Summary
Purpose 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. Methods 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). Results 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. Conclusions 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.
References
Suárez C, Morales R, Muñoz E, Rodón J, Valverde CM, Carles J (2010) Molecular basis for the treatment of renal cell carcinoma. Clin Transl Oncol 12:15–21
Basso M, Cassano A, Barone C (2010) A survey of therapy for advanced renal cell carcinoma. Urol Oncol 28:121–133
Murphy JD, Spalding AC, Somnay YR, Markwart S, Ray ME, Hamstra DA (2009) Inhibition of mTOR radiosensitizes soft tissue sarcoma and tumor vasculature. Clin Cancer Res 15:589–596
Chen H, Ma Z, Vanderwaal RP, Feng Z, Gonzalez-Suarez I, Wang S, Zhang J, Roti Roti JL, Gonzalo S, Zhang J (2010) The mTOR inhibitor rapamycin suppresses DNA double-strand break repair. Radiat Res (in press)
Chargari C, Campana F, Beuzeboc P, Zefkili S, Kirova YM (2009) Preliminary experience of helical tomotherapy for locally advanced pancreatic cancer. World J Gastroenterol 15:4444–4445
Kirova YM, Chargari C, Zefkili S, Campana F (2010) Could helical tomotherapy do whole brain radiotherapy and radiosurgery? World J Radiol 2:148–150
Chargari C, Kirova YM, Zefkili S et al (2009) Solitary plasmocytoma: improvement in critical organs sparing by means of helical tomotherapy. Eur J Haematol 83:66–71
Chargari C, Vernant JP, Tamburini J et al (2010) Feasibility of helical tomotherapy for debulking irradiation before stem cell transplantation in malignant lymphoma. Int J Radiat Oncol Biol Phys (in press)
Bhatt RS, Landis DM, Zimmer M et al (2008) Hypoxia-inducible factor-2alpha: effect on radiation sensitivity and differential regulation by an mTOR inhibitor. BJU Int 102:358–363
Conflict of interest statement
The authors declare that they have no conflict of interest relative to this work
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kirova, Y.M., Servois, V., Chargari, C. et al. Further developments for improving response and tolerance to irradiation for advanced renal cancer: concurrent (mTOR) inhibitor RAD001 and helical tomotherapy. Invest New Drugs 30, 1241–1243 (2012). https://doi.org/10.1007/s10637-010-9613-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10637-010-9613-1