Radiation Does Not Work For Renal Cell Carcinoma-The Obama Staged Misinformed Exhibit "A"

Am I the only one outraged by the misinformation that has been spread around the internet as Obama's Exhibit "A" for healthcare reform??? The issue is the staged so called kidney cancer patient with no health insurance who supposedly had health insurance when she was again supposedly diagnosed with Renal Cell Carcinoma and rather than have her kidney removed which is the only effective treatment for kidney cancer, she was treated with radiation therapy which caused her more health issues now that she has no insurance. She claims that she did not have her kidney removed because she was caring for her father who had colon cancer so had radiation instead. She must be a miracle of science to have had her RCC treated with radiation therapy in 1998 and still be alive today to complain about the effects of that treatment.

I was diagnosed with Renal Cell Carcinoma after a pathology report that occurred after surgery. Biopsy is rarely if ever used for kidney tumors due to the risk of spreading the cancer from the kidney to other parts of the body.

How this woman was definately diagnosed with Renal Cell Carcinoma without removing the tumor is beyond me and how she can state with a straight face that she did not have her kidney removed because she was caring for her father when removal of the tumor is the only effective treatment for kidney cancer is frankly insulting to me and should be insulting to other kidney cancer survivors.

* Renal cell carcinoma cells were the most radiation-resistant cells among 694 cell lines (271 tumor-derived and 423 fibroblast-derived), with D = 4.8Gy (compared with for example melanoma D = 2.51Gy) o Paris, 1996 (France) PMID 12118559 — “A review of human cell radiosensitivity in vitro.” (Deschavanne PJ, Int J Radiat Oncol Biol Phys. 1996 Jan 1;34(1):251-66.)

* Copenhagen Renal Cancer Study Group, 1987 (1979-84) - PMID 3445125 — “A randomized trial of postoperative radiotherapy versus observation in stage II and III renal adenocarcinoma.” Kjaer M et al. Scand J Urol Nephrol. 1987;21(4):285-9. o 72 pts. Stage II-III. After nephrectomy, randomized to RT vs observation. RT was 50 Gy in 20 fx to kidney bed, ipsilateral and contralateral nodes o No benefit for relapse rate or survival. Unacceptable toxicities from RT.

The second study above was after surgery was performed because removal of the tumor is the only acceptable treatment because chemo and radiation don’t work on kidney cancer.

Radical nephrectomy (total surgical excision of the kidney and surrounding tissues) is the accepted treatment for renal cell carcinoma. Other conventional cancer treatments are ineffective or only have a role in the treatment of metastatic disease. Immunotherapy is an investigational treatment that seems a promising new approach for advanced disease.

[d] Radiation Therapy Radiation therapy has little role in localized or metastatic renal cell carcinoma. Preoperative or postoperative radiotherapy in patients with primary renal cell carcinoma has not proved effective in prolonging the interval before disease recurrence; however, radiotherapy can sometimes palliate symptoms in patients with advanced disease. Many chemotherapy regimens have been investigated in metastatic renal cell carcinoma, but response rates have been disappointing. Hormonal therapy also appears ineffective, despite encouraging results of early studies.

[7] Prognosis Untreated renal cell carcinoma has an extremely poor prognosis. The natural history of renal cell carcinoma–that is, its course if left untreated–has been a subject of great interest because of its unpredictability. Spontaneous regression of metastatic renal cell carcinoma sometimes occurs following resection of the primary tumor, but not often enough to recommend resecting a tumor in the hopes of inducing a remission of metastatic disease (Neuwirth, et al., 1990). The primary tumor and metastases have variable growth rates and may sometimes grow quite slowly. However, renal cell carcinomas usually are not diagnosed until they are large, metastatic disease usually progresses rapidly and renal cell carcinoma is highly lethal.

The misinformation from this so called town hall meeting is simply outrageous!! The possibility that radiation might be an alternative to surgery was investigated for the first time last year and the results have not even come close to becoming in use by the urologists and oncologists who treat this disease.

Carbon ion radiation therapy for primary renal cell carcinoma: initial clinical experience. Nomiya T, Tsuji H, Hirasawa N, Kato H, Kamada T, Mizoe J, Kishi H, Kamura K, Wada H, Nemoto K, Tsujii H.

Research Center for Charged Particle Therapy, National Institute of Radiological Sciences (NIRS), Chiba, Japan.

PURPOSE: Renal cell carcinoma (RCC) is known as a radioresistant tumor, and there are few reports on radiotherapy for primary RCC. We evaluated the efficacy of carbon ion radiotherapy (CIRT) for patients with RCC.

CONCLUSIONS: This is one of the few reports on curative radiotherapy for primary RCC. The response of the tumor to treatment was uncommon. However despite inclusion of T4 and massive tumors, favorable local controllability has been shown. The results indicate the possibility of radical CIRT, as well as surgery, for RCC.

J Clin Oncol 26: 2008 (May 20 suppl; abstr 16009) http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=55&abstractID=31016

Author(s): C. Renner, E. Oosterwijk, N. Adrian, J. Oosterwijk-Wakka, L. Cohen, G. Ritter, A. Knuth, C. R. Divgi, A. M. Scott, L. Old, S. Bauer

Background: Renal cell cancer (RCC) is a chemotherapy and radiation resistant disease with high morbidity and mortality when detected at advanced stage. RCC cells express the G250/CAIX antigen at high levels and can be targeted very efficiently with monoclonal antibodies.

Immune Escape Mechanisms of Renal Cell Carcinoma European Urology Supplements, Volume 6, Issue 10, Pages 616-622 B. Seliger http://linkinghub.elsevier.com/retrieve/pii/S1569905607001030

Renal cell carcinoma (RCC) represents a chemotherapy- and radiation-resistant tumor with a generally poor prognosis and a 5-yr survival rate of patients of <10%.

