Single-fraction radiosurgery for the treatment of renal cell carcinoma.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 590-590 ◽  
Author(s):  
Michael D. Staehler ◽  
Boris Schlenker ◽  
Alexander Karl ◽  
Annabel Spek ◽  
Alexander Muacevic
Keyword(s):  
Renal Cell Carcinoma ◽  
Renal Function ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Long Term Results ◽  
Tumor Control ◽  
High Dose ◽  
Short Term ◽  
Single Fraction

590 Background: We report on patients with renal cell carcinoma (RCC) who were treated with single fraction high-dose local stereotactic radiosurgery (SRS) using the robotic Cyberknife system to avoid nephrectomy and consecutive hemodialysis. Methods: Fifty-two patients with histologically confirmed RCC and median age of 63.6 years (43.6-86.5) with the indication for renal surgery and highest risk for consecutive hemodialysis were entered into a prospective case control study of single fraction SRS with 25Gy. Tumor response, renal function, survival, and adverse events were estimated every three months with a follow-up of at least six months. Results: R.E.N.A.L. score was low in 1, moderate in 30 and high in 21 patients. 28 patients had singular renal units. Median follow-up was 26.9 months (1.8 - 52.6). Local tumor control nine months after SRS was 98% (95% CI: 89-99%). 43 lesions showed a measurable tumor size reduction including six complete remissions and 33 partial remissions. Renal function remained stable with a median serum creatinine at baseline of 1.10 mg/dl (0.4 -2.0) and 1.11 mg/dl (0.8-2.2) at follow-up. In one patient grade I erythrodermia, in three patients grade I fatigue and in two patients grade I nausea occurred. In all patients nephrectomy was avoided. Conclusions: Single-fraction SRS as an outpatient procedure is a treatment modality with short-term safety and efficacy to avoid treatment-related loss of renal function and hemodialysis in selected patients with RCC. Short term follow up of oncological and functional results so far is excellent. Further studies are needed to determine the limits of SRS in this setting and long term results.

scholarly journals Acute tubulointerstitial nephritis and IgM deposits on glomerular capillary walls after immunotherapy with nivolumab for metastatic renal cell carcinoma

2019 ◽  
Vol 9 (1) ◽  
pp. 48-54 ◽  
Author(s):  
Taisuke Irifuku ◽  
Ayaka Satoh ◽  
Hiroki Tani ◽  
Kouichi Mandai ◽  
Takao Masaki
Keyword(s):  
Renal Cell Carcinoma ◽  
Renal Function ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Tubulointerstitial Nephritis ◽  
Basement Membranes ◽  
High Dose ◽  
Close Monitoring ◽  
Acute Tubulointerstitial Nephritis ◽  
Igm Deposits

Abstract Nivolumab is an anti-programmed cell death-1 antibody that is utilized as an immune checkpoint inhibitor for several malignancies. However, this agent is associated with immune-related adverse events (irAEs), mainly in the spectrum of autoimmune disease including interstitial pneumonia, colitis, type 1 diabetes, and renal impairment. We herein present the case of a 59-year-old man with renal cell carcinoma who developed worsening renal function approximately 4 months after initiation of nivolumab. Urinalysis showed proteinuria and microscopic hematuria along with increase levels of N-acetyl-β-d-glucosaminidase. Renal biopsy revealed acute tubulointerstitial nephritis and thickening of the glomerular basement membranes. Immunofluorescence showed granular IgM deposits in capillary loops. We initiated high-dose prednisolone therapy with nivolumab, which improved renal function and achieved complete remission of proteinuria. Although renal irAEs are considered to be rare and glomerulonephropathy is not typical presentation, physicians need the close monitoring of renal function and urinalysis in patients under immunotherapy with this agents. In addition, our case provides a possible link between nivolumab and immune-mediated glomerulonephropathy.

