Mesh : Antineoplastic Combined Chemotherapy Protocols / adverse effects therapeutic use Carcinoma, Squamous Cell / radiotherapy secondary Chemoradiotherapy / adverse effects Cisplatin / adverse effects therapeutic use Esophagitis / etiology genetics Fluorouracil / adverse effects therapeutic use Genetic Variation Humans Lymph Node Excision Lymphatic Irradiation / adverse effects Lymphatic Metastasis / radiotherapy Male Middle Aged Neck Neoplasms, Multiple Primary / genetics Neoplasms, Unknown Primary Radiation Injuries / etiology genetics Radiation Tolerance / genetics physiology Radiodermatitis / etiology genetics Signal Transduction / genetics TOR Serine-Threonine Kinases / physiology Tuberous Sclerosis / genetics physiopathology Tuberous Sclerosis Complex 2 Protein Tumor Suppressor Proteins / deficiency genetics

来  源:   DOI:10.1016/j.canrad.2012.11.001   PDF(Sci-hub)

Abstract:
A 61-year-old man, with a tuberous sclerosis, experienced severe acute reactions during a concomitant chemoradiotherapy regimen after 22Gy and one cycle of 5-fluorouracil-cisplatinum. He was treated for a cervical squamous cell lymph node of unknown origin. Grade 3 mucitis and epitheliitis were observed only in the irradiated fields and required the end of the radiotherapy. Tuberous sclerosis is characterized by a loss of the TSC2 function, with a permanent activation of the mTOR pathway. Logically, some kind of \"radioresistance\" should be observed. Increased radiosensitivity is paradoxical. This case illustrates how radiosensitivity is a complex phenomenon and clinically unpredictable. Efficiency of the protocols associations of mTOR inhibitors and radiotherapy should be carefully scrutinized.
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