Amanda Wilde(Host): This is Community Connect presented by Tampa General Hospital. I'm Amanda Wilde. Joining me is radiation-oncologist, Dr. Sean Collins, Professor and Vice Chair of Faculty Affairs at Tampa General Hospital. Dr. Collins, good to be with you again.

Sean Collins, MD: Thank you for having me.

Host: Today, we're talking about kidney cancer, also referred to as renal cancer, and a specific treatment of it. What is kidney cancer specifically? And how is that different from other cancers

Sean Collins, MD: Well, first of all, your kidneys are very important. They remove toxins from your body. Unfortunately, they can develop tumors that can spread and cause death if not treated. They are commonly found incidentally these days when doctors order scans for other purposes. So, the incidence is growing, specifically because our population is living to an older age.

It's different from other cancers in the sense that it's relatively radiation-resistant. I treat cancer with radiation and some are radiation-resistant and some are radiation-sensitive. So, renal cancer is radiation-resistant. It responds better to a few large doses of radiation rather than several weeks of small doses. And also important is that the normal kidney that surrounds the kidney cancer is relatively sensitive to radiation. So, we have to make sure that we eradicate the cancer without injuring the normal kidney.

Host: So, you want to be as targeted as possible.

Sean Collins, MD: Absolutely.

Host: The one treatment option we're talking about today is stereotactic body radiation therapy, SBRT. What is that about?

Sean Collins, MD: SBRT is a precise form of external beam radiation therapy that delivers a very high dose of radiation to a specific area in the body, using one to five treatments with high accuracy and high precision, minimizing radiation exposure to surrounding healthy tissues. This is especially important when you're treating kidney, because we need to spare the adjacent normal kidney so that patients don't require dialysis. High accuracy is even more important because not everybody has two kidneys. Some patients unfortunately only have one kidney, and we have to try to spare their normal kidney as much as possible.

Host: How is it different than conventional radiation therapy for renal cancer?

Sean Collins, MD: Your kidneys actually move when you breathe. So to take this into account, usually, when we're doing conventional treatments, we use large treatment margins and treat a lot of normal kidney to make sure that we don't miss the cancer because of the kidney motion. With SBRT to protect the adjacent normal kidney, we actually try to minimize kidney motion as we're doing it. So, we make the treatment highly accurate and we minimize kidney motion. Smaller treatment margins and higher precision allows us to give high doses of radiation more quickly in the case of renal cancer more effectively. And generally, renal sBRT is delivered in one to three treatments over one to two weeks, which not only is it more effective, it's also more convenient.

Host: So with these high doses of radiation, how do patients feel after the treatment?

Sean Collins, MD: First of all, not everybody's a candidate for the treatment. So first, we have to go through who is a candidate. So, you meet with a radiation oncologist and a urologist, and they will determine if you're a candidate for treatment. If you are a candidate for treatment and decide to pursue it, we'll obtain a CT scan or a scan of your body. We'll make you drink some contrast to outline your bowels for treatment planning. To minimize kidney motion, we will utilize a belt to compress your abdomen so that, when you breathe, your kidneys don't move as much. We'll do the planning. You'll come back in one to two weeks. You'll lay comfortably on your back, on the machine as we deliver radiation that rotates around you in the shape of the tumor while minimizing damage to surrounding healthy tissue.

 Following the treatment, you will see a urologist once a year to verify that your cancer has not recurred. The side effects of this treatment generally are mild and similar to conventionally fractionated radiation. You might experience fatigue for a few weeks following treatment. You could have transient nausea or diarrhea, but this is easily managed with medications.

Having kidney failure requiring dialysis would be rare, so we don't damage that much normal kidney. It's painless, non-invasive form of radiation. We don't cut anything. We don't poke you. It doesn't require anesthesia. There's no incisions. There's no blood loss. There's no recovery time and there's no overnight hospital stays required. So, this should be a very convenient treatment for patients.

Host: So with all that sort of low impact from what you see, how does SBRT impact the quality of life for kidney cancer patients compared to other treatments?

Sean Collins, MD: To be honest with you, I'd say most patients say they don't even know that they got it. I mean, besides the mild fatigue, they're just happy that they didn't have to have surgery, that they didn't have incisions. They can go back to their jobs quickly. Go back to their lives. For people who are older and retired, they can go back to focusing on traveling and focusing on their kids and grandkids.

Host: So, who is the ideal kidney cancer patient for SBRT?

Sean Collins, MD: So, renal SBRT is the preferred treatment for tumors that are greater than four centimeters. Usually, if tumors are less than four centimeters, you can treat them by freezing or burning them. Also, it's generally for patients who are not candidates for surgery. The best way to cure kidney cancer is to remove your kidney, but not all elderly patients are candidates for kidney surgery. And if you've had prior surgery on your abdomen, you might not be a candidate. In general, we don't treat tumors that are larger than 10 centimeters. Usually, those ones will also have surgery. We can treat the left kidney, we can treat the right kidney. If you have cancer outside your kidney, but the primary lesion in your kidney is causing you problems, we can radiate that. If some patients just do not want to have surgery, they don't want to deal with up the incisions, the pain, the patient who refuses surgery or is concerned about possible blood loss during surgery, those are also candidates.

Host: And why come to Tampa General Hospital for a kidney cancer treatment?

Sean Collins, MD: Treating renal cancer is a team sport. Our team of radiation oncologists, urologists, nurses, therapists, and physicists are some of the most experienced in the world. I've been using SBRT for renal cancer for over 20 years. Our hospital has recently obtained this new imaging thing called HyperSight that allows us to do SBRT more effectively. It gives us better quality images, increase speed of images, larger fields of view than traditional systems. And this enhances our ability to see and target tumors with precision and accuracy. Precision and accuracy are really important when you're treating kidney cancer because you want to make sure you spare as much normal kidney as possible.

Host: And you're obviously using the latest cutting edge technology to do that.

Sean Collins, MD: I'm actually lucky that I get to work at Tampa General Hospital every day. I am spoiled. I have a amazing team. I love working here. I love living in Tampa. I just want to say, in summary, SBRT is a convenient and effective treatment with less radiation dose to surrounding normal kidney. If you need treatment for your kidney and you're not a candidate for surgery, Tampa General's the place for you to be.

Host: Dr. Collins, thank you for this comprehensive look at SBRT.

Sean Collins, MD: Thank you for having me. Love interacting with the community. Thank you for helping me.

Host: That was Dr. Sean Collins, Professor and Vice Chair of Faculty Affairs at Tampa General Hospital. For more information, please visit tgh.org/cancer. If you enjoyed this episode, please be sure to like, subscribe, and follow community Connect, presented by TGH on your favorite podcast platform. I'm Amanda Wilde, and this is Community Connect, presented by TGH. Thanks for listening.