Post operative radiotherapy improves disease free but not overall survival in high risk renal cell carcinoma patients

Abstract EN

Purpose : to evaluate treatment outcome and the value of postoperative radiotherapy in treatment of patients with renal cell carcinoma (RCC).

Material and methods : the records of 136 radically treated RCC patients were revised.

The patients were treated at the National Cancer Institute of Cairo and Kars El-Aini Centre of Radiation Oncology and Nuclear Medicine of Cairo University between 1989 and 1997.

According to the AJCC-TNM staging 21 % had stage II, 36% had stage III and 43 % had local stage IV disease.

Seventy-eight patients received post-operative radiotherapy to the renal bed and the para-aortic lymph-nodes, while 58 patients did not.

Results : the 5-year over-all and disease-free survival estimate for the whole group were 49% (SE = ± 14 %) and 23% (SE = ± 6 %) respectively.

Neither postoperative radiotherapy nor any of the tested potential prognostic factors have shown to have an impact on overall survival.

The disease-free survival on the other hand, was significantly influenced by three variables namely; renal vein involvement (p = 0.006), capsular infiltration (p = 0.0003) and post-operative radiotherapy (p = 0.001).

Post-operative radiotherapy improved the 5-year DFS from 17 % (SE = ±5 %) to 28 % (SE = ± 9 %) and increased the median DFS from 15 (SE = ± 5) months to 25 (SE = ± 5) months.

On multivariate analysis, capsular infiltration (p = 0.005) and post-operative radiotherapy (p = 0.01) remained to be significant independent parameters influencing disease-free survival.

Adjuvant radiotherapy reduced the 5-year cumulative risk of local failure from 38% to 22 % (p = 0.0145) but have no effect on the cumulative risk of developing distant metastasis.

Conclusion : this set of data supports the role of postoperative radiotherapy in improving the local control rate in locally advanced and high-risk RCC patients.