Palliative irradiation for focally symptomatic metastatic renal cell carcinoma: Support for dose escalation based on a biological model
Palliative irradiation for focally symptomatic metastatic renal cell carcinoma: Support for dose escalation based on a biological model
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DOI：
10.1016/s0022-5347(01)64305-2
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发表时间：
1997-09-01
影响因子：
6.6
通讯作者：
Corn, BW
中科院分区：
文献类型：
--
作者：
DiBiase, SJ;Valicenti, RK;Corn, BW
目的：肾细胞癌传统上被认为是一种放射抵抗性癌症，然而，关于姑息性辐射剂量的增加是否可以克服这种肿瘤转移时的固有抵抗力的争议仍在继续。近年来，线性二次模型已成为评价放射治疗生物学有效剂量的一个范例。本研究是为了确定放射治疗的能力，以减轻局灶症状转移性肾细胞癌，并评估是否提供更高的生物有效剂量是更有可能带来姑息respons.Materials和方法：在1966年和1995年之间，107例患者在150个地点的肾细胞转移进行了姑息性照射的意图;照射部位包括骨（89）、软组织（16）、脑（20）、脊髓（9）和肺（16）。为了确定剂量有效性，根据公式计算生物学有效剂量，戈伊（10）=总剂量（1 +部分剂量/α-β），使用α-β = 10。结果：对于整个组，86%的患者在放射治疗后获得姑息性反应，而49%的患者获得完全姑息性反应。缓解的中位持续时间为6个月（范围1至150）。就总体（即完全和部分）缓解率而言，Karnofsky体力状态高的患者最有可能缓解（状态70或更高vs小于70，88% vs 78%，p < 0.043）。关于完全缓解率、体能状态（状态70或更大对小于70，55%对31%，p < 0.03）和使用更高的生物学有效剂量的辐射（戈伊（10）50或更大对小于50，59%对39%，p = 0.001）与统计学显著增加的应答率相关。独立的预后价值的性能状态和更高的生物有效剂量的照射保持在多变量analysis.Conclusions：尽管流行的概念，肾细胞癌是一般耐放疗，绝大多数的患者在我们的机构中，转移性肾细胞癌的发展与放疗缓解。当给予更高生物有效剂量的辐射时，更有可能获得完全的姑息性反应，特别是对具有相对较高性能状态的患者。
Purpose: Renal cell carcinoma has traditionally been regarded as a radioresistant cancer, yet controversy continues as to whether escalation of the palliative radiation dose can overcome the inherent resistance of such tumors when they metastasize. Recently, the linear quadratic model has emerged as a paradigm to assess biologically effective dose of radiotherapy. This study was undertaken to determine the ability of radiotherapy to palliate focally symptomatic metastatic renal cell carcinoma and to assess whether the delivery of higher biologically effective dose was more likely to bring about a palliative response.Materials and Methods: Between 1966 and 1995, 107 patients with renal cell metastases at 150 sites were irradiated with palliative intent; Sites irradiated included bone (89), soft tissue (16), brain (20), spinal cord (9) and pulmonary (16). To determine dose effectiveness the biologically effective dose was calculated according to the formula, Gy(10) = total dose(1 + fractional dose/alpha-beta), using an alpha-beta of 10.Results: For the entire group 86% of patients derived a palliative response after treatment with irradiation, while 49% derived a complete palliative response. The median duration of palliation was 6 months (range 1 to 150). With respect to overall (that is, complete and partial) response rates, those presenting with high Karnofsky performance status were most likely to respond (status 70 or greater versus less than 70, 88% versus 78%, p < 0.043. With respect to the rate of complete palliative response, performance status (status 70 or greater versus less than 70, 55% versus 31%, p < 0.03) and the use of higher biologically effective doses of irradiation (Gy(10) 50 or greater versus less than 50, 59% versus 39%, p = 0.001) were associated with a statistically significant increased rate of response. The independent prognostic value of performance status and higher biologically effective doses of irradiation were maintained in multivariate analysis.Conclusions: Despite the prevailing concept that renal cell carcinoma is generally resistant to radiotherapy, the overwhelming majority of patients seen at our institution in whom metastatic renal cell carcinoma developed were palliated with radiotherapy. A complete palliative response is more likely when higher biologically effective doses of irradiation are delivered, especially to patients with a relatively high performance status.