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Urology (Expert Forum)
Possible tratment and outcomes
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
Possible tratment and outcomes
by Bil-Triantafylou, Jun 17, 1998 12:00AM
My father was diagnosed with renal cell carcinoma about four years ago resulting in a nephrectomy of the affected kidney. He had been a heavy smoker for most of his life and had quit one year prior to the cancer appearing.
Two years later we were told that the cancer had spread, via the bloodstream, to his lungs and bones. The only treatment that he is receiving is radiation therapy to areas in his bones where any pain manifests. Drugs prescribed are pain killers (morphine-Kapanol), bone strengthening drugs and paracetamol (Panadol).
The lesions in his lungs are growing, but at a slow rate. He has very little shortness of breath at this point in time. However, now more areas of pain in his bones have shown up.
Could you please give me any information on treatments, alternative or conventional, that we can try to prolong life. Also, any other information on similar cases that you know of that may help my father.
I need a reply as soon as possible because hope and time is running out.
Thank you and hope to hear from you soon.
=========================================================
Dear Bill Triantafyllou,
Metastatic Renal Cell Carcinoma (mRCC) is a difficult disease to cure. Many of the treatment modalities have considerable morbidity associated with them. The only agent currently approved by the FDA is Interleukin 2 (IL-2.) It is a form of immunotherapy that primes the bodies immune system to fight the cancer. The biggest problem with IL-2 is its toxicity which includes clinically significant hypotension. Patients who receive high doses of this treatment must be hospitalized.
IL-2 is toxic to the heart, kidneys, skin and mucous membranes, liver, gastrointestinal tract, and blood cells (hematologic toxicity). Ironically, there is also a risk of infection.
There have been studies where the patients immune cells have been treated with IL-2 outside of the body to "supercharge" them, and then returned to the patient. Although promising in both concept and early clinical trials, adoptive immunotherapy is not yet of proven benefit in patients with mRCC.
With respect to your father, patients with mRCC who are considered to have a good prognosis are patients with 1) Disease free interval of less than 2 years; 2) Solitary lung or bone metastasis 3) Normal performance status. These patients are treated aggressively with local therapy for long-term palliation with surgery or radiation. Other patients who do not fit into this category have a poor prognosis and receive palliative radiation therapy or surgery for pathologic or impending fracture.
What I suggest is that you consult with your father's physicians in a multidisciplinary setting to discuss the prognosis, goals and what protocols they may have that may suit your dad. Best of luck.
This information is provided for general medical education purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.
Sincerely yours;
HFHS M.D.-JL
* Keyword: Metastatic Renal Cell Carcinoma/ therapy
Two years later we were told that the cancer had spread, via the bloodstream, to his lungs and bones. The only treatment that he is receiving is radiation therapy to areas in his bones where any pain manifests. Drugs prescribed are pain killers (morphine-Kapanol), bone strengthening drugs and paracetamol (Panadol).
The lesions in his lungs are growing, but at a slow rate. He has very little shortness of breath at this point in time. However, now more areas of pain in his bones have shown up.
Could you please give me any information on treatments, alternative or conventional, that we can try to prolong life. Also, any other information on similar cases that you know of that may help my father.
I need a reply as soon as possible because hope and time is running out.
Thank you and hope to hear from you soon.
=========================================================
Dear Bill Triantafyllou,
Metastatic Renal Cell Carcinoma (mRCC) is a difficult disease to cure. Many of the treatment modalities have considerable morbidity associated with them. The only agent currently approved by the FDA is Interleukin 2 (IL-2.) It is a form of immunotherapy that primes the bodies immune system to fight the cancer. The biggest problem with IL-2 is its toxicity which includes clinically significant hypotension. Patients who receive high doses of this treatment must be hospitalized.
IL-2 is toxic to the heart, kidneys, skin and mucous membranes, liver, gastrointestinal tract, and blood cells (hematologic toxicity). Ironically, there is also a risk of infection.
There have been studies where the patients immune cells have been treated with IL-2 outside of the body to "supercharge" them, and then returned to the patient. Although promising in both concept and early clinical trials, adoptive immunotherapy is not yet of proven benefit in patients with mRCC.
With respect to your father, patients with mRCC who are considered to have a good prognosis are patients with 1) Disease free interval of less than 2 years; 2) Solitary lung or bone metastasis 3) Normal performance status. These patients are treated aggressively with local therapy for long-term palliation with surgery or radiation. Other patients who do not fit into this category have a poor prognosis and receive palliative radiation therapy or surgery for pathologic or impending fracture.
What I suggest is that you consult with your father's physicians in a multidisciplinary setting to discuss the prognosis, goals and what protocols they may have that may suit your dad. Best of luck.
This information is provided for general medical education purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.
Sincerely yours;
HFHS M.D.-JL
* Keyword: Metastatic Renal Cell Carcinoma/ therapy
