Radiotherapy for Kidney cancer

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Radiotherapy for Kidney cancer

• Dr Kate Fife
• Consultant Clinical Oncologist
• Addenbrookes Hospital, Cambridge

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Radiotherapy for Kidney cancer

• What is Radiotherapy?
• Some history
• Advances in radiotherapy
• When is it used in cancer treatment?
• When is it used in kidney cancer?
• Some examples
• Questions and Answers

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What is Radiotherapy?

• High energy XRays
• XRays interact with atoms
• Direct DNA damage
• Ionisation of water molecules
• Cause DNA damage such as Double strand breaks
• Cell suicide

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Why does it work?

• DNA damage has to be repaired for cell to
  continue dividing
• Normal cells are good at repairing themselves
• Cancer cells are not
• Cancer cells preferentially killed
• Some damage to normal tissues

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How is radiotherapy given?

• Linear Accelerator produces XRays
• Shaped to the area to be treated field

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Treatments

• Treatment planning CT
• Quick and painless!
• Single treatment
• Multiple treatments
• Dose and number of treatments depends on
• Purpose
• Sensitivity of tumour
• Sensitivity of normal tissues

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History I

• XRays discovered 1895 (Roentgen)
• XRays used for head and neck and skin cancers and
  benign conditions eg ringworm
• Did not penetrate deeply and high dose on the
  skin
• 1922 fractionation produced fewer side effects

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History II

• Radium discovered 1898 (Curie) natural
  radioactive emitter
• Radium used as implants for cancers of womb and
  other sites

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History III

• Post 1945 artificially produced radioisotopes
  became available eg radioiodine, cobalt-60
  (atomic weapon technology)
• 1952 First linear accelerator (LINAC) introduced
• Magnetron (high power electron source) developed
  during war for Radar

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History III

• Linacs have high energy XRays which penetrate
  deep into body with much lower dose on skin
  (limiting factor with early XRay treatments)
• Computerisation has revolutionised treatment
  planning to improve accuracy, spare normal
  tissues and increase dose to tumour

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Present and Future

• Improved planning CT planning now routine
• Intensity modulated radiotherapy planning
  technique producing shaped beams of varying
  intensity
• Tomotherapy Image guided radiotherapy

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Tomotherapy

• Combines CT and Linac
• RT delivered in multiple spiral fields
• Allows very accurate dose delivery
• Daily real time CT imaging high accuracy

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Standard treatments

• Conventional planning and Linac treatment highly
  accurate
• Sufficient for most treatments

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Use of Radiotherapy in Cancer treatment

• Surgery
• Local treatment
• Early stage
• Radiotherapy
• Local treatment
• Early and late stage
• Systemic therapy early and late stage
• Chemotherapy
• Hormone therapy
• Targeted therapy

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What about RT for kidney cancer

• Treatment of primary tumour
• Usually surgery
• Treatment of advanced disease
• Usually TKIs/immunotherapy
• Treatment of symptoms from tumour deposits in
  advanced disease
• Radiotherapy

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Does RT work in kidney cancer?

• Many websites and medical texts say kidney cancer
  is resistant to radiotherapy
• Kidney cancers have a range of sensitivity to RT
• Some respond well, others not so well

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Sites for radiotherapy

• Anywhere!
• Bone
• Spine
• Soft tissue
• Lymph nodes
• Brain
• Lung
• Combined with surgery in some cases

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Soft tissue chest wall
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After RT and TKIs (4 years later.)
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Severe pain from secondary tumour
4 months after RT
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MRI Femur
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Bone scan and XRay
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Cambridge Study

• Over 100 radiotherapy treatments given to
  patients with bone or soft tissue secondary
  cancers
• Response rate (improvement in symptoms or scans)
  in those reassessed after treatment was 85

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Could we treat the kidney tumour itself?

• Previously very toxic because of normal tissue
  damage (bowel, liver)
• Probably, with new techniques
• Small kidney tumours in people who cant have
  surgery
• Tumour bed if some tumour left after surgery