目的 探讨γ-体部立体定向放射治疗（stereotactic body radiation therapy with γ-knife，γ-SBRT)配合靶向药物索拉非尼 (sorafenib)治疗复发及转移性肾癌的效果。 方法 2007-05至2009-05收治的肾癌术后复发及转移患者45例中 ，26例单纯行γ-SBRT，19例行γ-SBRT配合Sorafenib治疗,比较两组的有效率、局部控制率、生存率及生存质量改善情况。 结果 治疗后3个月总有效率为80.0%(36/45)。单纯γ-SBRT组的1年、2年局部控制率分别为42.3%(11/26)、 19.2% (5/26)；中位生存12个月；1年、2年生存率分别为46.2％、19.2％。γ-SBRT+Sorafenib组的1年、2年局部控制率分 别为47.3%(18/19)、21.1%(4/19)，中位生存18个月；1年、2年生存率分别为57.9％、26.3％。 结论 采用γ- 体部立体定向放疗结合靶向药物索拉非尼对复发及转移性肾癌进行治疗效果较好，不良反应轻微，多数患者能耐受治疗。
Abstract
Objective To study the efficacy of stereotactic radiation therapy with gamma-knife (γ-SBRT) combined with targeted drug sorafenib in treatment of recurrent and metastatic renal cell carcinoma. Methods From May 2007 to May 2009, 45 patients with recurrent and metastatic renal cell carcinoma patients were admitted. 26 of them were treated with γ-SBRT alone and 19 cases treated with γ-SBRT with Sorafenib treatment. Results The total effective rate after three-month treatment was 80.0% (36/45). The local control rate at 1, 2 years was 42.3% (11/26), 19.2% (5/26)，median survival 12 months, and the cumulative survival rate at 1, 2 years was 46.2 %, 19.2%, respectively in γ-SBRT group. The local control rate at 1, 2 years was 47.3% (18/19) and 21.1% (4/19)，median survival 18 months, and the cumulative survival rate at 1, 2 years was 57.9% and 26.3%, respectively inγ-SBRT + sorafenib group. Conclusions The combination of stereotactic gamma-body radiation therapy with targeted drug sorafenib for treatment of recurrent and metastatic renal cell carcinoma is an effective treatment. Adverse reactions are mild, and most patients can tolerate the treatment.
关键词
肾细胞癌 /
体部立体定向放射治疗 /
靶向治疗 /
索拉非尼
Key words
renal cell carcinoma /
stereotactic body radiation therapy /
targeted therapy
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参考文献
［1］TONG T Q，ROHDE D，PETER S．Progress in the management of advanced renal cell carcinoma （RCC）［J］．Aktuelle Urol，2010，41（1）：57-60.
［2］ Brookman-Amissah S, Kendel F, Spivak I, et al . Impact of clinical variables on predicting disease-free survival of patients with surgically resected renal cell carcinoma［J］. BJU Int. 2009,103(10):1375-1380.
［3］ 崔传亮,马建辉,郭军,等. 索拉非尼一线治疗晚期转移性肾癌的期临床研究［J］. 中华泌尿外科杂 志,2009,30( 1):15-17.
［4］ 赵欣,寿建忠,周爱萍,等. 索拉非尼治疗晚期肾癌临床观察［J］ .中华泌尿外科杂志,2010, 31(1):8 -11.
［5］ A kaza H, T sukamoto T, Murai M, et al . Phase II study to investigate the efficacy, safety, and pharmacokinetics of sorafenib in Japanese patients with advanced renal cell carcinoma［J］. Jpn J Clin Oncol, 2007,37(10):755-762.
［6］ Escudier B, Eisen T, Stadler WM, et al . Sorafenib in advanced clear-cell renal-cell carcinoma［J］. N Engl J Med, 2007，356(2):125-134.
［7］ Escudier B, Eisen T, Stadler WM, et al . Sorafenib for treatment of renal cell carcinoma: Final efficacy and safety results of the phase III treatment approaches in renal cancer global evaluation trial［J］. J Clin Oncol,2009,27(20):3312-3318.
［8］ 康静波，聂青，张丽萍，等.伽玛刀序贯TACE治疗肝癌伴门静脉癌栓的临床观察［J］.临床肿瘤学杂志 ，2011，16（7）：617-621.
［9］ Teh B, Bloch C, Galli-Guevara M, et al . The treatment of primary and metastatic renal cell carcinoma (RCC) with image-guided stereotactic body radiation therapy (SBRT)［J］. Biomed Imaging Interv J,2007,3(1):e6.
［10］宋德刚转移性肾细胞癌分子靶向治疗研究进展［J］. 中国肿瘤临床，2007，34（10）：594-597.
［11］Beck J, Procopio G, Bajetta E, et al .Final results of the European Advanced Renal Cell Carcinoma Sorafenib (EU-ARCCS) expanded-access study: a large open-label study in diverse community settings［J］. Ann Oncol,2011,22(8):1812-1823.
［12］Bukowski R M, Stadler W M, McDermott D F, et al . Safety and efficacy of sorafenib in elderly patients treated in the North American advanced renal cell carcinoma sorafenib expanded access program［J］. Oncology,2010,78(5-6):340-347.
基金
全军科技攻关项目（06G034）,国家卫生部专题项目（W2009BX042）
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