发性和转移性RCC中使用消融性放射治疗（SABR）的临床证据。鉴于高剂量RT潜在的免疫原性效应，我们还探讨了将SABR与全身治疗相结合的新兴机遇。此外，我们探索了在这一疾病不断演变的背景下未来的发展方向和正在进行的临床试验。
The Landscape of Stereotactic Ablative Radiotherapy (SABR) for Renal Cell Cancer (RCC)
肿瘤(癌症)患者之家