J Korean Med Sci.  2008 Aug;23(4):740-743. 10.3346/jkms.2008.23.4.740.

Hypofractionated High-Dose Intensity-Modulated Radiotherapy (60 Gy at 2.5 Gy per Fraction) for Recurrent Renal Cell Carcinoma: A Case Report

• Cho J
• Kim GE
• Rha KH
• Ahn JB
• Lee CG
• Suh CO
• Seong J
• Keum KC
• Kim SI
• Lee YH

• KMID: 1785842
• DOI: http://doi.org/10.3346/jkms.2008.23.4.740

Abstract

A patient with renal cell carcinoma (RCC) developed synchronous bone metastasis with metachronous relapses to the bone and renal fossa. The primary lesion was initially removed surgically, and the metastatic bone lesions and locally recurrent tumours were treated by a high-fractional dose and high-total-dose intensitymodulated radiotherapy (IMRT, 60 Gy at 2.5 Gy per fraction) without significant side effects. All the grossly relapsed tumors underwent complete remission (CR) within a short time after IMRT. To date, CR has been maintained for more than two years. This case study reports the successful treatment of radioresistant RCC using a new scheme that involves a fractionation regimen with a high precision radiotherapy.

Keyword

Radiotherapy, Intensity-Modulated; Carcinoma, Renal Cell; Radioresistance

MeSH Terms

Carcinoma, Renal Cell/pathology/*radiotherapy
Dose Fractionation
Female
Humans
Kidney Neoplasms/pathology/*radiotherapy
Middle Aged
Neoplasm Recurrence, Local/pathology/*radiotherapy
Radiotherapy, Intensity-Modulated

Figure

• 

  Fig. 1 (A) Abdomino-pelvic CT revealing a heterogeneous mass lesion (approximately 7 cm in size) on the left kidney midpole extending to the renal pelvis. (B) Whole-body bone scan performed for staging workup, showing a focus of increased uptake in the left ischium, left anterior ilium, and left acetabulum. (C) Gross appearance: a circumscribed tumor in the midpole of the kidney shows a variegated cut surface composed of golden yellow and pinkish parenchyma and areas of necrosis. (D) This tumor is predominantly composed of conventional RCC (right side) and a small portion of sarcomatoid RCC (left side). The conventional RCC component has clear cells interspersed with abundant, thin-walled blood vessels, while the sarcomatoid component consists of interlacing bundles of spindle cells with pleomorphic nuclei. (E) Metastatic carcinoma on the ischial bone (H&E, ×200); most metastatic carcinoma are the sarcomatoid component of RCC.

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  Fig. 2 Dose distribution for the SIB-IMRT plans. (A) The 1st IMRT SIB delivers 60 and 45.06 Gy in 24 fractions to the gross metastatic tumors (blue) and the rest of the left pelvic bone (violet). (B) The 2nd IMRT SIB also delivers 60 Gy in 24 fractions to the gross renal fossa recurrent tumor (blue) and the left rib mass in the vicinity of the left 9th costochondral junction (blue). The isodose lines of 60, 55, 50, 45, 30, and 20 Gy are shown.

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  Fig. 3 Metastatic bony lesions to the left ischium (A), the left rib in the vicinity of the left 9th costochondral junction (B), and the renal fossa recurrent tumor (C). a-1, b-1, and c-1 reveal pre-treatment gross tumors. a-2, b-2, and c-2 show SIB-IMRT differential-dose distribution, which is highly conformed to the gross and microscopic tumors on each site. a-3, b-3, and c-3 are follow-up images showing complete disappearance 1-3 months after IMRT to each site. a-4 and b-4 show the re-ossification of the metastatic bones 20 months and 25 months after IMRT. c-4 also shows complete remission of renal fossa, which has been maintained 25 months after IMRT.

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