Renal function assessment during follow-up after surgical treatment for renal cell carcinoma

2019 ◽  
Vol 18 (1) ◽  
pp. e1419-e1420
Author(s):  
P. Capogrosso ◽  
A. Larcher ◽  
F. Cianflone ◽  
F. Muttin ◽  
F. Trevisani ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Renal Function ◽  
Surgical Treatment ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Function Assessment

Sarcomatoid Renal Cell Carcinoma: Biologic Behavior, Prognosis, and Response to Combined Surgical Resection and Immunotherapy

1999 ◽  
Vol 17 (2) ◽  
pp. 523-523 ◽  
Author(s):  
Thomas Cangiano ◽  
Joseph Liao ◽  
John Naitoh ◽  
Frederick Dorey ◽  
Robert Figlin ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Overall Survival ◽  
Multivariate Analysis ◽  
Cell Carcinoma ◽  
Surgical Resection ◽  
Median Duration ◽  
Renal Cell ◽  
High Dose ◽  
Risk Of Death

PURPOSE: Sarcomatoid variants of renal cell carcinoma (RCC) are aggressive tumors that respond poorly to immunotherapy. We report the outcomes of 31 patients with sarcomatoid RCC treated with a combination of surgical resection and immunotherapy. PATIENTS AND METHODS: Patients were identified from the database of the University of California Los Angeles Kidney Cancer Program. We retrospectively reviewed the cases of 31 consecutive patients in whom sarcomatoid RCC was diagnosed between 1990 and 1997. Clinical stage, sites of metastasis, pathologic stage, and type of immunotherapy were abstracted from the medical records. The primary end point analyzed was overall survival, and a multivariate analysis was performed to distinguish any factors conferring an improved survivorship. RESULTS: Twenty-six percent of patients were male and 74% were female, and the median age was 59 years (range, 34 to 73 years). Length of follow-up ranged from 2 to 77 months (mean, 21.4 months). Twenty-eight patients (84%) had known metastases at the time of radical nephrectomy (67% had lung metastases and 40% had bone, 21% had liver, 33% had lymphatic, and 15% had brain metastases). Twenty-five patients (81%) received immunotherapy, including low-dose interleukin (IL)-2–based therapy (five patients), tumor-infiltrating lymphocyte–based therapy plus IL-2 (nine patients), high-dose IL-2–based therapy (nine patients), dendritic cell vaccine–based therapy (one patient), and interferon alpha–based therapy alone (one patient). Two patients (6%) achieved complete responses (median duration, 46+ months) and five patients (15%) achieved partial responses (median duration, 36 months). One- and 2-year overall survival rates were 48% and 37%, respectively. Using a multivariate analysis, age, sex, and percentage of sarcomatoid tumor (< or > 50%) did not significantly correlate with survival. Improved survival was found in patients receiving high-dose IL-2 therapy compared with patients treated with surgery alone or any other form of immunotherapy (P = .025). Adjusting for age, sex, and percentage of sarcomatoid tumor, the relative risk of death was 10.4 times higher in patients not receiving high-dose IL-2 therapy. Final pathologic T stage did not correlate significantly with outcome, but node-positive patients had a higher death rate per year of follow-up than did the rest of the population (1.26 v 0.76, Cox regression analysis). CONCLUSION: Surgical resection and high-dose IL-2–based immunotherapy may play a role in the treatment of sarcomatoid RCCs in select patients.

scholarly journals P0845INCREASING TOTAL RENAL VOLUME AFTER NEPHRECTOMY FOR RENAL CELL CARCINOMA IS ASSOCIATED WITH RENAL FUNCTION EVOLUTION

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
SAUL PAMPA-SAICO ◽  
M Soledad Pizarro-Sánchez ◽  
Simona Alexandru ◽  
Laura García Puente-Suárez ◽  
María López-Picasso ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Renal Function ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Linear Regression Analysis ◽  
Multivariate Linear Regression Analysis ◽  
Renal Volume

