Kidney Cancer

Background

Outside Approval SquareKidney cancer is one of the 10 most common cancers in the United States. According to the National Cancer Institute, more than 65,000 new cases are diagnosed and more than 13,000 patients die of kidney cancer each year.

The exact causes for kidney cancer are not clear. However, risk factors include smoking, misuse of pain medications, and genetic conditions such as von Hippel-Lindau syndrome or a hereditary form of renal cell carcinoma.

Current Treatment

Clinical Trials Square

Treatment options for kidney cancer include surgery, radiation, chemotherapy, other pharmacologic therapies, arterial embolization, or ablation. Selection of the precise treatment regimen depends on the location, type, and severity of the tumor.

Surgery
Surgery includes partial, simple, or radical nephrectomy. With partial nephrectomy, only part of the kidney is removed, whereas simple nephrectomy removes the entire kidney. Radical nephrectomy removes the kidney, adrenal gland, and nearby tissues and lymph nodes.

Radiation
Radiation uses high-energy X-rays or other types of radiation to kill cancer cells or slow their growth. This can be done externally by using a machine to send waves toward the tumor, or it can be internally by using a needle, seed, or tube to place radioactive material directly into the cancer.

Chemotherapy
Chemotherapy involves the use of drugs that kill cells or stop them from dividing. The type of chemotherapeutic agents used depends on the type and stage of the tumor.

Other Pharmacologic Therapies
Other drugs can be used to target the cancer without affecting the normal tissue surrounding it. 

Arterial Embolization
Arterial embolization is used if surgery is not possible. With this option, material is injected through a catheter to block the main artery feeding the tumor. With this method, however, both the kidney and the tumor die. 

Ablation
With ablation, a needle is inserted through the skin or during surgery. Cryoablation involves the passage of cold gases through the needle to freeze and destroy the tumor. Radiofrequency and microwave ablation involves the passage of high-frequency radio waves, which heat and destroy the tumor.

Focused Ultrasound Treatment

Focused ultrasound offers a potential alternative to the ablation procedures described above. Like radiofrequency ablation, focused ultrasound destroys the tumor by heating it. Rather than insert a needle surgically or through the skin, however, the physician directs a focused beam of acoustic energy to destroy the tumor without harming adjacent tissue. Focused ultrasound is completely noninvasive. Follow-up imaging can determine whether the entire tumor has been destroyed, and if necessary, focused ultrasound can be repeated.

Focused ultrasound may offer the following benefits in treating kidney cancer:

  • It is non-invasive treatment with a shorter recovery time.
  • Compared with radiofrequency ablation, focused ultrasound may offer a reduced risk for infection, damage to adjacent tissue, or other complications.
  • Patients avoid the long-term side effects of radiation, chemotherapy, or other pharmacologic therapies.
  • Because it does not use ionizing radiation, focused ultrasound can be repeated as needed to reduce the likelihood of tumor cells being left behind.

Clinical Trials

Two clinical trials have been completed in the United Kingdom. One explored the effectiveness of using high-intensity focused ultrasound before surgery, and the other examined the effectiveness of high-intensity focused ultrasound in patients with advanced, inoperable kidney cancer. The results of these trials are not yet available.

There is a clinical trial ongoing at Indiana University. For more information, contact Cindy Franklin (317.274.1798 or ) or Clint Bahler, MD (317.274.1798 or )

Regulatory Approval and Reimbursement

A focused ultrasound system has been approved in China and in Europe for treatment of kidney cancer.

To the best of our knowledge, the use of focused ultrasound to treat kidney cancer is not yet reimbursed by medical insurance.

Treatment Sites

See here for a list of treatment sites for kidney cancer

Notable Papers

Cranston D. A review of high intensity focused ultrasound in relation to the treatment of renal tumours and other malignancies. Ultrason Sonochem. 2015 Nov;27:654-8. doi: 10.1016/j.ultsonch.2015.05.035. Epub 2015 May 27.

Ritchie R, Collin J, Coussios C, Leslie T. Attenuation and de-focusing during high-intensity focused ultrasound therapy through peri-nephric fat. Ultrasound Med Biol. 2013 Oct;39(10):1785-93. doi: 10.1016/j.ultrasmedbio.2013.04.010. Epub 2013 Aug 9.

Al-Bataineh O, Jenne J, Huber P. Clinical and future applications of high intensity focused ultrasound in cancer. Cancer Treat Rev. 2012 Aug;38(5):346-53. Epub 2011 Sep 15.

Dutcher JP, Mourad WF, Ennis RD. Integrating innovative therapeutic strategies into the management of renal cell carcinoma. Oncology 2012 Jun;26(6):526-30, 532, 534.

Zagoria RJ, Childs DD. Update on thermal ablation of renal cell carcinoma: oncologic control, technique comparison, renal function preservation, and new modalities. Curr Urol Rep. 2012 Feb;13(1):63-9.

Ritchie RW, Leslie TA, Turner GD, Roberts IS, D'Urso L, Collura D, Demarchi A, Muto G, Sullivan ME. Laparoscopic high-intensity focused ultrasound for renal tumours: a proof of concept studyBJU Int. 2011 Apr;107(8):1290-6. Epub 2010 Sep 21.

Finley DS, Pouliot F, Shuch B, Chin A, Pantuck A, Dekernion JB, Belldegrun AS. Ultrasound-based combination therapy: potential in urologic cancer. Expert Rev Anticancer Ther. 2011 Jan;11(1):107-13.

Click here for additional references from PubMed.

     

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