Urology: Clear cell renal carcinoma — Tumor resection. Treatment
Clear cell renal sarcoma (CCRS) accounts for about 3% of malignant diseases of the genitourinary system in children. This tumor is embryonic, i.e. is developed from embryonic tissue. The bulk of cases is diagnosed from 2 to 5 years old. CCRS is prone to rapid growth and metastasis to the bones, so the treatment is commenced immediately after diagnosis.
Usually, the first treatment stage is surgery. For large formations, the initial chemotherapy is advisable, which will reduce the volume of the tumor tissue and facilitate the surgical procedures.
A complete removal of the affected kidney, irrespective of the tumor size, is preferred in patients with CCRS. During the intervention, the surgeon examines all abdominal organs and tissues and excises the suspicious lesions or performs their biopsy. Quite often, the neighboring lymph nodes and adrenals are removed too.
In rare cases, a partial kidney resection is performed. This approach is practiced, if the disease is bilateral, or the child does not have the second kidney.
After intervention, the radiation therapy for the operated area is prescribed. In recent years, the proton therapy has become widely used in pediatric oncology, which, in comparison with a conventional treatment, features a high degree of safety. The method implies irradiation of a pathological focus with proton beams. Most of the energy is released at a preset depth, not distributing around the healthy tissues.
The procedures are conducted daily, except for weekends, for 15 to 20 minutes. The treatment duration varies from 1 to 6 weeks. Irradiation can also be focused on bone and liver metastases. For inoperable CCRS, the proton therapy can be used as a primary treatment.
In parallel with radiotherapy, the anticancer drugs are recommended. The treatment pattern is selected in view of the disease stage. In the early stages, the patients are treated with dactinomycin, vincristine and doxorubicin. At the 3rd and 4th stage, cyclophosphamide, vepezide and other drugs are also used.Hide