Syrios John, Kechagias Georgios, Tsavaris Nicolas
Department of Pathophysiology, Oncology Unit, Laikon General Hospital, Athens University School of Medicine, 75 Mikras Asias street, Athens, 11527, Greece.
J Med Case Rep. 2012 Sep 14;6:303. doi: 10.1186/1752-1947-6-303.
In this case series and short review of the literature, we underline the impact of nephrectomy combined with sequential therapy based on cytokines, antiangiogenic factors, and mammalian target of rapamycin inhibitors along with metastasectomy on overall survival and quality of life in patients with metastatic clear cell renal carcinoma.
In the first of two cases reported here, a 53-year-old Caucasian man underwent a radical left nephrectomy for renal cell cancer and relapsed with a bone metastasis in his right humerus. He was treated with closed nailing and cytokine-based chemotherapy. For 5 years, the disease was stable and he had great improvement in quality of life. Subsequently, the disease relapsed in his lymph nodes, lung, and thorax soft tissue. He was then treated with antiangiogenic factors and mammalian target of rapamycin inhibitors. The disease progressed until September 2009, when he died of allergic shock during a blood transfusion, 9 years after the initial diagnosis of renal cell cancer.In the second case, a 54-year-old Caucasian man underwent a radical left nephrectomy for renal cell cancer. A year later, the disease progressed to his neck lymph nodes, and cytokine-based chemotherapy was initiated. While he was on cytokines, a solitary pulmonary nodule appeared and he underwent a metastasectomy. Nine months later, magnetic resonance imaging of his brain revealed a focal right occipitoparietal lesion, which was resected. After two years of active surveillance, the disease relapsed as a pulmonary metastasis and he was treated with an antiangiogenic factor. Further progressions presenting as enlarged axillary lymph nodes, chest soft tissue lesions, and thoracic spine bone metastases were sequentially observed. He then received a first-generation mammalian target of rapamycin inhibitor, an antiangiogenic factor, and later a second-generation mammalian target of rapamycin inhibitor and palliative radiotherapy. Ten years after the initial diagnosis of renal cell cancer, his disease is stable and he is on a third antiangiogenic factor and leads an active life.
One multidisciplinary approach to patients with metastatic renal cell cancer combines nephrectomy, metastasectomy, and radiotherapy (when feasible) with medical therapy based on cytokines and targeted treatment employing agents inhibiting angiogenesis, other receptor tyrosine kinases, and mammalian target of rapamycin. This approach could prolong survival and improve quality of life.
在本病例系列及文献综述中，我们强调了肾切除术联合基于细胞因子、抗血管生成因子和雷帕霉素靶蛋白抑制剂的序贯治疗以及转移灶切除术对转移性透明细胞肾细胞癌患者总生存期和生活质量的影响。
在此报告的两例病例中的第一例，一名53岁的白种男性因肾细胞癌接受了根治性左肾切除术，随后右肱骨出现骨转移复发。他接受了闭合穿钉术及基于细胞因子的化疗。5年来，病情稳定，生活质量有显著改善。随后，疾病在其淋巴结、肺部和胸部软组织复发。之后他接受了抗血管生成因子和雷帕霉素靶蛋白抑制剂治疗。疾病持续进展，直至2009年9月，他在肾细胞癌初诊9年后，因输血时发生过敏性休克死亡。
在第二例病例中，一名54岁的白种男性因肾细胞癌接受了根治性左肾切除术。一年后，疾病进展至颈部淋巴结，遂开始基于细胞因子的化疗。在接受细胞因子治疗期间，出现了一个孤立性肺结节，他接受了转移灶切除术。9个月后，脑部磁共振成像显示右侧枕顶叶有一个局灶性病变，予以切除。经过两年的积极监测，疾病复发为肺转移，他接受了抗血管生成因子治疗。随后依次观察到疾病进展为腋窝淋巴结肿大、胸部软组织病变和胸椎骨转移。然后他接受了第一代雷帕霉素靶蛋白抑制剂、抗血管生成因子治疗，后来又接受了第二代雷帕霉素靶蛋白抑制剂和姑息性放疗。在肾细胞癌初诊10年后，他的病情稳定，正在接受第三种抗血管生成因子治疗，过着积极的生活。
对于转移性肾细胞癌患者，一种多学科治疗方法是将肾切除术、转移灶切除术和放疗（可行时）与基于细胞因子的药物治疗以及使用抑制血管生成、其他受体酪氨酸激酶和雷帕霉素靶蛋白的靶向治疗相结合。这种方法可以延长生存期并改善生活质量。
