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Dear colleagues, would you give adjuvant RT after nephrectomy for renal cell carcinoma but with residual disease in a LN that was not resected because of adherence to the vena cava ?
Without SBRT, I think I'd ptobably treat the area to 54 in 6 weeks as tolerated by surrounding structures.There's no right answer in this situation. If that's the only site of gross disease, we'd probably SBRT it with fiducials and/or CBCT with 4D sim and attention to motion/motion management (though this may not move much or at all). Dose is 5 fractions to 30-60 Gy as limited by bowel tolerance. I'd only recommend doing that at a center that has expertise in GI SBRT.
Dear colleagues, would you give adjuvant RT after nephrectomy for renal cell carcinoma but with residual disease in a LN that was not resected because of adherence to the vena cava ?
I was referred a patient who had a prior nephrectomy on the left for RCC and now has a Right renal mass seen on contrast CT invading into the IVC (7 cm renal mass), non surgical candidate, no distant disease. Pt is on HD. Any role for RT you guys know of? Is cryo/RF/renal art ablation even an option in a stage III RCC. Should this be biopsied? Thanks, im pretty clueless about RCC as a rad onc.
I have no good data behind this, but if the patient is already on HD, you could consider SBRT
https://www.ncbi.nlm.nih.gov/pubmed/28188682
I was referred a patient who had a prior nephrectomy on the left for RCC and now has a Right renal mass seen on contrast CT invading into the IVC (7 cm renal mass), non surgical candidate, no distant disease. Pt is on HD. Any role for RT you guys know of? Is cryo/RF/renal art ablation even an option in a stage III RCC. Should this be biopsied? Thanks, im pretty clueless about RCC as a rad onc.
Why a nonsurgical candidate? How old?
No role for cryo/RF with T3 disease. Really only used for small masses away from the renal hilum. You can't freeze the renal vasculature.
No need for biopsy. Nothing else besides RCC will look like that on RCC. Path is usually concordant with his prior contralateral cancer.
In my opinion, no role for RT. If truly not a surgical candidate, I don't think RT is going to improve survival with large T3 lesion and IVC tumor thrombus. Prognosis very poor for a patient too unhealthy for surgery and on HD with this bad disease.
Renal artery embolization could be considered for palliative reasons if the patient develops intractable hematuria, but also unlikely to change survival.
Thanks thats all very helpful; so basically he should go to surgery, its his only chance. He's 80 years old, COPD/CHF but not terrible. I mean hes not an amazing candidate but hes between a rock and a hard place. Im still not sure why you cant just ablate the renal artery, thats what I would opt for. I mean Kidney isnt working anyway, just cut off its blood supply entirely, see what happens. Its prob a better palliative procedure than RT.
What is he on now @Haybrant ? He should be on some systemic therapy if he's been deemed surgically unresectable.
As urologists, @cpants and @DoctwoB , you're doing a IVC reconstruction with enbloc resection of the tumor thrombus involved IVC for this patient, co-morbidities willing? Even with obvious hematogenous seeding of tumor?
Why would you sacrifice the remaining kidney- unless I am missing something.
We this guy having one kidney at age 80, expectant management is the only reasonable choice. Sorry, tell him to put his affairs in order.
Why? He is already on HD. Whack the other one out.