1. Radiotherapy for Kidney cancer
Dr Kate Fife
Consultant Clinical Oncologist
Addenbrooke’s Hospital, Cambridge

2. 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

3. 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’

4. 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

5. How is radiotherapy given?
Linear Accelerator produces XRays
Shaped to the area to be treated ‘field’

6. 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

7. 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

8. History II Radium discovered 1898 (Curie): natural radioactive emitter
Radium used as implants for cancers of womb and other sites

10. 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

11. 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

12. Present and Future Improved planning: CT planning now routine
Intensity modulated radiotherapy: planning technique producing shaped beams of varying intensity
Tomotherapy: ‘Image guided’ radiotherapy

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

16. Standard treatments
Conventional planning and Linac treatment highly accurate
Sufficient for most treatments

17. Use of Radiotherapy in Cancer treatment
Surgery
Local treatment
Early stage
Radiotherapy
Early and late stage
Systemic therapy: early and late stage
Chemotherapy
Hormone therapy
Targeted therapy

18. 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

19. 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

20. Sites for radiotherapy
Anywhere!
Bone
Spine
Soft tissue
Lymph nodes
Brain
Lung
Combined with surgery in some cases

21. Soft tissue chest wall

22. After RT and TKIs (4 years later….)

23. Severe pain
from
secondary
tumour
4 months
after RT

24. MRI Femur

25. Bone scan and XRay

27. 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%

28. 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 can’t have surgery
Tumour bed if some tumour left after surgery