b'Redefining Research & CareLu H Lu2Radiation plan to treat aL T S L Lu T H S Borrowing from Immunotherapykidney tumor inside the vena cava. The upper edge of theK to Lower Recurrencetumor is within an inch of theOriginal Size Stage 3 tumors (T3), such as those invadingAtezolizumab. Sponsor: Genentech/ Pembrolizumab. Sponsor: Merck. heart. Legend: (T) tumor, (H)Dr. Malladi studies heart, (K) left kidney, (L) liver,K how kidney cancerthe IVC, or stage 4 tumors (T4) invadingRoche. UT Southwestern principalUT Southwestern principal investigator: (Lu) lung, (S) stomach.causes metastases. beyond the kidney have recurrence rates asinvestigator: Dr. BrugarolasDr. Hammers (NCT03142334).high as 80 percent. To reduce recurrence,(NCT03024996). investigators in the Kidney Cancer Program First in the World: Deployingtumors elsewhere. Many patients undergo- Massagu, Ph.D., biologist and currenthave opened three major phase 3 trials (eachNivolumab. Sponsor: National Cancer Stereotactic Radiotherapy to Targeting this treatment eventually developDirector of the Sloan Kettering Institute atinvolving more than 200 centers) testing theInstitute. UT Southwestern principal Tumor Invasionmetastatic disease, notes Dr. Hannan, whoMemorial Sloan Kettering Cancer Center,following immune-checkpoint inhibitors.investigator: Dr. Margulis (NCT03055013).UT Southwestern urologists are teamingleads the trial along with Dr. Margulis.joined UT Southwestern in 2017 and is up with radiation oncologists to break newResearchers hope that treating theapplying his expertise in tumor invasion to ground in the treatment of tumor exten- tumor inside the vein with SBRT just beforekidney cancer. Dr. Malladi is using samples sions into the IVC. A multidisciplinarysurgery will kill the tumor cells and reducefrom patients with IVC tumor extensions to team, featuring radiation oncologiststhe risk of cancer spreading. Their trial wasunderstand how tumors get inside bloodTEAMING UP FOR SUCCESSDrs. Hannan and Robert Timmerman, urol- selected for oral presentation at the Latevessels and travel to other organs. He isThe Kidney Cancer Program gathers experts from variousor pancreas), or into the vena cavaogists Drs. Margulis and Sagalowsky, andBreaking Abstract session of the Americanevaluating how cells once part of thedisciplines to collaborate on challenging cases, developingMultiple tumors, tumors in both kidneys, or a tumor in a medical oncologist Dr. James Brugarolas,Urological Association Annual Meeting inoriginal tumor stealthily survive in thetailored strategies for treatment. These teams includepatient with just one kidney reported for the first time the deploymentSan Francisco in 2018. It is an example ofblood, later giving rise to metastases. Oneurologic surgeons, medical and radiation oncologists,Tumors already metastaticof SBRT (Stereotactic Body Radiationthe innovation and team approach thatapproach he has taken, in partnership withpathologists, radiologists, and, depending on the circum- The programs interdisciplinary teamworkalong with its Therapy) for treating tumors invading thecharacterizes the Kidney Cancer Program,Dr. Brugarolas and Somasekar Seshagiri,stances of each patients cancer, cardiothoracic surgeons,comprehensive infrastructure, vast experience, and cut-vena cava. says Dr. Brugarolas. (Hannan et al., CancerPh.D., longtime molecular biologist withneurosurgeons, orthopedic surgeons, liver surgeons, andting-edge approachesgives hope to patients who may The team is now conducting a phase 2Biol Ther, 2015; Freifeld et al., KidneyGenentech, involves using next-genera- other physicians. have few options elsewhere.clinical trial (NCT02473536) using SBRTCancer, 2019)tion sequencing technologies.Challenging cases that most benefit from thisOne goal is to make these forums available to physicians before surgery to treat IVC tumors, whichapproach are: in the community, who are then able to obtain expert input they hope will reduce the chances of cancerHow Do Cancer Cells A Radiotherapy BoostKidney cancer invading adjacent organs (such as the liverabout their patients via teleconference. spreading. Because the cancer is alreadyInvade, Travel, and Spread? Radiation is also being used in another inside a blood vessel, live cells may beWith funding from the SPORE, Srinivascontext. Radiation oncologist Dr. Michael shed during surgery that could create newMalladi, Ph.D., who trained with JoanFolkert has established a program to assist surgeons with complex cases in which the tumor infiltrates nearby struc-tures, from where they may be difficult to remove. The approach uses IORT (intraop-erative radiation therapy). IORT delivers high doses of radiation to these areas during surgery. Surgeons directly expose the area of concern, which is then treated with radiation. Radiation can treat areas up to 5 millimeters deep. Adjacent normal tissues, such as bowel or stomach, are moved out of the way, or even shielded with lead. The procedure typically takes 30 minutes. It requires, however, a shielded operating room, where radiotherapy can be safely delivered. UT Southwestern is the only center in North Texas to offer IORT.Dr. Raquibul Hannan, Co-Leader of radiationCase review at aoncology, discussing multidisciplinarya case with medicalUT Southwestern is theconference.oncologist Dr. Kevin Courtney and urologicalonly center in North surgeon Dr. Yair Lotan. Texas to offer IORT.32 33'