Page 63 - ARNM-1-1

Advances in Radiotherapy
& Nuclear Medicine PRaG therapy for renal pelvis carcinoma

A

B

C

D

Figure 1. The 18 fluorodeoxyglucose positron emission tomography/computed tomography ( F-FDG PET/CT) scans were conducted before and after
18
PRaG therapy treatment. The scans indicate significant tumor regression at both the irradiated sites (A, white arrows) and distant unirradiated sites (B,
C, and D, white arrows) from May 13 , 2021, to September 24 , 2021. However, on December 7 , 2021, a repeat PET-CT scan revealed enlarged lymph
th
th
th
nodes beside the right inferior vena cava. Subsequently, a reassessment PET-CT scan conducted on February 8 , 2022, following 4 cycles of PRaG therapy,
th
demonstrated a reduction in the number of lesions (A-D) and a decrease in the FDG metabolism.
In addition, it is noteworthy that the irradiated field was According to the perioperative chemotherapy versus
confined in this scenario, and every lesion was exposed surveillance in upper Tract urothelial cancer study, providing
to a relatively low radiation dose of 5 Gy × 2 fractions, postoperative chemotherapy that combines gemcitabine
which is substantially lower than the standard radical with either cisplatin or carboplatin can significantly
irradiation dose. Evidence showed that the regimen improve the disease-free survival of patients suffering from
of hypofractionated radiotherapy (5 Gy × 3 fractions) RPC . Notably, certain patients may be unable to endure
[6]
demonstrates a greater efficacy in releasing tumor antigens, platinum-based chemotherapy due to complications and
enhancing the levels of tumor necrosis factor-α, IL-6, renal impairment. In addition, patients who undergo
IL-8, and other cytokines associated with tumor necrosis, chemotherapy and experience disease progression may have
reducing the infiltration of myeloid-derived suppressor restricted options for second-line treatments.
cells into the tumor microenvironment and preventing
lymphocytes depletion when compared to conventional Currently, a mounting body of evidence has emerged,
fractionated radiotherapy (2 Gy × 5 fractions) [3-5] . In this providing support for the effectiveness of immune
case, a relatively low radiation dose of 5 Gy × 2 fractions checkpoint inhibitors (ICI) in the treatment of UC.
was applicated, considering the lymphocytes protection Moreover, several compounds have already been sanctioned
and acting radiotherapy as a sensitizer to immunotherapy for utilization in the advanced UC first- and second-line
and successfully eliciting a systemic antitumor effect for settings [7,8] . However, the step-by-step administration of
this patient who failed from previous anti-PD-1 therapy. PD-1/PD-L1 inhibitors has not shown significant clinical

Volume 1 Issue 1 (2023) 3 https://doi.org/10.36922/arnm.0441