Abstract Background and Aims Renal cell carcinoma is the most common form of kidney cancer. Reduction of renal mass after radical nephrectomy (RN) in these patients, results in compensatory hypertrophy of the contralateral kidney. The capacity of compensation will determine the renal function (RF) evolution. Measuring of total renal volume (TRV) of the remaining kidney pre and post RN can help assess the RF evolution. Aims To determine the correlation between TRV pre and post nephrectomy (a year of follow-up) with RF and the factors that modify. Method A retrospective cohort study was carried out in our institution, in 62 patients who had underwent RN from 2014 to 2018, due to renal cell carcinoma (confirmed by histopathology). The demographic data included age, gender, body mass index (BMI), associated comorbidities, smoking habits were collected. Serum creatinine, estimated glomerular filtration rate (eGFR) and proteinuria were collected in the preoperative period and in the follow-up. The TRV was calculated pre and post (a year of follow-up) RN, using ellipsoid formula equation (computed tomography scan or magnetic resonance imaging). Renal function evolution was assessed by eGFR using the modification of diet in Renal Disease formula. Multivariate linear regression analysis was used to determine the predictor of TRV at 1 year of follow-up. Results The median age at the time of RN was 71 years old (range, 43-86 years). Most of them were men, 69% (43/19). The estimated glomerular filtration rate (FGe) pre and post nephrectomy was 74 (41-102) and 52.1 ml/min/ m2 (22-89) respectively (P=0.013). The TRV pre and post-nephrectomy was 165.3 (102.3-259.7) and 188.3 ml (115.3-271.2) respectively (P=0.001). On multivariate linear regression analysis, controlling for age and sex; the pre-nephrectomy FGe (β = 0.42; P = 0.023) and the pre TRV (β = 1.23; P &lt;0.0001) were positively correlated with the post-nephrectomy TRV, while the FGe at year of follow-up was correlated negatively (β = -1.11; P = 0.024) Conclusion The post nephrectomy TRV was positively correlated with TRV and FGe pre nephrectomy. While with the FGe at one year post nephrectomy was negatively correlated. The increasing TRV pre and post nephrectomy can help to predict renal function at a year of follow-up in this group of patients.

High-dose interleukin-2 therapy for metastatic renal cell carcinoma: A contemporary experience.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e15604-e15604
Author(s):  
Ahmed A. Aboumohamed ◽  
Naveen Yarlagadda ◽  
Terrance Creighton ◽  
Diana Mehedint ◽  
Kristopher Attwood ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Renal Function ◽  
Renal Impairment ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell ◽  
Renal Toxicity ◽  
Interleukin 2 ◽  
Cancer Center ◽  
High Dose

e15604 Background: Despite recent advances in targeted treatment options, high dose interleukin-2 (HDIL-2) remains an important therapeutic option for metastatic renal cell carcinoma (mRCC). We present a contemporary experience of HDIL-2 in a high-volume, National Cancer Institute (NCI)-designated cancer center. Methods: Patients with mRCC who received HDIL-2 monotherapy as a first- or second-line therapy during 2004-2011 were identified. Patients’ demographics, pathologic variables, renal function, time until start of HDIL-2 therapy, number of cycles given (1-3), best responses (complete response; CR, partial response; PR, stable disease; SD, and progressive disease; PD), and primary RCC treatment were analyzed. Progression free survival (PFS) and overall survival (OS) were determined. Results: Of 176 mRCC patients, 91 patients were treated with HDIL-2 (59 as a primary treatment). Median age was 51 years and 73.9% were males. Median Follow-up was 44.9 months. Majority (92%) of tumors showed clear cell histology, and 14.8% had impaired renal function (creatinine >1.5 mg/dL) prior to treatment. Patients with impaired initial renal function were more likely to get more treatment cycles (2-3) than those with adequate initial kidney function (92.3% vs.50.6%, respectively; p=0.002). Eighteen (20.5%) patients underwent cytoreductive nephrectomy. Lower tumor stage at diagnosis correlated with better treatment response (p=0.023), but with longer time from diagnosis to initiation of HDIL-2 (p=0.011). Prominent therapy complications included hypotension (67.4%), renal impairment (63%), impaired liver function (42.4%), and thrombocytopenia (31.5%). None needed hemodialysis for IL-2 induced renal toxicity, and all regained their pre-treatment baseline kidney functions after therapy. Four patients (4.5%) had CR, 11.4% had PR, and 31.8% had SD. Median PFS and OS were 8.6 and 35.5 months, respectively. Estimated 2-year OS rate was 60.6%. Conclusions: Incorporating HDIL-2 therapy in treatment strategies of patients with mRCC added to the patients’ survival in this contemporary series. HDIL-2 therapy appears to be well tolerated in patients with preexisting renal impairment with no long term renal toxicity.

