Department of Radiation Oncology, Institut Curie, 26, rue d'Ulm, 75248, Paris Cedex 05, France.
Invest New Drugs. 2012 Jun;30(3):1241-3. doi: 10.1007/s10637-010-9613-1. Epub 2010 Dec 14.
Radiotherapy remains marginal in the treatment of renal cell carcinoma (RCC), due to radioresistance and risks of acute toxicity. However, recent data have shown that the m-TOR inhibitors could decrease the tumor resistance to ionizing radiation. At the same time, new highly conformal irradiation modalities may significantly improve the tolerance to radiation.
Here, we report the first case of concurrent use of mTOR antagonist, rapamycin and Helical Tomotherapy and its potential in critical organs sparing in a patient with retroperitoneal relapse from a RCC. He was treated with Everolimus, 10 mg/d and concurrent Helical Tomotherapy to the region of the recurrence (45 Gy, 1.8 Gy per fraction).
Helical Tomotherapy allowed very sharp dose distributions around the target volumes, while sparing critical organs from useless radiation. No radiotherapy related acute toxicity was observed. At last follow-up (6 months later), the patient remains in partial remission at the irradiated region.
While targeted agents might find applications for radiosensitizing purposes, this report highlights the potential of Helical Tomotherapy for reducing the doses delivered to the critical organs, thus improving tolerance to irradiation.
由于放射性抗性和急性毒性的风险，放射疗法在肾细胞癌（RCC）的治疗中仍然处于边缘地位。然而，最近的数据表明，mTOR 抑制剂可以降低肿瘤对电离辐射的抗性。同时，新的高度适形照射方式可能会显著提高对辐射的耐受性。
在这里，我们报告了首例同时使用 mTOR 拮抗剂雷帕霉素和螺旋断层放疗（Helical Tomotherapy）及其在 RCC 腹膜后复发患者的关键器官保护中的潜在应用。他接受了依维莫司（Everolimus）治疗，每天 10mg，并对复发病灶区域进行同步 Helical Tomotherapy（45Gy，1.8Gy/次）。
Helical Tomotherapy 允许在靶区周围进行非常锐利的剂量分布，同时避免关键器官受到无用的辐射。未观察到放疗相关的急性毒性。在最后一次随访（6 个月后），患者在照射区域仍处于部分缓解状态。
虽然靶向药物可能有用于放射增敏的应用，但本报告强调了螺旋断层放疗降低关键器官接受剂量的潜力，从而提高了对辐射的耐受性。