Two other points regarding "Exhibit A":

1) She's been an active advocate for ObamaCare through a lobbying organization for (at least) the better part of the past year.

2) There have also been reports that she served for some period of time in the Marine Corps. As a veteran with limited income, she should easily qualify for some level of VA health coverage, even with no service connection to her illness.

VA coverage link

“Deal with the world as it is.”

Why? It was changed once. There is no reason it can’t be changed (corrected) again. To simply give in is not an appropriate response.
IF we are to take the time and expend the effort to enable change, why not change it completely to the proper state?

Keep fighting the good fight. We’ll get there, I hope and pray.

It’s time to take back the country.

I emailed this thread to my son to see what he might think. If he posted here, he might be NC DOC (if your SC stands for South Carolina?)

I read the link you sent me. I always like to hear how patients, the press, and politicians describe cancers and their treatments... so I found it interesting. i have no idea what exhibit A is... I’m guessing some person (perhaps fictional) who would “benefit” from Obama’s health care plan. As far as completely debunking it... not enough information. I think the most likely possibility has not been mentioned yet:

She may have refused surgery (to care for her father) or not been considered a fit surgical candidate; in this case, other alternative treatments would have been considered. One commonly used and effective procedure is called radiofrequency ablation (RFA) which would have been available at the time in question. It is done as an outpatient and is often mistakenly referred to as “radiation” by patients. IMO, this is a plausible scenario and perhaps a genuine “misunderstanding” — I’m sure you like that word. For the reasons stated by SC DOC, I too think it is unlikely (but not impossible) that she received traditional radiation therapy (external beam radiation).

No plans on watching the video though... I can’t stand the latest trend of referring to specific people as examples (as is now trendy even in the state of the union addresses).

Love,

I agree that the whole Obama dog and pony show is pure exploitation and whining.

RFA is a very good option for small lesions in the kidney and is becoming preferable to radical nephrectomy in many cases. What I mostly see these days are symptomatic kidney lesions in patients with widespread metastatic disease, postoperative patients with positive margins after nephectomy, or patients with prior nephrectomy who now have recurrence in the retroperitoneum.

As mentioned before, I have treated a handful of primary kidney cancer cases in the past with radiation, and now that we have all the modern tools (IMRT, IGRT, Stereotactic radiosurgery, etc) I haven't seen one. At least I am ready, if the circumstance arises.

Where in North Carolina is you son? I have a mountain home between Hendersonville and Bat Cave. I love the cool weather up there compared to SC.

My son has spent the past 6 years in Winston-Salem at Wake and that big Baptist Regional hospital (the name is so long, I always forget it!) for his 3-yr residency in academic internal med, then a 3-yr fellowship in oncology/hematology. He and his family lived in Kernersville, halfway between Winston and G’boro. My daughter-in-law did her residency in G”boro at Moses Cone, and now practices Family Med in High Point.

THey have just bought a house and moved to a little town maybe halfway between Charlotte and Winston — Salisbury. He has joined an oncology practice there. My husband and I haven’t been to the new locale yet, not until Labor Day weekend. We are in Florida.

My sons are rather apolitical, but I am guessing all this Obama stuff has raised their interest quite a bit. Esp. the healthcare plan that isn’t even a plan. It’s all quite disgusting.

Are you a radiologist?

“Translated to me, the underlined part that highlights the difference sounds like he was not hired on as a professor because of his knowledge or any other ‘scholarly’ designation or knowledge that would happen with a professor, he was just granted a job. It seems to me they are saying here he wouldn’t qualify as a professor.”

No, translated, the underlined part means that he was in a category of active professionals teaching in a professional school because the presence of such teachers is considered important to the professional training.

His was not an academic track and published academic journal articles were not part of the requirements. But in his case they did try to persuade him to make that transition and he chose not to. He probably knew he wouldn’t be any good at it; certainly didn’t want to expend the energy toward it.

He was not a professor but neither was he glorified TA. I agree that people exaggerate when they call him a professor of law. But you undermine your case when you compare him to the sessional lecturers employed to teach undergrads at slave wages.

They had rights and appealed to them and their cases were heard. They were not slaughtered by the millions. If you would actually read some history, you would discover that the late medieval peasant revolts were largely the result of a rising standard of living for peasants due to the labor shortages caused by the great Plague, combined with the lords, who were being squeezed by inflation (obligations of peasants had to some degree been converted into money but at fixed rates because no one understood or expected inflation), so the lords were losing ground and tried oppressive means to squeeze the peasaznts IN NEW WAYS. The peasant revolts did not challenge the notion of serfdom itself (most peasants had actually been granted personal freedom by the later Middle Ages) but claimed that the Lords were violating ancient rights and customary laws. They were simply asking for their due under the law, largely because they were better off than their ancestors a few centuries earlier and they knew it.

Sure, being personally free they could run off to the cities, but most of them did not want to. In the cities they were on their own and had fewer rights. Having a piece of land that was yours by long tradition that you could farm to earn a living was not a bad thing for everyone. Entrepreneurial types wanted the city with its risk and freedoms, but not everyone did. And not all peasants reolted. And the ones who revolted were, for the most part, not serfs but free men—their expectations had been raised. But they thought, rightly or wrongly, that the lords were not upholding their end of the bargain.

But if it makes you feel better to use the Middle Ages as your bogeyman so you don’t have to confront the truly horrific conditions of the early modern and modern era,

be my guest.

It’s just bad history. That’s all.

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