If a single metastatic renal cell carcinoma metastases, it can take a kidney transplant or excision, and adjuvant chemotherapy or biological therapy. The main clinical manifestations of pulmonary metastasis of cough, hemoptysis, or shortness of breath, but many patients and asymptomatic, often in conventional chest radiography or chest was discovered. Solitary pulmonary metastasis should be lobe lobectomy or wedge, 5-year survival rate of 25% to 35%.
Multiple metastatic renal tumors, when conditions permit, should be given after resection of the primary lesion comprehensive treatment, stable disease or relieve symptoms, with occasional reports of metastatic lesions disappear on their own, and thus the treatment of metastatic renal cell carcinoma can not be ignored.
Targeted therapy has become a second-line treatment of metastatic renal cell carcinoma primary
In the past, the treatment of metastatic renal cell carcinoma limited to cytokine therapy or clinical trials. In the past 15 years, a number of targeted metastasis, recurrence or unresectable clear cell carcinoma in patients with IL-2 and interferon combined with different doses of different forms of clinical trials. These studies show that high-dose IL-2 are more efficient than low-dose. Therefore, the guidelines recommend a good physical condition, especially the tumor load is small or mainly in patients with lung metastases, can be used high-dose IL-2 treatment.
Cytokine immunotherapy treatment of renal cell carcinoma is still the first choice for the current stage of non-surgical therapy, in the traditional chemical treatment on the basis of renal cancer cells with the biological characteristics and its inherent better understanding of physiological and biochemical processes, new and more targeted drugs and monoclonal antibodies for renal cell carcinoma are being gradually used clinically for the treatment of metastatic kidney cancer hope.
At the same time vaccine therapy and bone marrow / stem cell transplantation for treatment although the implementation is very complex and in rare cases for treatment, but this method of treatment for patients with good effect, there is still possibility of further development. The final treatment of renal cell carcinoma will still be a comprehensive treatment of a variety of methods. With the biological characteristics of renal cell carcinoma and treatment methods, step by step to reveal the diversity, the survival rate of patients with kidney cancer will be further improved.
Immunotherapy treatment of renal cell carcinoma is the conventional means. High-dose interleukin-2 (HD IL-2) for the treatment of metastatic renal cell carcinoma of the effective drugs, in 1992, was formally approved by the U.S. FDA, and its efficiency up to 14%. In order to improve the therapeutic index of IL-2, Boston, USA cytokine Working Group (CWG) conducted a prospective multi-center clinical trial (SELECT).
The study included 120 cases of renal cell cancer (Abstract No. 4514). The results showed, HD IL-2 are significantly higher than reported in previous studies (95% CI 21% ~ 38%, P = 0.0009). The median progression-free survival (PFS) was 4.4 months, response rate was 30% (95% CI 22% ~ 40%, P = 0.0004; 35/115 patients), IL-2's effectiveness and clinical pre- processing factors or high-UCLA SANI score has nothing to do.
The research suggests, HD IL-2 are significantly higher than previous studies, IL-2 may be transparent to the treatment of tissue with a certain selectivity. Tumor analysis and predictive blood-based markers analysis may improve the HD IL-2 in patients with renal cell carcinoma sensitive screening standards.
In addition, CWG study group also bevacizumab (Bev) combined HD IL-2 therapy for metastatic renal cell carcinoma has a phase Ⅱ clinical trial (Abstract No. 4530). The results showed that 51 patients were included, with a median PFS of 9.0 months (90% CI 5.7 ~ 13.0), 2-year PFS rate was 15% (90% CI 5% ~ 24%). 8 cases of complete remission (CR), 10 partial response (PR) and 21 stable disease (SD). Markedly and the treatment fails in patients with a median baseline serum VEGF concentrations were 459 μg / L and 383 μg / L. Compared with the monotherapy group, two-drug combination group, no significant differences in toxicity. It follows that bevacizumab combined HD IL-2 in the treatment of metastatic renal cell carcinoma has a good safety and efficiency, while prompts to extend bevacizumab has received IL-2 therapy in patients with PFS .
