KCC attended the 10th International Kidney Cancer Symposium, a Medical Information Symposium, hosted by the KCA (Kidney Cancer Association) in Chicago, USA. Kidney Cancer Canada sent a physician delegate to report back to our membership on the highlights of this important conference. We are pleased to be able to share these conference highlights with you. While these notes have been prepared by a physician for interested KCC members, please refer to your oncologist for any specific questions regarding your kidney cancer care and treatment.
The IKCS Conference was attended by top RCC experts from North America & Europe. Attendees included distinguished RCC treating Medical Oncologists, Surgeons & Nurses. Industry representation from Pfizer, Novartis, GSK & Bayer
This blog post includes a summary of sessions on Day One. Full presentations may be accessed at the following link: http://kca.omnibooksonline.com/chicago2011/index.html
1) Small Renal Masses
Dr. David Miller discussed the epidemiology and trends among patients in USA. Kidney Cancer rates have been steadily rising from 8 per 100,000 in 1975 to 18 per 100,000 in 2006. Mean age at diagnosis continues to be around 60.
60% are diagnosed with localized tumours. Most patients are without symptoms, but have significant other diseases (hypertension, dialysis, anemia, etc). Mortality is still a challenge with early tumours.
Why should we move away from Open Radical Nephrectomy?
• Preserve non malignant kidney tissue
• Easier convalescence
• Shorter hospital stay
• Reduce pain at the site of surgery
Laparoscopic surgery has equivalent data for cancer control and has a much easier convalescence. However data show patient are more likely to die, immediately after surgery due to complications.
Renal Mass Ablation
Dr. Thomas Atwell, Mayo Clinic, discussed Radio Frequency ablation (RFA) & Cryoablation of tumours. RFA causes tumour death by delivering electrical current, which in turn produces heat, in the tumour. In contrast , Cryoablation, causes tumour death by freezing.
- RFA is easy to use & is fast & safe. The disadvantage is that it cannot be used for large tumours & it is difficult to monitor its effects.
- Complications include nerve & ureter injury, bleeding & abscess formation
- Cryoablation can be used for large tumours & central tumours. Needs less monitoring. Disadvantages are bleeding, cumbersome to use & takes longer.
In conclusion, both techniques are useful, depends on size & location of tumour.
Active Surveillance of Localized RCC
Dr. Robert Uzzo discussed active surveillance versus treatment for small, renal masses at Fox Chase Cancer center.
• 86% of Small renal masses are 4 cm)
• No patient under active surveillance metastasized
• Average time from detection to metastasis=40 months
The data show that although kidney cancer is a deadly disease active surveillance is an option and calculated risk for some patients.
Nephron Sparing surgery
Dr. Paul Russo, from Memorial Sloan Kettering, suggested that data show routine Radical Nephrectomy (RN) for small renal tumours is unjustified. Urologists need to be made aware that CKD (Chronic Kidney Disease) can be created or pre-existing CKD made worse with Radical Nephrectomy. Still RN accounts for 80% of surgeries for SRM (small renal masses< 4 cm in size).
AUA (American Urology Association) guidelines, strongly support PN (partial nephrectomy), when feasible.
2) Pediatric renal Tumours
Renal tumours account for 6.3 % of cancer diagnoses in children <15 years of age. Wilms’ tumour (nephroblastoma) is the most common, accounting for 91% of all renal tumours during childhood. Other tumours include clear cell RCC, Sarcoid tumour & angiomyplipoma.
Surgery is the best option for Wilms’ tumour, followed by chemotherapy with doxorubicin, etoposide, vincristine & cyclophosphamide in some cases.
3) Localized & Locally advanced Clear cell RCC
Imaging Innovations: Dr. Ivan Pedrosa
Newer Imaging techniques include:
• Contrast enhanced ultrasound
• Dual source CT scan
o Arterial spin labeling
o Dual weighted imaging
All have a very important role in the diagnosis of kidney cancer and in active surveillance of small renal masses
Neo-Adjuvant Therapy: Dr. Christina Suarez Rodriguez
Discussion around a patient given neo-adjuvant therapy with Sutent. Although not a standard therapy, it should be considered in selected cases. Several trials are underway and the outcome is eagerly awaited.
Role of Lymphadenectomy: Dr. Michael Blute
Retroperitoneal lymphadenectomy (RPN) does produce improvement in survival; however there is increase in morbidity (complications & death from surgery)
RPN is currently recommended for:
• High Risk primary disease
• Cytoreductive nephrectomies
• Isolated Retroperitoneal recurrence
RPN is not recommended for Low Risk primary disease
Prognostic factors: Dr. Vincenzo Ficara
Prognostic factors are of 3 types:
• Clinical & Laboratory findings
• Molecular & Genetic
Newer Integrated Prognostic Factor systems take into account:
• TNM (Tumor/Node/Metastasis) staging
• Histologic subtype
• Nuclear Grading
• Coagulative necrosis
• Microvascular Invasion
• Sarcomatoide differentiation
Integrated Prognostic Factor Systems significantly improve prognostic accuracy.
Inclusion of cytogenetic & molecular markers is encouraging and awaits validation.
4) Distinguished lecture
Genetic Basis of Kidney Cancer: Dr. Marston Linehan, National Cancer Institute
There are several forms of inherited Renal Cell carcinoma
1. Von Hippel Lindau
2. Hereditary Papillary Carcinoma
3. Burt Hoge Dube disease
4. Hereditary Leiomymatosis
5. Succinate Dehydrogenase
All have distinct genetic markers. Targeted therapies such as Sutent and Avastin are an option for these forms of RCC