An evaluation of postoperative radiotherapy in hypernephroma treatment—A clinical trial

Abstract

A controlled trial was planned in order to assess the value of postoperative radiotherapy in the treatment of hypernephromata. Crude survival figures, covering 3–12 years following treatment, revealed that those cases treated by surgery only did better than those treated by combined surgery and irradiation, although the results are not statistically significant. Analysis over the first 5 years revealed that the greatest differences in survival between the 2 groups occurred in the first 12 months postoperatively. Radiotherapy did not influence the incidence of local recurrence or distant metastases. However, a considerable number of cases receiving radiotherapy died from co‐incidental causes including radiation liver damage. Those tumors with histologic evidence of venous involvement showed no improvement in survival despite radiotherapy. Other factors associated with tumor prognosis—grade, capsular involvement, and node metastases—demonstrated no advantage in terms of survival for cases having radiotherapy. No correlation could be obtained between histologic grading and prognosis in a small number of cases. Definite evidence of liver damage was obtained in patients with right‐sided lesions as a result of radiotherapy and assessed by biochemical liver function tests and isotope scans. No difference between the 2 sides was noted in relation to side effects during treatment.

The Characteristics of Renal Cell Carcinoma Patients, Who may Benefit from Radiotherapy and Post-Nephrectomy

“…Published results are controversial. Finney randomized 52 patients to post-operative radiotherapy with a total dose up to 55 Gy and 48 patients to no further therapy [10,12]. Radiation therapy did not result in an overall survival advantage and had no impact on the local recurrence rate.…”

“…Reports of beneficial effects of radiation therapy after nephrectomy come from non-randomized trials [5 -9]. In contrast, a few randomized studies found no benefit from post-operative radiotherapy [10,11].…”

Adjuvant Therapy for Renal Cell Carcinoma

“…28 A similar trial performed even earlier, in the 1970s, also did not find a benefit from postoperative radiation therapy. 29 Some other studies explored the role of hormone therapies, with disappointing results. One prospective multicenter study compared medroxyprogesterone acetate treatment for 1 year versus no treatment after radical nephrectomy, and failed to demonstrate any benefit in survival.…”

Intravenous interleukin-2 in patients over 65 with metastatic renal carcinoma

“…Until the eighties, attempts to treat widespread diseases were not successful and renal cancer is considered as a radio-resistant and chemoresistant tumour (Finney, 1973;Droz et al, 1988 The characteristics of the 25 eligible patients are detailed in Table I. There were 16 males and nine females; median age was 69 (range 65-77).…”

“…the highest incidence occurs at 65 years of age and 50 to 60% of the patients develop distant metastases (Holland, 1977;Ritchie et al, 1987). Until the eighties, attempts to treat widespread diseases were not successful and renal cancer is considered as a radio-resistant and chemoresistant tumour (Finney, 1973;Droz et al, 1988).…”