scholarly journals Neoadjuvant (presurgical) therapy for renal cell carcinoma: A new treatment paradigm for locally advanced and metastatic disease

Cancer ◽  
2009 ◽  
Vol 115 (S10) ◽  
pp. 2355-2360 ◽  
Author(s):  
Christopher G. Wood ◽  
Vitaly Margulis
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Metastatic Disease ◽  
Renal Cell ◽  
Locally Advanced ◽  
Treatment Paradigm ◽  
New Treatment ◽  
Presurgical Therapy

scholarly journals Adaptive Magnetic Resonance-Guided Stereotactic Body Radiotherapy: The Next Step in the Treatment of Renal Cell Carcinoma

2021 ◽  
Vol 11 ◽  
Author(s):  
Brian Keller ◽  
Anna M. E. Bruynzeel ◽  
Chad Tang ◽  
Anand Swaminath ◽  
Linda Kerkmeijer ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Oncologic Outcomes ◽  
Invasive Treatment ◽  
Non Invasive ◽  
Treatment Paradigm ◽  
Plan Adaptation ◽  
New Treatment ◽  
Tissue Sparing

Adaptive MR-guided radiotherapy (MRgRT) is a new treatment paradigm and its role as a non-invasive treatment option for renal cell carcinoma is evolving. The early clinical experience to date shows that real-time plan adaptation based on the daily MRI anatomy can lead to improved target coverage and normal tissue sparing. Continued technological innovations will further mitigate the challenges of organ motion and enable more advanced treatment adaptation, and potentially lead to enhanced oncologic outcomes and preservation of renal function. Future applications look promising to make a positive clinical impact and further the personalization of radiotherapy in the management of renal cell carcinoma.

Role of Surgery for Locally Advanced and Metastatic Renal Cell Carcinoma

2011 ◽  
Vol 9 (9) ◽  
pp. 985-993 ◽  
Author(s):  
Robert Torrey ◽  
Philippe E. Spiess ◽  
Sumanta K. Pal ◽  
David Josephson
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Metastatic Disease ◽  
Renal Cell ◽  
Locally Advanced ◽  
Disease Stage ◽  
Disease Characteristics ◽  
Multimodal Management

Both locally advanced and metastatic renal cell carcinoma (RCC) present a challenge in terms of their optimal management. This article reviews the literature and evaluates the role of surgery in the treatment of advanced RCC. Surgery is the optimal treatment for locally advanced RCC and minimal, resectable, metastatic disease. Patients with metastatic disease, and some forms of locally advanced disease, may also benefit from multimodal management with local surgical therapy and systemic treatment using either immunotherapy or targeted therapy. Regardless of the disease stage, patients with locally advanced or metastatic RCC represent heterogenous patient populations with different disease characteristics and risk factors. Individualization of care in the setting of a sound oncologic framework may optimize the risk/benefit ratio within individual patient cohorts.

Retrospective review of clear cell and non-clear cell renal carcinomas: Characteristics and course in the pre-TKI (tyrosine kinase inhibitor) and post-TKI era.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e16052-e16052 ◽  
Author(s):  
Kanika Gupta ◽  
Amanda Nizam ◽  
Kristen Millado ◽  
Jiaqi Liu ◽  
Hiwot Guebre-Xabiher ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Overall Survival ◽  
Cell Carcinoma ◽  
Metastatic Disease ◽  
Renal Cell ◽  
Kinase Inhibitor ◽  
Clear Cell ◽  
Locally Advanced ◽  
Local Treatment ◽  
Cancer Center

