Radiology, Vol 193, 725-730, Copyright © 1994 by Radiological Society of North America
Locally advanced renal cell carcinoma: low complication rate and efficacy of postnephrectomy radiation therapy planned with CT
GD Kao, SB Malkowicz, R Whittington, AV D'Amico and AJ Wein
Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia 19104.
PURPOSE: To determine the usefulness of computed tomography (CT) in
planning radiation therapy for locally advanced renal cell carcinoma after
nephrectomy. MATERIALS AND METHODS: The authors retrospectively analyzed
the treatment records and follow-up status of 12 consecutive patients who
underwent radical nephrectomy and postoperative radiation therapy for
locally advanced renal cell carcinoma. Records' of 12 consecutive patients
who underwent only radical nephrectomy were also analyzed. RESULTS: None of
the patients who received radiation therapy after nephrectomy had
local-regional recurrence, despite disease at the surgical margins in six
patients; the actuarial disease-free survival at 5 years was 75%. In
contrast, the 5-year actuarial local failure rate in the surgery-only group
was 30% (significant difference at P < .01) and the disease-free
survival rate was 62% (mean and median follow- up was 4.6 and 5.1 years,
respectively). CONCLUSION: With CT, radiation can be delivered to the renal
bed safely and without undue morbidity. Given the lack of chronic
complications associated with the side effects of radiation therapy and
uniform local control of cancer in these patients, the role of radiation
therapy in patients at high risk for local failure may be reconsidered.
