Background: Stereotactic body radiation therapy (SBRT) is the most commonly used metastasis-directed therapy (MDT) for oligometastatic urothelial carcinoma (omUC). Despite efforts in defining this disease entity, open questions remain concerning the role of MDT and the use of biomarkers, imaging, and its combination with systemic therapies. The aim of the present systematic review is to provide an updated overview of the current clinical evidence on SBRT for omUC in terms of survival and local control benefits. We also aim to provide updates on controversial areas and future directions in this emerging field. Methods: With a systematic approach, following PRISMA recommendations, we searched two databases to identify and select articles published up until March 2024 reporting the use of SBRT for omUC with or without concomitant systemic therapies. Prospective randomized or non-randomized studies as well as retrospective studies were included. Results: Eight studies were selected for data extraction and 293 omUC patients treated with SBRT were collectively analyzed. In metachronous omUC patients, SBRT delivered with ablative doses (BED10 ≥ 78 Gy) was associated with a 2-year overall survival (OS) rate of 50.7% (95% CI 35.1–64.4%). The use of sub-ablative SBRT doses (BED10 = 43.2 Gy) in combination with immunotherapy did not demonstrate significant clinical outcome improvement in two prospective studies. The overall tolerance was good, with only one study reporting toxicity of grade 3 in up to 18% of the patients treated with SBRT in combination with immunotherapy. Conclusions: SBRT is an effective and widely available MDT option in omUC, although this is based on a limited number of studies. Despite the attempt to use SBRT as an immune response trigger in combination with immunotherapy, no significant improvement in survival outcomes has been observed. The integration of new systemic agents with MDT will likely define a new scenario for the treatment of omUC. The review protocol was registered in PROSPERO, ID: CRD42024522381.
背景：立体定向体部放疗（SBRT）是寡转移性尿路上皮癌（omUC）最常用的转移灶定向治疗（MDT）。尽管学界已对该疾病实体进行了诸多界定，但关于MDT的作用、生物标志物与影像学应用及其与全身治疗的联合方案仍存在未解问题。本系统性综述旨在从生存获益与局部控制角度，对SBRT治疗omUC的现有临床证据进行更新概述，同时就该新兴领域的争议焦点与未来方向提供最新见解。 方法：遵循PRISMA指南，采用系统性检索策略，我们在两个数据库中检索并筛选截至2024年3月发表的、报道SBRT单用或联合全身疗法治疗omUC的文献。纳入标准包括前瞻性随机/非随机研究及回顾性研究。 结果：共纳入8项研究进行数据提取，汇总分析了293例接受SBRT治疗的omUC患者。在异时性omUC患者中，采用消融剂量（BED10 ≥ 78 Gy）的SBRT治疗与50.7%（95% CI 35.1–64.4%）的2年总生存率相关。两项前瞻性研究显示，联合免疫治疗时采用次消融剂量SBRT（BED10 = 43.2 Gy）未显著改善临床结局。总体耐受性良好，仅一项研究报告接受SBRT联合免疫治疗的患者中出现最高达18%的3级毒性反应。 结论：基于现有有限研究，SBRT是omUC有效且可广泛应用的MDT选择。尽管尝试将SBRT作为免疫反应触发剂与免疫疗法联用，但尚未观察到生存结局的显著改善。新型全身治疗药物与MDT的整合可能为omUC治疗开辟新格局。本综述方案已在PROSPERO平台注册，注册号：CRD42024522381。
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