scholarly journals Renal Cancer is Not Radioresistant: Slowly but Continuing Shrinkage of the Tumor After Stereotactic Body Radiation Therapy

2019 ◽  
Vol 18 ◽  
pp. 153303381882232 ◽  
Author(s):  
Satoshi Funayama ◽  
Hiroshi Onishi ◽  
Kengo Kuriyama ◽  
Takafumi Komiyama ◽  
Kan Marino ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Renal Function ◽  
Radiation Therapy ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Stereotactic Body Radiation Therapy ◽  
Solitary Kidney ◽  
Stereotactic Body Radiation ◽  
Local Progression

Purpose: To evaluate the safety and efficacy of stereotactic body radiation therapy for primary lesion of renal cell carcinoma with long-term and regular follow-up of tumor size and renal function. Methods: This prospective study included 13 patients treated with stereotactic body radiation therapy for primary lesion of stage I renal cell carcinoma between August 2007 and June 2016 in our institution. Diagnosis of renal cell carcinoma was made by 2 radiologists using computed tomography or magnetic resonance imaging. A dosage of 60 Gy in 10 fractions or 70 Gy in 10 fractions was prescribed. The higher dose was selected if dose constraints were satisfied. Tumor response on imaging examination, local progression-free rate, overall survival, and toxicity were assessed. Results: The mean follow-up period was 48.3 months (range: 11-108 months). The tumors showed very slow but continuous response during long-term follow-up. Three cases (23.1%) showed transient progression during the short follow-up. The mean duration until the day on which partial response was confirmed among the partial or complete response cases was 22.6 months (95% confidence interval, 15.3-30.0 months). Local progression-free rate was 92.3% for 3 years and overall survival rate 91.7% for 2 years and 71.3% for 3 years. Twelve cases (92.3%) had impaired renal function at baseline. Renal function decreased slowly and mildly in most of the cases, but 2 cases of solitary kidney showed grade 4 or 5 renal dysfunction. Conclusion: All renal tumors decreased in size slowly but continuously for years after stereotactic body radiation therapy. Renal cancer can be treated radically with stereotactic body radiation therapy as a radiosensitive tumor, but careful attention should be given in cases with solitary kidney.

scholarly journals Renal function after nephron-sparing surgery versus radical nephrectomy in localized renal cell carcinoma (T1)

10.52786/j.1 ◽  
2020 ◽  
Vol 41 (2) ◽  
pp. 1-8
Author(s):  
Siros Jitpraphai ◽  
Chaiyong Nualyong ◽  
Tawatchai Taweemonkongsap ◽  
Sittiporn Srinualnad ◽  
Teerapon Amornwesukit ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Renal Function ◽  
Cell Carcinoma ◽  
Partial Nephrectomy ◽  
Recurrence Rate ◽  
Renal Cell ◽  
Radical Nephrectomy ◽  
Tumor Recurrence ◽  
Tumor Recurrence Rate

