Renal cell carcinoma
Magnetic Resonance Imaging (MRI) scans provide an image of the soft tissues in the body using radio waves and strong magnets. MRI can be used instead of CT if the patient exhibits an allergy to the contrast media administered for the test. Sometimes prior to the MRI scan, an intravenous injection of a contrasting material called gadolinium is given to allow for a more detailed image. Patients on dialysis or those who have renal insufficiency should avoid this contrasting material as it may induce a rare, yet severe, side effect known as nephrogenic systemic fibrosis. A bone scan or brain imaging is not routinely performed unless signs or symptoms suggest potential metastatic involvement of these areas.
MRI scans should also be considered to evaluate tumour extension which has grown in major blood vessels, including the vena cava, in the abdomen. MRI can be used to observe the possible spread of cancer to the brain or spinal cord should the patient present symptoms that suggest this might be the case.
Intraoperative electron radiation therapy
Soft tissue sarcomas can be effectively treated by electron IORT, which appears to be gaining acceptance as the current practice for sarcomas in combination with EBRT (preferably preoperative) and maximal resection. Used together, IOERT and EBRT appear to be improving local control, and this method is being refined so that it can effectively be used in combination with other interventions if indicated. In studies regarding the delivery of therapeutic radiation in the limb-sparing approach to extremity soft tissue sarcomas, electron IORT has been called ‘precision radiotherapy’ by some, because the treating physician has direct visualization of the tumor or surgical cavity and can manually exclude normal tissue from the field.