Danish researchers report Donskov a professor of IL-2-based treatment of unresectable metastatic renal cell cancer study (Abstract No. 4591). The study included 422 cases of patients with a total effective rate was 15%, of which 17 cases of CR, 47 例 PR. 36 patients with no signs of disease (9%), with a median follow-up was 76 months and median overall survival time was 15.7 months, the expected 5-year and 10 year survival rates were 15% and 10%. The findings suggest that the use of the IL-2-based immunotherapy, either single-agent or joint surgery, no signs of disease, the expected 10-year survival rate of patients up to 10%. IL-2-based immunotherapy is still first-line treatment of metastatic renal cell carcinoma and effective program.
Monday, December 19, 2011
Thursday, December 15, 2011
Renal Cell Carcinoma Staging
Kidney cancer more common in adult population, is a very high degree of disease malignant disease, clinical stages in medicine has a very important sense, the principles of clinical staging of renal cell carcinoma is a kidney cancer clinical treatment must be followed. Because the choice of treatment according to stage classification more in line with the biological characteristics of renal cell carcinoma, the treatment of blindness and can avoid subjective and arbitrary, selection must be based on different clinical stages of treatment. The most effective immunotherapy method involves staging. Stages of the treatment plan and prognosis has clinical significance.
Western type of kidney cancer:
In pathology, according to the different cell morphology, kidney doctors usually divided into 4 types: clear cell type renal cell carcinoma, granular cell type renal cell carcinoma, mixed cell type renal cell carcinoma, undifferentiated cell type renal cell carcinoma. Clear cell type renal cell carcinoma: cancer cells were polygonal, clear cytoplasm, small and deeply stained nuclei, also known as clear cell carcinoma, a little light for the deterioration of renal cell carcinoma. Granulosa cell type renal cell carcinoma: cube-shaped or polygonal cells, red granular cytoplasm Iraq than clear cell type of malignant cancer cells high, the prognosis is poor.
Mixed cell type renal cell carcinoma of clear cell type renal cell carcinoma and granular cell type RCC mix. Undifferentiated type of kidney cancer: cancer spindle-shaped or irregular in shape, like sarcoma, a higher degree of malignancy. For highly malignant granular cell type and undifferentiated type, treatment is usually combination therapy, as radical nephrectomy and regional lymph node dissection, surgery may be given chemotherapy foreword, renal cell carcinoma after radiotherapy feasible. In order to reduce the recurrence rate, and enhance treatment and improve treatment of negative Western reaction symptoms, usually after surgery supplemented by encouraging Chinese medicine treatment.
In the course of the development period, the Western type of renal cell carcinoma, there are two methods, namely TNM and Robson staging classification.
1 of the Western type of kidney cancer TNM staging: T0 period: no primary tumor. With T1: tumor is small, the same risk of kidney shape, confined within the renal capsule. T1 a period: tumor diameter less than 4cm; T1b tumors larger than 4cm, less than 7cm. T2A period: a large tumor, suffering from kidney deformation, but the tumor is still confined within the renal capsule. T3a tumors invading perirenal fat. T3b tumors invading the vein. T4 tumors had invaded adjacent organs. Followed by lymph nodes and whether there is a remote transfer of classification is in accordance with the development of disease classification. For the lesser degree of deterioration, surgical excision is the preferred method. For a higher degree of deterioration, or remote metastatic disease has emerged, the use of combination therapy, can withstand the surgery for early surgery, chemotherapy, or those who can not afford to radiotherapy, with Chinese medicine treatment or immunotherapy, in order to maximize the elimination of lesions .
TNM staging
Primary tumor (T) stage:
To: no evidence of primary tumor.
T1: tumor diameter less than or equal to 2.5cm, limited to the kidney capsule.
T2: tumor diameter greater than 2 5cm, kidney deformation, the tumor remains in the envelope.
T3a: tumor invasion of perirenal fat.
T3b: Tumor invasion and vein.
T4: the tumor has invaded adjacent organs.
Regional lymph nodes (N) stages:
NX: lymph node metastasis are not sure.
No: lymph node metastasis.
N1: ipsilateral single lymph nodes.
N2: number of regional lymph node involvement.
N3: clear lymph nodes has been fixed in surgery.
N4: close to the regional lymph node involvement.
Distant metastasis (M) phases:
Mx: shift range is not sure.
Mo: no evidence of distant metastasis.
M1: distant metastasis.
Mla: occult metastases.
M1b: the transfer of a single organ.
M1c: a multiple organ transfer.
M1d: Multiple organ metastasis.