e16052 Background: Renal cell carcinoma (RCC) confers a lifetime risk of 1.6% of developing cancers. Early, localized cancers have high cure rates after surgical treatment, but locally advanced/distant metastatic disease remains a devastating disease. The use of TKIs has been considered a mainstay of treatment for clear cell pathology, but other histologic subtypes such as papillary, chromophobe, and mixed subtypes, which is considered non-clear cell RCC, also make up a heterogeneous pattern and course of disease. This retrospective study characterizes renal cell carcinomas and their treatments. Methods: A retrospective chart review of the last 15 years was performed using data from a single-institution center at the George Washington University Cancer Center Tumor Registry Data. Statistical analysis was performed using the Fisher’s test, Chi-squared test, T-test, and Kaplan-Meier survival curves. Results: 1043 patients with RCC were identified. Preliminary data analysis was performed on 92 of these patients. 48 had pure clear cell renal cell carcinoma (CCRCC) and 44 had non-clear cell carcinoma (NCC). Mean age of diagnosis was similar for both groups (58.25 years for CCRCC vs 62.14 years for NCC, p = 0.0977). However, hemoglobin levels at diagnosis were statistically significantly lower for CCRCC (p = 0.0261), as were calcium levels (p = 0.0187). All patients underwent surgical or local treatment. Only 2 patients received chemotherapy and 5 patients received molecularly targeted therapy. While not statistically significant, patients with CCRCC had surgery sooner after diagnosis than NCC (71 days vs 92 days), had longer time to metastatic disease (1033 days vs 820 days), and improved overall survival (1955 days vs 1446 days). Conclusions: NCC was a less favorable pathology than CCRCC with apparent later institution of surgical intervention as well as shorter time to metastatic disease and worse overall survival. Identifying patients with more aggressive disease earlier allows for the potential role for more aggressive therapies that may result in improved outcomes.

Contemporary outcomes of pT3 renal cell carcinoma: A Canadian multi-institutional experience.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 434-434
Author(s):  
Jasmir Nayak ◽  
Clare Gardiner ◽  
Zhihui Liu ◽  
Simon Tanguay ◽  
Anil Kapoor ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Metastatic Disease ◽  
Renal Cell ◽  
Locally Advanced ◽  
Staging System ◽  
Tnm Staging ◽  
Cancer Information ◽  
Oncological Outcomes

434 Background: A large, multi-institutional analysis was undertaken to examine the pathological and oncological outcomes for patients with pT3 renal cell carcinoma (RCC) treated surgically. Materials and Methods: Institutional databases on patients surgically treated for RCC were obtained from 14 centers across 6 Canadian provinces forming the Canadian Kidney Cancer Information System (CKCis) database. Data were collected on 2204 patients and included patient characteristics, peri-operative information, pathological and oncological outcomes. Results: Of the 2,204 patients, 498 (22.6%) patients had pT3 disease according to the 2009 TNM staging system. Mean pathological tumor size was 8.6 cm. 443 (89.0%) patients underwent a radical nephrectomy (RN) and 55 (11.0%) underwent a partial nephrectomy (PN). Of those treated with RN, 247 (55.8%) were open, 159 (35.9%) laparoscopic and 1 (0.2%) robotic. In the PN group, 37 (67.3%), 14 (25.5%) and 4 (7.3%) patients were treated open, laparoscopic and robotically, respectively. Average operative time was 184 mins, with an average blood loss of 650 cc. Of the pT3 lesions, 365 (73.3%) were pT3a, 97 (19.5%) pT3b and 12 (2.4%) pT3c. 109 (22%) patients had a metastatic diagnosis before or at the time of nephrectomy. Of the remaining 389 patients, 68.9% remained free of disease after a median follow-up of 1.3 years. Common sites of metastatic disease included lung, lymph nodes and bone (77%, 35%, and 25%, respectively). Clear cell RCC was the predominant histopathology (74%). There were no peri-operative (<30 days) mortalities. Complications were found in 14.1% of patients. Systemic therapy was initiated in 132 (26.5%) of patients, most commonly with Sunitinib in 106 (80%) patients. Conclusions: Locally advanced, pT3 renal cell carcinoma is an aggressive disease that is associated with high rates of metastatic disease. Despite this, a significant portion remained disease free at the time of our follow-up.

