Other Treatments

Radiotherapy

Radiotherapy uses high energy X-rays to destroy cancer cells. For patients who are unable to have surgery, it can be used to shrink a kidney cancer and so control symptoms. It can also be used if the cancer has spread to other areas of the body, such as the brain, lungs, liver or bone, or for the treatment of cancer that has come back (recurred).

Because kidney cancer cells are not very sensitive to radiation, radiotherapy is not used very often to treat kidney cancer patients. Radiotherapy may be used to help control and alleviate the symptoms of advanced kidney cancer. It can be used to shrink a large tumour and relieve pressure on nearby organs, and the subsequent pain and discomfort this causes. Shrinking the tumour may also relieve the pressure on nerves that may be causing pain (neuropathic pain).

Treatment is given in the hospital radiotherapy department and will be tailored to you. Some people have daily treatments (or fractions) from Monday to Friday for several weeks. Others may need only one or two treatment fractions.

Radiotherapy can be directed at the area of the body containing the tumour so as to kill most of the cancer cells and avoid as much healthy tissue as possible. The actual treatment only takes a few minutes and does not hurt. You will be able to talk to the radiographer via an intercom if you need them.

Side-effects can include fatigue, nausea and vomiting, and sore or red skin. They take a while to build up and usually persist for a few days after the treatment has finished. Your doctor will be able to tell you what to expect and how to cope.

If your cancer has spread to your brain, radiotherapy can be very successful at controlling symptoms and slowing down the growth of the cancer. It can be given in a number of different ways and is usually given in combination with steroids. How it is given depends mostly on the size and number of areas of cancer spread in the brain. If there is only one area affected, it may be treated with stereotactic radiotherapy (also called radiosurgery or gamma knife surgery or CyberKnife) using high doses of radiation directed at the cancer using a head frame. Only a single treatment is required. If stereotactic radiotherapy is not available, lower dose radiation is given in 10 separate fractions over two weeks. If the cancer is widespread, there is the possibility of the spread of cancer cells throughout the brain, which are too small to detect on a scan. In this case whole brain radiotherapy is sometimes employed. This is usually given in five fractions over a week. Stereotactic radiotherapy can now be used to treat metastases found in the liver, lung and pancreas, as well as the brain.

All drugs used to treat cancer can affect fertility. If you are prescribed drugs they may only affect your ability to have children while you are taking them. However, with newer treatments the long-term effects may not yet be known, so this is an important issue to discuss with your doctor before you start treatment.

Renal Artery Embolisation

Renal Artery Embolisation simply means blocking the blood flow to the cancer in the kidney. For some people, surgery or systemic cancer treatments may not be an option due to other health factors making the negatives outweigh the benefits. In these situations you may be offered renal artery embolisation, normally it would only be offered if you are symptomatic.

The idea is that this would then starve the kidney of the oxygen and nutrients needed and prevent growth. This reduction in oxygen and nutrients would therefore help the cancer to shrink and control your symptoms.

You may also be offered embolisation if you have a large tumour which has been deemed too large for surgery and are symptomatic. It may also be used to help reduce bleeding during surgery if you have a large tumour.

The procedure

It is a minor procedure that you would have done within the radiology department and you may be required to stay in hospital for a couple of days after.  A sedative is normally administered to help you relax during the procedure and a local anesthetic will be used to numb the area in your groin.

A thin catheter will be inserted into your groin by a doctor, the catheter will be pushed upwards until it reaches the renal artery that carries the blood to the cancer. Once it is in place they will then inject the substance they are using to block the vessel.

There are different ways of blocking the vessel, such as medical putty/glue, plastic beads or small metal coils.

It is important to note that this procedure does not cure the cancer as it has not been removed and that there is a chance of it spreading in the future.

References
www.cancerresearchuk.org/about-cancer/kidney-cancer/treatment/renal-artery-embolisation
www.cancer.ca/en/cancer-information/cancer-types/kidney/treatment/arterial-embolization#:~:text=Arterial%20embolization%20is%20a%20procedure,a%20large%20tumour%20during%20surgery
www.gosh.nhs.uk/conditions-and-treatments/procedures-and-treatments/embolisation
www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/arterial-embolisation-for-kidney-cancer
www.nhs.uk/conditions/kidney-cancer/treatment

New treatments

Cancer researchers are always looking for new and more effective ways of treating kidney cancer, as well as trying to find out what causes cancer and how to prevent it. All treatments need to be vigorously tested before they are allowed onto the market to make sure they are safe, they are effective at treating cancer, and they work better than treatments that are already available. Testing new treatments is done in clinical trials. For more information about clinical trials, please take a look at our Introduction to Clinical Trials page or to find a clinical trial visit our Clinical Trials finder page.

The following new treatments are being investigated in clinical trials:

• Monoclonal antibodies, such as naptumomab, cG250, and nivolumab are being investigated alone or in combination with interferon or everolimus for the treatment of advanced kidney cancer or to reduce the risk of the cancer coming back after surgery.
• New targeted therapies, such as AZD2014 (an mTOR inhibitor) and lapatinib (a TKI) are being tested for the treatment of advanced RCC. The most effective way of taking these new drugs is also being investigated.
• New immunotherapy drugs, such as the anti-PD-L1 antibody, are being tested to see if they are effective and safe to use for the treatment of advanced kidney cancer.
• Cancer vaccines are designed to stimulate the body’s own immune system to fight cancer. Cancer researchers are studying vaccines that will stop or slow down advanced kidney cancer, or reduce the risk of the cancer coming back after surgery. Vaccines can be made from tumour cells or a type of white blood cell called dendritic cells. Tumour cell vaccines are made from each individual patient’s kidney cancer cells, which are removed during surgery. Kidney cancer cells and dendritic cells are mixed together in a laboratory and are injected back into the patient as a vaccine.