b'Redefining Research & CareKidney Cancer in the Lungsultrasound and electromagnetic nav-Lung is the most common site of metas- igational bronchoscopy, physicians FIRST TO DEVELOP tases of kidney cancer, though lessin the Interventional Pulmonology TOOLS FOR problematic than spread to the brainService, including Dr. Hsienchang or bone. With state-of-the-art trainingThomas Chiu and Dr. Muhanned Abu-KIDNEY CANCERand equipment, such as endobronchialHijleh, perform advanced procedures Dr. Ananth Madhuranthakam andto remove metastases that block his team, includingairway passages. This is to stop bleed-Drs. Joseph Maldjian and Ivaning (a life-threatening complication) Pedrosa, were awarded $3.1and open the airways, thereby avoid-million from the National Cancering pneumonia. Institute in 2017 to become one ofThe interventional group works 18 institutions in the Quantitativeclosely with UT Southwesterns Imaging Network. This Networkthoracic surgeons. The team, which develops tools to measureincludes Drs. Alberto de Hoyos, Kemp response to cancer therapy. TheKernstine, and Scott Reznik, can UT Southwestern team is the onlyremove isolated metastases to the team in the Network focusing onlungs. In 85 percent of cases, metas-kidney cancer. tases can be removed using minimally invasive approaches and simplified surgeries with rapid recovery times. Innovative MRI finds hidden bone metastases invisible onThe team performs more than 1,000 conventional scans as shown for the left leg femur bone.thoracoscopic or minimally invasive procedures in and around the lungs contribute to the improved survival ratesWhen metastases are advancedThe protocol, dubbed DETECTeach year. Dr. Kemp Kernstine uses minimally invasive approaches to remove isolated kidney cancer of stage 4 kidney cancer patients at theand threaten the integrity of the bone,(dual-echo T2-weighted acquisition formetastases from the lungs.Kidney Cancer Program, which are triplestabilization may be required, saysenhanced conspicuity of tumors), was the national benchmarks (see page 10).Dr. Alexandra Callan, an oncology orthope- tested on a handful of kidney cancer (Bowman et al., Clin Genitourin Cancer,dic surgeon who trained at MD Andersonpatients. DETECT identified 30 percent 2019; Wardak et al., Clin Genitourin Cancer,Cancer Center.more bone metastases, all missed using 2019)Metastases are particularly problem- conventional techniques. Using thisDISCOVERING ANOTHER atic when they occur in the spine, whereprotocol, bone metastases could be When Bones Are the Destination bone collapse may cause paralysis. Atdetected earlier, reducing risk of boneDEADLY MALIGNANCYRenal cancer commonly spreads toUT Southwestern, Drs. Carlos Bagley andfractures and other complications. WithCancer in the lungs of kidney cancer bone. Approximately a third of patientsKevin Morrill and their colleagues in bothSPORE funding, a larger clinical trial ispatients most often represents kid- A CT scan will develop bone metastases. When thisneurosurgery and orthopedics regularlyongoing. (Wang et al., Magn Reson Med,shows an happens, the cancer can destroy thetreat complex spinal column metastases.2018)ney cancer that has traveled there.independent According to a recent report bylung cancer bone, leading to pain and sometimesThese surgeries require careful planningtumor (T) in a spontaneous fractures. Early detectionand often materials to reconstruct theChallenge: Why Does Drs. Bowman and Brugarolas, this is notpatient with always the case.kidney cancer. is imperative.spinal column. Kidney Cancer Travel to Bone?The distinction is crucial. Kidney can- (Lu), Lung.During these procedures, neurosur- Molecular biologist Yihong Wan, Ph.D.,cer spreads mainly to the lungs. But it geons and orthopedic surgeons workstudies the interplay between cancertends to be less aggressive than primaryDr. Bowman reviewed 151 cases ofpresence of irregular, poorly defined closely with radiation oncologists. and the microenvironment. With fundslung cancer, which, if found, should bemetastatic kidney cancer treated withedges in the tumorcan help dis-SBRT, a field in which UT Southwesternfrom the Kidney Cancer SPORE, shequickly addressed. Further, failing totargeted drugs at Simmons Cancertinguish primary lung cancer from is an international leader (see page 52), canevaluates why some kidney cancersestablish this distinction can lead to pre- Center from 20062013. More than halfrenal cell carcinoma metastases, says also offer an alternative.travel to bone. Her team has developedmaturely stopping effective treatmentsthe patients had lung metastases, andDr. Pedrosa, radiology Co-Leader of new approaches to study how kidneyfor kidney cancer. Unknowingly, the3.5 percent were later found to also havethe Kidney Cancer Program. The team Innovative MRI Finds cancer cells relate to cells in the bone.growth of a tumor in the lung (while otheran independent lung cancer. Only fourestimates that as many as 6 percent Hidden Bone Metastases These approaches allow her to study thesites may be responding) could be takenother reported cases were found in aof all kidney cancer patients with lung A new MRI (magnetic resonance imaging)interplay in both the laboratory and in liveto indicate that kidney cancer is resistantreview of the literature, which suggestsinvolvement may have a primary lung protocol developed by UT Southwesternsanimals. The Wan team has also devel- to therapy, while in reality it may indicatethat this is a problem often overlooked. cancer. (Bowman et al., Clin Genitourin Dr. Ananth Madhuranthakam promises tooped nanoparticlestiny particles thatthat the tumor is lung cancer.Imaging findingssuch as theCancer, 2017) improve the detection of bone metastasescan travel through the bloodto deliver anywhere in the body. It takes just sevena form of gene therapy (a microRNA-34a Expert spine surgeon Dr. Carlos Bagley performingminutes, less time than traditional MRI.mimic) to sites of bone metastases. a complex procedure.54 55'