Surgeons and researchers are continually investigating new surgical techniques or trying to refine existing surgical techniques to improve the quality of life of the patient after surgery. This unit summarises the advances in this area.
Combining Surgery with Drug Treatments
There are two recent clinical trials investigating the benefits of surgery in patients with advanced RCC that has spread to other parts of the body. For patients with advanced RCC, a nephrectomy or partial nephrectomy will not cure their cancer. The CARMENA trial is designed to investigate whether surgery followed by adjuvant treatment with sunitinib is more effective at treating advanced RCC than sunitinib alone.
The SURTIME trial is being run in centres throughout the UK and is investigating the optimal time to have surgery for the treatment of advanced RCC; either before or after sunitinib treatment.
High Intensity Focused Ultrasound (HIFU)
High intensity focused ultrasound (HIFU) involves directing a strong beam of sound waves through the skin precisely at the tumour using a specialised probe. The high intensity ultrasound waves destroy cancerous cells. This technique avoids the need to have surgery and surgeons have suggested that in future patients may be able to have a primary renal cancer treated without needing an operation. Various clinical trials are ongoing to investigate the effectiveness of HIFU for tumours, which can’t be removed by surgery, and as a neo-adjuvant treatment before surgery. HIFU is also hampered by the same limitations as cryotherapy, i.e. limits with respect to the size of the tumour that can be ablated (less than 4cm diameter), location of the tumour (accessibility and proximity to pelvic blood vessels) and risk of compromising renal function.
Heat Treatment
Heat treatment (or microwave therapy) involves heating the kidney to destroy the cancer. This technique is in the early stages of development and more experience in clinical trials is needed before this technique can be considered for the treatment of renal cancer.
Photodynamic Therapy (PDT)
Photodynamic therapy (PDT) involves the use of a light activated drug, which is administered intravenously and given time to reach the tumour before percutaneous laser fibres are inserted into the tumour to activate the drug. This damages the blood vessels supplying the tumour causing the tumour to shrink. This technique is still very experimental and undergoing clinical testing on small renal tumours.
References
Kidney cancer research, Cancer Research UK: http://www.cancerresearchuk.org/about-cancer/type/kidney-cancer/treatment/whats-new-in-kidney-cancer-research. Accessed December 2014.