The Value of Radiotherapy in the Treatment of Hypernephroma-a Clinical Trial

Abstract

The radical treatment of hypernephroma or renal cell carcinoma has been accepted as primarily, if not solely, a surgical problem. Riches (1964) states "whatever ancillary methods are employed the only effective treatment of malignant renal tumours is a surgical removal. In almost every case this implies nephrectomy." This approach is similar to that expressed by Paterson in his book (1963), where these tumours are classified under the heading of "Radiotherapy Usually Contra-indicated'' and qualified by the statement "in this group surgical excision must be selected as the treatment of choice and must expect no help as a curative measure from radiotherapy as a pre-or post-operative procedure". This basic policy is based on a number of factors. Firstly, and of primary importance, is the relative non-responsiveness of these tumours to irradiation. Accepting that radio-sensitivity and radio-resistance are relative terms, the dose of irradiation which needs to be given to eradicate renal cell tumours is of such magnitude that the tolerance of the normal tissues is far exceeded. This poor responsiveness to irradiation is further accentuated by the macroscopic features of many of these tumours which often contain areas of necrosis with associated avascularity and blood cystic spaces ; features which would further lessen the responsiveness of the tumour to ionising irradiation in view of the anoxic tissues present. Further features which suggest that radiotherapy is unlikely to play anything more than a minor part in the treatment of these malignant tumours is the natural history of the lesions with a propensity to invade veins and hence disseminate widely and finally the complementary factor of the large volume of tissue to be irradiated in order to encompass all sites of possible local extension, specifically including the renal bed, para-aortic gland area and surgical scar. Not surprisingly, therefore, the survival rates for renal cell tumours treated by surgery have shown very little improvement over the years with 5-year survival rates in different published series varying from 33 %-48 % (Table I).Three series of cases of hypernephroma have, however, been published in which an attempt was made to improve the results of treatment by the addition of postoperative radiotherapy. Riches, Griffiths and Thackray in 1951, Flocks and Kadesky in 1958and Bratherton in 1964 showed in their respective series that postoperative irradiation did increase the survival rates at the 5-and 10-year periods (Tables 11, I11 and IV).In each of the series definite improvement was noted in survival rates even though the series were not randomised trials. In view, therefore, of these published figures and the noted improvement it was felt that a randomised trial should be undertaken to evaluate the place of radiotherapy given postoperatively on a more accurate basis. This paper is a review and an analysis of the results from this trial undertaken by the combined Urological and Radiotherapy Units at the Newcastle General Hospital from 1961 to...

Renal Cell Carcinoma: The Experience of Kuwait Cancer Control Center, Kuwait

“…Several randomized studies performed 20-30 years ago showed no apparent survival benefit with adjuvant therapy [10]. Earlier studies have been limited by relatively low postoperative doses used secondary to concerns of late radiation sequelae.…”

Locally advanced renal cell carcinoma

“…So far, most authors 79,81,82 report that disease control with both treatment modalities used alone is reduced. However, this finding may be the result of the retrospective nature of this reported experience and the bias associated with patient selection and referral for possible surgical resection.…”

Nuevos tratamientos para el carcinoma renal

“…El tratamiento con interferón-a 20-22 o interleukina-2 a dosis altas por vía intravenosa 23 , no ha demostrado disminuir ni retrasar dicho riesgo en comparación con la realización de observación, por lo que su uso no está recomendado. Se han comunicado los resultados de 4 estudios aleatorios valorando el papel de la radioterapia adyuvante [24][25][26][27] . Ninguno de ellos demostró beneficio a favor de la radioterapia, aunque hay que destacar que todos ellos son ensayos muy antiguos realizados en pocos pacientes.…”