Radiation Treatments for Kidney Cancer
The preferred treatment for kidney cancer (renal cell carcinoma) is surgery. Typically, when a patient has kidney cancer, part or all of the kidney is removed. This surgery is called a nephrectomy. Sometimes, chemotherapy is also needed. Your treatment plan depends on a number of factors, including the type, location and size of the tumor as well as your age and general health. Renal cell carcinomas are tumors that start in the kidneys. Some other types of cancer can start in the kidney, and tumors can also grow in the kidneys after metastasizing (spreading) from another site.
Over the years, radiation therapy has had a small role in the treatment of kidney cancer. This is because renal cell carcinoma is usually considered "radioresistant" - or resistant to the effects of radiation. However, for some patients, there is a role for radiation therapy in kidney cancer. Radiation can be given over the course of several weeks. In this setting, a small amount of radiation is given each day. This is known as “fractionated radiation therapy” and can be given with either photon or particle therapy, including proton beam and carbon ion therapy.
More recently, a type of treatment called “stereotactic body radiation therapy (SBRT)” has been found to be useful in the treatment of kidney cancers. In this setting, a higher daily dose of radiation is given to a specific area of the kidney or surgical bed, using a fewer total number of treatments. Another type of radiation, known as “intraoperative electron radiotherapy” has also been used after surgery in the treatment of kidney cancer.
In addition to treatments that are directed at the kidney, treatments are sometimes needed for other parts of the body where kidney cancer may have spread. These may include the bones and/or brain.
Your radiation oncologist will work with your treatment team to decide on the best plan for your treatment.
Treatment Options for Kidney Cancer
The following treatment options are used to deliver fractionated radiation therapy and stereotactic body radiation therapy (SBRT). Your clinical team will decide which method is best for treating your particular case.
Stereotactic body radiation therapy (SBRT) is a technique that is now commonly used for the lung and can also be applied to the kidney. Unlike fractionated radiation therapy, SBRT is delivered using higher doses of radiation with each session than is used with fractionated radiation therapy.
In SBRT, a focused high-intensity beam of radiation targets the tumor. There are several ways it delivers this intense beam including:
- Intensity Modulated Radiation Therapy (IMRT): Multiple beams are used at different angles. The dose is dynamically modulated (the intensity of the beam is changed) in different parts of the target area to conform to the size and shape of the tumor. This lets the beam avoid the nearby normal organs, such as the liver, small bowel, and/or the other kidney, which decreases the risk of side effects.
- Volumetric Modulated Arc Therapy (VMAT): In VMAT, an advanced linear accelerator is used to circle around the patient at a speed that is up to eight times faster than what is possible with standard radiation therapy. Special software is used again to modulate the beam (change the intensity of the beam) as it moves around the patient. It delivers the dose to the entire tumor in a single (or back-and-forth) rotation in a few minutes.
- Either IMRT or VMAT can be combined with image-guided radiation therapy (IGRT) which uses images taken before the patient’s treatment. It then compares these images to what the images should look like based on the planning scan. Sometimes it uses x-rays and sometimes it uses modified CT scans, known as cone-beam CT scans. In addition, small metallic markers can be implanted into or near the tumor before treatment starts. The location of markers is then compared to the original planning scan and an image right before the patient’s treatment.
- The original planning scan, or simulation scan, is performed using computed tomography (CT scan). Magnetic resonance imaging (MRI) and/or positron emission tomography (PET scan) can also be used in addition to CT to help define the area of the tumor.
There is a role for particle therapy in the treatment of kidney cancer, either using proton beam therapy or heavy particles such as carbon ion therapy. Both of these technologies may be used to spare healthy organs and tissue near the tumor.
Lastly, intraoperative electron radiotherapy can be given after a kidney tumor is removed or after a nephrectomy. The radiation is given in a single session while the patient is still in the operating room. The area targeted is where there may be microscopic tumor (few cells) left behind. Shielding devices are used to protect the surrounding normal tissue. This type of treatment can also be combined with fractionated radiotherapy, as described above, that begins after the patient has started recovering from surgery.
Possible Side Effects of Radiation Treatment for Kidney Cancer
The doses of radiation used to destroy cancer cells can also hurt normal cells. The side effects are directly related to the area of the body being treated. Side effects are caused by the cumulative effect (total amount over time) of radiation on the cells. Most patients do not experience any side effects until a few weeks into their treatments. While side effects may be unpleasant, there are treatments to help manage them. Most side effects are temporary, disappearing over time when therapy is complete.
Most radiation oncologists see their patients at least once a week while the patient is receiving treatment. This visit with the healthcare team is an opportunity to ask questions, discuss any side effects, and find out what works best to help relieve the side effects. However, you can report concerning symptoms anytime to the treatment team.
The following list includes some of the most common side effects of radiation therapy for kidney cancer. Remember that the treatment can affect each patient differently and you may not experience these effects. Talk with your radiation oncologist and health care team about what you can expect from your specific treatment.
- Skin irritation: Your skin may become red, irritated, dry, or sensitive. This may progress to look like a sunburn. Treat the skin gently to avoid further irritation, and bathe carefully using only warm water and mild soap. Avoid perfumed or scented lotions or soaps, as these may cause further irritation. Avoid sun exposure, which can worsen the irritation.
- Fatigue is very common with radiation treatment and tends to begin a few weeks into therapy. Fatigue typically gets better slowly over the weeks and months following treatment.
- Loss of hair, also known as alopecia, in the treatment area. Hair typically starts to regrow a month or so after treatment. However, your hair might not grow back exactly as it was before treatment and for some, the hair loss becomes permanent.
- Nausea and/or vomiting can occur. Your healthcare team can prescribe medications to manage nausea. Dietary changes can also help.
Long-Term Side Effects
The side effects discussed above tend to occur during treatment up until a few months after treatment. Long-term effects can happen months to many years after cancer treatment. The risks vary depending on the areas included in the field of radiation and the radiation techniques that were used. Long-term side effects of radiation for kidney cancer can include:
- Secondary cancers: There is a low risk of developing a second cancer in or near the radiation field. These are called secondary cancers, and they develop as a result of the exposure of healthy tissue to radiation. Modern radiation techniques are designed to limit this exposure, but it is not always possible to prevent all exposure and still achieve the desired outcomes.
- Damage to the kidney, causing high blood pressure and decreased kidney function.
- Bowel problems, including scarring and strictures, ulceration and bleeding, chronic diarrhea, and fistula.
- Liver damage.
- Damage to the spleen, including having a higher risk of certain serious infections.
- Skin changes.
Stereotactic radiation treatment for kidney cancer is relatively new and research is ongoing into late effects of this treatment.
A more detailed guide to the late effects of radiation for kidney cancer can be found in our survivorship section: Survivorship: Late Effects After Radiation for Kidney Cancer.
After treatment, talk with your oncology team about receiving a survivorship care plan, which can help you manage the transition to survivorship and learn about life after cancer. You can create your own care plan using the OncoLife Survivorship Care Plan.
American Society of Clinical Oncology (ASCO). (2019). Kidney Cancer: Types of Treatment. Retrieved from https://www.cancer.net/cancer-types/kidney-cancer/types-treatment.
The American Cancer Society. (2020). Treatment of Kidney Cancer by Stage. Retrieved from https://www.cancer.org/cancer/kidney-cancer/treating/by-stage.html.