Department of Oncology, Azienda Ospedaliera Treviglio-Caravaggio, Piazzale Ospedale 1, 12-24047 Treviglio, Bergamo, Italy.
Nat Rev Urol. 2010 Nov;7(11):634-7. doi: 10.1038/nrurol.2010.161. Epub 2010 Oct 12.
A 57-year-old woman presented with metastatic renal cell carcinoma (RCC). She was enrolled in a clinical study, in which she received two cycles of neoadjuvant sunitinib therapy followed by cytoreductive nephrectomy. Her primary tumor and rib metastasis showed a good response to neoadjuvant therapy; however, after surgery, the patient developed neurologic symptoms, including flaccid paraparesis with paresthesia and hypoesthesia. MRI of the brain and spine revealed a leptomeningeal lesion at the T12-L1 space, which was presumed to have progressed during the 3-week treatment-free perioperative period. The patient underwent radiation therapy for the intramedullary lesion 1 month later, and sunitinib therapy was subsequently reinstated. After 6 months, her extracranial lesions remained stable and the intramedullary lesion was undetectable on MRI.
CT of the chest and abdomen, bone scan, kidney and liver function tests, measurement of serum levels of calcium, electrolytes and lactate dehydrogenase, CBC, MRI of the brain and spine.
Progression of a central nervous system metastasis linked to the interruption of neoadjuvant sunitinib therapy.
Neoadjuvant sunitinib therapy followed by cytoreductive nephrectomy for the primary RCC; radiation therapy for the intramedullary lesion, followed by reinstatement of sunitinib therapy owing to a good clinical response observed in the extracranial lesions.
一名 57 岁女性因转移性肾细胞癌 (RCC) 就诊。她参加了一项临床研究，在该研究中她接受了两个周期的新辅助舒尼替尼治疗，随后进行了肾切除术。她的原发肿瘤和肋骨转移对新辅助治疗有良好的反应；然而，手术后，患者出现神经症状，包括伴有感觉异常的弛缓性截瘫。脑部和脊柱的 MRI 显示 T12-L1 间隙有软脑膜病变，这被认为是在 3 周无治疗手术围手术期进展的。一个月后，患者因髓内病变接受放射治疗，随后重新开始舒尼替尼治疗。6 个月后，她的颅外病变仍然稳定，MRI 上无法检测到髓内病变。
胸部和腹部 CT、骨扫描、肾功能和肝功能检查、血清钙、电解质和乳酸脱氢酶水平测定、CBC、脑部和脊柱 MRI。
与新辅助舒尼替尼治疗中断相关的中枢神经系统转移进展。
新辅助舒尼替尼治疗联合肾切除术治疗原发 RCC；髓内病变行放射治疗，随后因观察到颅外病变有良好的临床反应而重新开始舒尼替尼治疗。