Immune Check Point Inhibition in Sarcomatoid Renal Cell Carcinoma: A New Treatment Paradigm

2017 ◽  
Vol 15 (5) ◽  
pp. e897-e901 ◽  
Author(s):  
Ruben Raychaudhuri ◽  
Matthew J. Riese ◽  
Kathryn Bylow ◽  
John Burfeind ◽  
Alexander C. Mackinnon ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Check Point ◽  
Treatment Paradigm ◽  
Sarcomatoid Renal Cell Carcinoma ◽  
New Treatment

Utilizing percentage of sarcomatoid differentiation as a prognostic factor in renal cell carcinoma.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 507-507
Author(s):  
Timothy Kim ◽  
Hui-Yi Lin ◽  
Binglin Yue ◽  
Jasreman Dhillon ◽  
Mayer N. Fishman ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Risk Stratification ◽  
Cell Carcinoma ◽  
Metastatic Disease ◽  
Renal Cell ◽  
Locally Advanced ◽  
Multivariable Analysis ◽  
Continuous Variable ◽  
Early Stage Disease ◽  
Sarcomatoid Differentiation

507 Background: Sarcomatoid renal cell carcinoma (sRCC) is a histologic feature that denotes an aggressive variant of kidney cancer and worse overall outcomes. Our aim was to determine if the percentage of sarcomatoid differentiation (% Sarc) could be used for prognostic risk stratification. Methods: We performed a retrospective analysis of patients who underwent surgery at our center and found to have sRCC. A single genitourinary pathologist reviewed each specimen for %Sarc and other pathologic variables of interest. %Sarc was analyzed as a continuous variable and as a binary variable using cut-points of 5%, 10%, and 25%. Potential prognostic factors associated with overall survival (OS) were determined using the Cox regression model. OS curves were generated with Kaplan-Meier methods and survival differences compared using the log-rank test. Results: Between 1998 and 2012, 1,307 consecutive cases of RCC were identified, of which 59 patients were confirmed to have sRCC (4.5%). As a continuous variable %Sarc was associated with OS (p=0.023). Predictors of survival on multivariable analysis included pT stage, tumor size, cM stage and % Sarc at the 25% binary level. OS was most dependent on the presence or absence of metastatic disease (4 months vs. 21.2 months, p=0.001). However, in a subgroup analysis of cM0 patients with locally advanced (≥ pT3) tumors, OS was significantly diminished in patients with >25% Sarc compared to ≤25% Sarc (p=0.045). OS relative to %Sarc was no different in subgroup analyses of patients with early stage disease (pT1-T2, M0) or in patients with clinical metastatic disease. Conclusions: Patients with sRCC have a poor overall outcome as evidenced by high rates of recurrence and death. Patients without clinical metastatic disease and >25% Sarc have a higher risk of relapse and worse OS. More effective understanding of the biological basis for the aggressive behavior of sarcomatoid RCC is needed, and nomograms to predict recurrence or survival following nephrectomy could incorporate this pathologic feature for added risk stratification.

Advances in the Treatment Options for Kidney Cancer— Is There an Optimal Regimen?

2009 ◽  
Vol 05 (01) ◽  
pp. 78
Author(s):  
Gihan Ratnayake ◽  
James Larkin ◽  
Lisa Pickering ◽  
◽  
◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Metastatic Disease ◽  
Renal Cell ◽  
Treatment Options ◽  
Chemotherapeutic Agents ◽  
Phase Iii ◽  
Routine Practice ◽  
Pivotal Phase ◽  
Treatment Paradigm

Treatment of renal cell carcinoma had long been hindered by poor responses to standard chemotherapeutic agents. Immunological modulators have some activity in metastatic disease but with considerable treatment-associated morbidity. Recent years have resulted in a shift in the treatment of advanced renal cell carcinoma towards novel targeted agents. Pivotal phase III trials involving bevacizumab, sorafenib, sunitinib, and temsirolimus have demonstrated improved disease control over the previous standards of first-line cytokine therapy and second-line palliative care. These trials have led to a change in routine practice in metastatic disease and the development of internationally accepted treatment algorithms. However, an optimal treatment paradigm has not yet been established: the role of combination therapy and the sequential use of these agents, and new investigational agents, remains the subject of ongoing investigation. In addition, these novel agents are being evaluated in the adjuvant and neoadjuvant settings.

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