The value of postoperative radiotherapy in advanced renal cell cancer

The study reviews experience with the treatment of advanced renal cell cancer at Bydgoszcz Regional Cancer Center within a 10-year period from 1985 to 1996. The aim of this paper was to evaluate the value of postoperative radiotherapy. The medical records of 186 patients with locally advanced renal cell cancer were reviewed retrospectively. Postoperative radiation therapy with a median dose of 50.0 Gy/t was given in 114 patients. The overall and disease-free survival, the pattern of recurrences, time interval to recurrence were assessed. For all patients, the 5-year overall and disease-free survival rates were 36.2% and 30.5%, respectively. Non significant difference was observed in terms of 5-year overall and disease-free survival between the group of patients with postoperative radiotherapy and without, 37.9%/29.5% vs. 35.5%/31.3%, respectively. A total of 29 patients (15.6%) developed local recurrences. Local failure by stage was as follows: T3N0 without postoperative radiation therapy--15.8%, with irradiation--8.8%; T3N(+) without radiation therapy--33.3%, with irradiation--33.3%; T4N0 without radiation therapy--33.3%, with irradiation--33.3%, T4N(+) without radiation therapy--33.3%, with irradiation--25.0%. 73 patients (39.3%) had distant metastases as a first symptom of renal cell cancer relapse. The median time to relapse for local recurrence or distant metastases were approximately two times longer in patients with adjuvant radiotherapy compared to those without, 27.0/21.0 months vs. 16.0/12.5 months, respectively. In our opinion postoperative radiotherapy reduces the probability of local recurrences in selected patients, mainly with pathologic stage T3N0, but its impact on survival is minimal.