Context: Surgery is the gold standard for the local treatment of primary renal cell carcinoma (RCC), but alternatives are emerging. We conducted a systematic review and meta-analysis to assess the results of prospective studies using definitive stereotactic body radiotherapy (SBRT) to treat primary localised RCC. Evidence acquisition: This review was prospectively registered in PROSPERO (CRD42023447274). We searched PubMed, Embase, Scopus, and Google Scholar for reports of prospective studies published since 2003, describing the outcomes of SBRT for localised RCC. Meta-analyses were performed for local control (LC), overall survival (OS), and rates of adverse events (AEs) using generalised linear mixed models (GLMMs). Outcomes were presented as rates with corresponding 95% confidence intervals (95% CIs). Risk-of-bias was assessed using the ROBINS-I tool. Evidence synthesis: Of the 2983 records, 13 prospective studies (n= 308) were included in the meta-analysis. The median diameter of the irradiated tumours ranged between 1.9 and 5.5 cm in individual studies. Grade ≥ 3 AEs were reported in 15 patients, and their estimated rate was 0.03 (95%CI: 0.01–0.11;n= 291). One- and two-year LC rates were 0.98 (95%CI: 0.95–0.99;n= 293) and 0.97 (95%CI: 0.93–0.99;n= 253), while one- and two-year OS rates were 0.95 (95%CI: 0.88–0.98;n= 294) and 0.86 (95%CI: 0.77–0.91;n= 224). There was no statistically significant heterogeneity, and the estimations were consistent after excluding studies at a high risk of bias in a sensitivity analysis. Major limitations include a relatively short follow-up, inhomogeneous reporting of renal function deterioration, and a lack of prospective comparative evidence. Conclusions: The short-term results suggest that SBRT is a valuable treatment method for selected inoperable patients (or those who refuse surgery) with localised RCC associated with low rates of high-grade AEs and excellent LC. However, until the long-term data from randomised controlled trials are available, surgical management remains a standard of care in operable patients.
背景：手术是原发性肾细胞癌（RCC）局部治疗的金标准，但替代疗法正在兴起。我们进行了一项系统性回顾与荟萃分析，旨在评估采用确定性立体定向体部放疗（SBRT）治疗原发性局限性肾细胞癌的前瞻性研究结果。 证据获取：本综述已在PROSPERO前瞻性注册（注册号CRD42023447274）。我们检索了PubMed、Embase、Scopus和Google Scholar数据库中自2003年以来发表的前瞻性研究报告，这些报告描述了SBRT治疗局限性肾细胞癌的疗效。采用广义线性混合模型（GLMMs）对局部控制率（LC）、总生存率（OS）及不良事件（AEs）发生率进行了荟萃分析。结果以发生率及其相应的95%置信区间（95% CI）呈现。使用ROBINS-I工具评估偏倚风险。 证据综合：在2983条记录中，共有13项前瞻性研究（n=308）被纳入荟萃分析。各项研究中受照射肿瘤的中位直径范围为1.9至5.5厘米。共报告了15例≥3级不良事件，其估计发生率为0.03（95% CI: 0.01–0.11；n=291）。一年和两年的局部控制率分别为0.98（95% CI: 0.95–0.99；n=293）和0.97（95% CI: 0.93–0.99；n=253），而一年和两年的总生存率分别为0.95（95% CI: 0.88–0.98；n=294）和0.86（95% CI: 0.77–0.91；n=224）。未发现统计学上的显著异质性，且在敏感性分析中排除高偏倚风险研究后，估计结果保持一致。主要局限性包括随访时间相对较短、肾功能恶化报告不一致以及缺乏前瞻性比较证据。 结论：短期结果表明，对于经过选择的无法手术（或拒绝手术）的局限性肾细胞癌患者，SBRT是一种有价值的治疗方法，其高级别不良事件发生率低且局部控制率优异。然而，在获得随机对照试验的长期数据之前，手术治疗对于可手术患者仍是标准治疗方案。
肿瘤(癌症)患者之家