(2) RCC Western type of Robson classification mainly on the basis of tumor size and metastasis classification, TNM staging method similar to the treatment, the lower degree of deterioration with surgical resection, the higher degree of deterioration of an integrated therapy.
In general, the treatment of kidney cancer, usually in accordance with progression and metastasis to select the period of treatment, so patients need to clear itself and the Western type of kidney cancer stage. Radical nephrectomy is the most basic method of treatment of renal cell carcinoma, surgical resection of disease include the kidney, perirenal fat, perirenal fascia and the ipsilateral adrenal gland. Radical resection of renal cell carcinoma, while for regional lymph node dissection can be achieved by reducing the local recurrence rate, to help correct the clinical stage and improve survival purposes. For granular cell type, undifferentiated type and a higher degree of deterioration of renal cell carcinoma, surgery should be conditional early surgery, can not afford the surgery, patients should take timely chemotherapy, radiotherapy and combined with the combination therapy of Chinese medicine in order to eliminate the greatest extent lesions, and Western medicine treatment to reduce the negative reaction symptoms.
Robson staging:
Phase I: The tumor is located within the renal capsule.
Phase Ⅱ: tumor invasion of perirenal fat, while still confined to perirenal fascia.
Ⅲ: tumor invasion of the renal vein or regional lymph nodes, with or without inferior vena cava, perirenal fat involvement.
Ⅲ a stage: tumor invasion of the renal vein or inferior vena cava.
Stage Ⅲ b: regional lymph node involvement.
Phase Ⅲ c: involved the renal vein, inferior vena cava, lymph nodes.
Ⅳ: distant metastasis or invasion of adjacent organs.
Ⅳ a stage: In addition to adrenal tumor invasion of adjacent organs.
Ⅳ b of: tumor metastasis.
Pathological type of kidney cancer!
In pathology, according to the different cell morphology, kidney cancer usually divided into 4 types: clear cell type renal cell carcinoma, granular cell type renal cell carcinoma, mixed cell type renal cell carcinoma, undifferentiated cell type renal cell carcinoma.
1, clear cell type renal cell carcinoma: cancer cells were polygonal, clear cytoplasm, small and deeply stained nuclei, also known as clear cell carcinoma, a little light for the deterioration of renal cell carcinoma.
2, granular cell type renal cell carcinoma: cube-shaped or polygonal cells, red granular cytoplasm Iraq, compared with clear cell type of malignant cancer cells is high, the prognosis is poor.
3, mixed cell type renal cell carcinoma: the clear cell type renal cell carcinoma and granular cell type RCC mix.
4, undifferentiated renal cell carcinoma: cancer spindle-shaped or irregular in shape, like sarcoma, a higher degree of malignancy.
Western type of kidney cancer:
In pathology, according to the different cell morphology, kidney doctors usually divided into 4 types: clear cell type renal cell carcinoma, granular cell type renal cell carcinoma, mixed cell type renal cell carcinoma, undifferentiated cell type renal cell carcinoma. Clear cell type renal cell carcinoma: cancer cells were polygonal, clear cytoplasm, small and deeply stained nuclei, also known as clear cell carcinoma, a little light for the deterioration of renal cell carcinoma. Granulosa cell type renal cell carcinoma: cube-shaped or polygonal cells, red granular cytoplasm Iraq than clear cell type of malignant cancer cells high, the prognosis is poor.
Mixed cell type renal cell carcinoma of clear cell type renal cell carcinoma and granular cell type RCC mix. Undifferentiated type of kidney cancer: cancer spindle-shaped or irregular in shape, like sarcoma, a higher degree of malignancy. For highly malignant granular cell type and undifferentiated type, treatment is usually combination therapy, as radical nephrectomy and regional lymph node dissection, surgery may be given chemotherapy foreword, renal cell carcinoma after radiotherapy feasible. In order to reduce the recurrence rate, and enhance treatment and improve treatment of negative Western reaction symptoms, usually after surgery supplemented by encouraging Chinese medicine treatment.
In the course of the development period, the Western type of renal cell carcinoma, there are two methods, namely TNM and Robson staging classification.