Objective: To evaluate renal function (GFR) after radical nephrectomy compared to partial nephrectomy in stage T1 renal cell carcinoma patients between 2005 and 2015. Material and Method: Retrospective chart review of 409 patients who were diagnosed with renal cell carcinoma (T1) and treated with radical nephrectomy (RN) or partial nephrectomy (PN) between 2005 and 2015 (RN=136, PN=92); 228 patients with pathologically confirmed pT1 remained for analysis and were then evaluated for their estimated glomerular filtration rate (eGFR) after the surgery. Results: There were a total of 228 (149 males and 79 females) T1 RCC patients; 136 patients were T1a with RN (57.8%) and 92 with PN (42.2%). Median follow-up was 58 months and 35 months for the RN and PN groups. From the analysis, post-operative eGFR of the RN group was decreased from 77.49 to 59.61 ml/min/1.73m2 and the PN group was decreased from 78.85 to 69.9 ml/min/1.73m2. The comparative eGFR between the 2 groups at 1 month had a significant difference (p-value<0.05). eGFR at 3 months (50.24 in RN vs 64.67 in PN), 6 months (47.98 vs 64.51), 3 years (48.79 vs 67.22) and 5 years (52.63 vs 73.59) were also significantly altered between the 2 groups. The tumor recurrence rate was not significantly different between RN and PN. Conclusion: We found that patients treated with PN had superior post-operative renal function compared with RN. However, there was no difference in the tumor recurrence rate between the 2 groups after a follow-up of 10 years.

scholarly journals Robotic stereotactic ablative radiotherapy for renal cell carcinoma in patients with impaired renal function

BMC Urology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
C. Senger ◽  
A. Conti ◽  
A. Kluge ◽  
D. Pasemann ◽  
M. Kufeld ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Renal Function ◽  
Kidney Disease ◽  
Cell Carcinoma ◽  
Local Control ◽  
Renal Cell ◽  
Impaired Renal Function ◽  
Stereotactic Ablative Radiotherapy ◽  
Tumor Motion

Abstract Background Robotic stereotactic ablative radiotherapy (SABR) is currently under investigation as a noninvasive treatment option for patients with renal cell carcinoma (RCC). For radiation therapy of RCC, tumor motion and the need for high ablative doses while preserving the remaining renal parenchyma is a challenge. We aimed to analyze the safety and efficacy of robotic radiosurgery in RCC in a specific difficult subgroup of patients with impaired renal function. Methods We retrospectively identified all patients with RCC, treated with robotic SABR and motion compensation in our institution between 2012 and 2017. Either single fraction SABR of 24 or 25 Gy or 3 fractions of 12 Gy prescribed to the 70% isodose line was applied. Local control, overall survival, radiation side effects were evaluated together with renal function and tumor motion. Results We analyzed data of 13 lesions treated in 10 patients with clear cell RCC and a mean age of 70.5 ± 13.6 years (range: 48–87). Prior to SABR, 8 patients underwent previous complete and/or partial nephrectomy, 7 patients presented with chronic kidney disease ≥ stage 3. The median of minimum, mean and maximum planning target volume doses were 23.2, 29.5 and 35.0 Gy for single fraction and 24.4, 42.5 and 51.4 Gy for the three fractions regime. Persistent local control by robotic SABR was achieved in 9 out of 10 patients (92.3% of all lesions) within a median follow-up period of 27 month (range: 15–54). One patient underwent nephrectomy due to progressive disease and sufficient renal function of the contralateral kidney. Renal function remained stable with a mean estimated glomerular filtration rate (eGFR) of 51.3 ± 19.7 ml/min at baseline and 51.6 ± 25.8 ml/min at follow-up. The largest respiratory-induced tumor motion was seen in superior-inferior direction, compensated by the CyberKnife with mean targeting errors of maximal 2.2 mm. Conclusions Robotic SABR is technically feasible for the treatment of RCC in preexisting kidney disease with good local tumor control at about 2 years follow-up. Robotic SABR with motion tracking offers a valid treatment option for patients, who are at increased risk for progression to end-stage renal disease due to partial nephrectomy or ablative techniques.

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