Acevedo Alfredo, Zapata Laguado Martin
Clinical Oncology, Universidad El Bosque, Bogota, COL.
Clinical Oncology, Instituto Nacional de Cancerología, Bogota, COL.
Cureus. 2025 May 28;17(5):e84962. doi: 10.7759/cureus.84962. eCollection 2025 May.
A 65-year-old woman was first diagnosed in 2011 with stage III clear cell renal cell carcinoma (pT3aNxM0) of the left kidney, managed successfully with radical nephrectomy. She remained disease-free for three years. In 2014, she developed a metachronous stage III papillary thyroid carcinoma (T1N1M0), treated with total thyroidectomy, nodal dissection, and adjuvant radioactive iodine therapy (100 mCi). In 2019, two pulmonary lesions were detected in the left upper lobe. Biopsy confirmed metastatic clear cell carcinoma. Due to intolerance to sunitinib, the patient was treated with pazopanib. By September 2022, she developed four intracranial metastatic lesions, predominantly in the right frontal lobe and bilateral mesial temporal lobes. A neurosurgeon performed a biopsy, confirming metastatic clear cell carcinoma. The patient underwent whole-brain radiotherapy over five sessions and began treatment with nivolumab. After receiving five cycles of immunotherapy, the patient experienced a seizure associated with edema around the dominant lesion and neurological decline. She was treated with anticonvulsants and a short steroid course, leading to functional recovery. We used this treatment for around 10 days and continued immunotherapy and anticonvulsant therapy. In January 2023, ketogenic metabolic therapy (KMT) was initiated using a 3:1 ratio ketogenic supplement (KetoVie). Ketone levels and neurological status were closely monitored. Upon confirmation of ketones in the urine or blood, therapy adjustments were made to optimize adherence. By July 2023, the patient no longer required assistance for medical appointments, discontinued anticonvulsant therapy, and retained full cognitive function. In January 2024, the patient maintained a partial response, and dietary supplementation was stopped. This case highlights the potential role of KMT as a safe and complementary approach in advanced clear cell renal cell carcinoma. KMT may enhance the efficacy of immunotherapy and radiotherapy, contributing to improved progression-free survival and neurological function without increasing toxicity.
一名65岁女性于2011年首次被诊断为左肾III期透明细胞肾细胞癌（pT3aNxM0），通过根治性肾切除术成功治疗。她保持无病状态三年。2014年，她出现异时性III期乳头状甲状腺癌（T1N1M0），接受了全甲状腺切除术、淋巴结清扫术和辅助放射性碘治疗（100毫居里）。2019年，在左上叶发现两个肺部病变。活检证实为转移性透明细胞癌。由于对舒尼替尼不耐受，该患者接受了帕唑帕尼治疗。到2022年9月，她出现了四个颅内转移病灶，主要位于右额叶和双侧颞叶内侧。一名神经外科医生进行了活检，证实为转移性透明细胞癌。该患者接受了五个疗程的全脑放疗，并开始使用纳武单抗治疗。在接受五个周期的免疫治疗后，患者出现了与主要病灶周围水肿相关的癫痫发作和神经功能衰退。她接受了抗惊厥药物治疗和短期类固醇疗程，从而实现了功能恢复。我们使用这种治疗方法约10天，并继续进行免疫治疗和抗惊厥治疗。2023年1月，开始使用3:1比例的生酮补充剂（KetoVie）进行生酮代谢疗法（KMT）。密切监测酮水平和神经状态。在确认尿液或血液中存在酮后，进行治疗调整以优化依从性。到2023年7月，患者不再需要他人陪同就医，停止了抗惊厥治疗，并保留了全部认知功能。2024年1月，患者维持部分缓解，停止了饮食补充。该病例突出了KMT作为晚期透明细胞肾细胞癌一种安全且辅助性方法的潜在作用。KMT可能增强免疫治疗和放疗的疗效，有助于改善无进展生存期和神经功能，而不会增加毒性。
