Rx of Renal Cancer Flashcards
What is the principal means of producing a cure in renal cancer?
thru surgical excision
What are the 4 situations in the treatment of renal cancer when chemotherapy/radiotherapy drugs would be employed?
- With advanced stage/grade
- If the tumor has metastasized
- As an adjunctive therapy with surgery/radiation
- As a primary therapy where medical circumstances preclude surgery
What are common sites for renal tumor metastasis (5)? What is the most common? Where does a renal tumor metastasis cause destructive lesions?
- Lymph nodes (most common)
- Lung Liver Bone (destructive lesions)
- Adrenal Gland, Brain
- Opposite kidney
- Subcutaneous skin nodules
What are the three types of childhood renal tumors? Which is most common?
- Nephroblastoma (WIlm’s Tumor)→most common
- Clear Cell Sarcoma
- Rhabdoid and Neuroepithelial Tumor
In what age group is nephroblastoma (Wilm’s) most common? What is the prognosis and 5-yr survival rate?
children age 3-4; curable in the majority of children; 5-yr survival rate above 90% (not as high for clear cell sarcoma)
What is standard therapy for nephroblastoma?
Nephrectomy followed by a 1.5-2 yr regimen of a combo containing Vincristine + Dactinomycin and/or Doxorubicin +/- others.
Treatment of recurrent nephroblastoma involves what?
Alternating courses of 1. Vincristine + Doxorubicin + Cyclophosphamide and 2. Etoposide + Cyclophosphamide
Standard chemotherapy of Clear Cell Sarcoma (CCSK)?
Combo of components of nephroblastoma tx and RADIATION THERAPY
Tx of recurrent CCSK?
initially carboplatin and cyclophosphamide (CC=CC)
Patients with recurrent CCSK involving the brain respond to what treatment?
ICE (ifosfamide, carboplatin, and etoposide) with either surgery or radiation
What is the standard therapy for Rhabdoid and Neuroepithelial tumors?
No satisfactory therapy has been discovered
Toxicities of Carboplatin?
myelosuppresion; infection susceptibility; ototoxicity, nephrotoxicity
Toxicity of Cyclophosphamide?
Myelosuppresion; Hemorrhagic Cystitis→MESNA
Toxicity of Doxorubicin?
Bone marrow suppression; acute and chronic CARDIOTOXICITY
Toxicity of Dactinomycin?
Myelosuppression; HEPATIC dysfunction; infection susceptibility
Toxicity of Etoposide?
Hematologic toxicity; BP INSTABILITY
Toxicity of Ifosfamide?
bone marrow suppression; Hemorrhagic Cystitis→MESNA
Toxicity of Vincristine?
Neurotoxicity; bilateral sensory “stocking glove pattern→peripheral neuropathy
How do adult renal tumors respond to cytotoxic therapy? What has this led to?
responses to cytotoxic therapy generally have not exceeded 10% for any traditional drug regimen. So, now patients receive a single of combination therapy of the drugs listed in the table on p. 3