1 of the Western type of kidney cancer TNM staging: T0 period: no primary tumor. With T1: tumor is small, the same risk of kidney shape, confined within the renal capsule. T1 a period: tumor diameter less than 4cm; T1b tumors larger than 4cm, less than 7cm. T2A period: a large tumor, suffering from kidney deformation, but the tumor is still confined within the renal capsule. T3a tumors invading perirenal fat. T3b tumors invading the vein. T4 tumors had invaded adjacent organs. Followed by lymph nodes and whether there is a remote transfer of classification is in accordance with the development of disease classification. For the lesser degree of deterioration, surgical excision is the preferred method. For a higher degree of deterioration, or remote metastatic disease has emerged, the use of combination therapy, can withstand the surgery for early surgery, chemotherapy, or those who can not afford to radiotherapy, with Chinese medicine treatment or immunotherapy, in order to maximize the elimination of lesions .
TNM staging
Primary tumor (T) stage:
To: no evidence of primary tumor.
T1: tumor diameter less than or equal to 2.5cm, limited to the kidney capsule.
T2: tumor diameter greater than 2 5cm, kidney deformation, the tumor remains in the envelope.
T3a: tumor invasion of perirenal fat.
T3b: Tumor invasion and vein.
T4: the tumor has invaded adjacent organs.
Regional lymph nodes (N) stages:
NX: lymph node metastasis are not sure.
No: lymph node metastasis.
N1: ipsilateral single lymph nodes.
N2: number of regional lymph node involvement.
N3: clear lymph nodes has been fixed in surgery.
N4: close to the regional lymph node involvement.
Distant metastasis (M) phases:
Mx: shift range is not sure.
Mo: no evidence of distant metastasis.
M1: distant metastasis.
Mla: occult metastases.
M1b: the transfer of a single organ.
M1c: a multiple organ transfer.
M1d: Multiple organ metastasis.
(2) RCC Western type of Robson classification mainly on the basis of tumor size and metastasis classification, TNM staging method similar to the treatment, the lower degree of deterioration with surgical resection, the higher degree of deterioration of an integrated therapy.
In general, the treatment of kidney cancer, usually in accordance with progression and metastasis to select the period of treatment, so patients need to clear itself and the Western type of kidney cancer stage. Radical nephrectomy is the most basic method of treatment of renal cell carcinoma, surgical resection of disease include the kidney, perirenal fat, perirenal fascia and the ipsilateral adrenal gland. Radical resection of renal cell carcinoma, while for regional lymph node dissection can be achieved by reducing the local recurrence rate, to help correct the clinical stage and improve survival purposes. For granular cell type, undifferentiated type and a higher degree of deterioration of renal cell carcinoma, surgery should be conditional early surgery, can not afford the surgery, patients should take timely chemotherapy, radiotherapy and combined with the combination therapy of Chinese medicine in order to eliminate the greatest extent lesions, and Western medicine treatment to reduce the negative reaction symptoms.
Robson staging:
Phase I: The tumor is located within the renal capsule.
Phase Ⅱ: tumor invasion of perirenal fat, while still confined to perirenal fascia.
Ⅲ: tumor invasion of the renal vein or regional lymph nodes, with or without inferior vena cava, perirenal fat involvement.
Ⅲ a stage: tumor invasion of the renal vein or inferior vena cava.
Stage Ⅲ b: regional lymph node involvement.
Phase Ⅲ c: involved the renal vein, inferior vena cava, lymph nodes.
Ⅳ: distant metastasis or invasion of adjacent organs.
Ⅳ a stage: In addition to adrenal tumor invasion of adjacent organs.
Ⅳ b of: tumor metastasis.
Pathological type of kidney cancer!
In pathology, according to the different cell morphology, kidney cancer usually divided into 4 types: clear cell type renal cell carcinoma, granular cell type renal cell carcinoma, mixed cell type renal cell carcinoma, undifferentiated cell type renal cell carcinoma.
1, clear cell type renal cell carcinoma: cancer cells were polygonal, clear cytoplasm, small and deeply stained nuclei, also known as clear cell carcinoma, a little light for the deterioration of renal cell carcinoma.
2, granular cell type renal cell carcinoma: cube-shaped or polygonal cells, red granular cytoplasm Iraq, compared with clear cell type of malignant cancer cells is high, the prognosis is poor.
3, mixed cell type renal cell carcinoma: the clear cell type renal cell carcinoma and granular cell type RCC mix.
4, undifferentiated renal cell carcinoma: cancer spindle-shaped or irregular in shape, like sarcoma, a higher degree of malignancy.
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