Probability of renewal and distant metastases in B and C stadium according to Robson in patients suffering from renal cell carcinoma, treated with nephrectomy and irradiation Article published in Urologia Polska 2002/55/3.
authors
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Małgorzata Zarzycka 1, Zbigniew Wolski 2, Wiesława Windorbska 1, Andrzej Lebioda 3
- 1 Regionalne Centrum Onkologii w Bydgoszczy, Oddział i Zakład Teleradioterapii
Kierownik zakładu: dr Wiesława Windorbska
2 Klinika Urologii Akademii Medycznej im. L. Rydygiera w Bydgoszczy
Kierownik kliniki: prof, dr hab. Zbigniew Wolski
3 Katedra i Zakład Onkologii Akademii Medycznej w Bydgoszczy
Kierownik katedry: dr hab. Roman Makarewicz
keywords
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kidney, renal cell carcinoma, radiotherapy, late recurrence, distant metastases
summary
- Objective. A retrospective analysis of 251 patients, with advanced renal cell carcinoma from 1985-1998, is presented.
- Purpose. The aim of this study was to assess the influence of postoperative radiotherapy on local recurrence and distant metastases rates.
- Materials and methods. The medical records of 148 patients with stage B and 103 patients with stage C treated according to the Robson system were reviewed. Postoperative radiotherapy with megavoltage was given to 136 patients - group 11-R[+],
- A control group I-R[-] - underwent nephrectomy, but did not receive radiation therapy. This group consisted of 115 patients, who had indications to postoperative radiotherapy. Differences between the groups were evaluated by Student s-tesl or test U, respectively. Actuarial Curves for local recurrence and distant metastases rates, were calculated using the Kaplan-Meier method. Survival curves were compared using the log rank test. Results. Thirty patients (11,95%) had local recurrence. The local failure rate and lime when the failure appeared was comparable in both groups in stage B and C according to the Robson system. The observed difference was not statistically significant (p>0,05). The 5 years actuarial local relapse rates in stage B was 19% for group R[-] and 4% for group R[+J. The difference in both groups was statistically significant (p=0,032). There was no statistical difference in stage C (p>0,05). Seventy seven (30,7%) patients had distant metastases. The difference in rates and time when the failure appeared in both groups in stage B and C according to the Robson system was not statistically significant (p>0,05). The 5 years actuarial distant metastases rates in stage B was 38% for group Rf-J and 20% for group R[+J. The difference in both groups was statistically significant (p=0,014). There was no statistical difference in stage C (p>0,05). Conclusion. Postoperative radiotherapy decrease the probability of local recurrences and distant metastases within 5 years in patients with stage B according to the Robson system with renal cell carcinoma after nephrectomy.
references
- 1. Giuliani L, Giberti C, Martorana G. i wsp: Radical extensive surgeiyfor renal cell carcinoma: Long-term results and prognostic factors. J Urol 1990; 143: 468-473.
- 2. Skinner DG, Colbin RB, Vermilion CD i wsp: Diagnosis and management of renal cell carcinoma: A clinical and pathologic study of 309 cases. Cancer 1971; 28: 1165-1177.
- 3. Rafia S: Renal cell carcinoma. Natural history and results of treatment. Cancer 1975; 25: 26-40.
- 4. Riches SE: The place of radiotherapy in the management of parenchymal carcinoma of the kidney. I Urol 1966; 95: 313-317.
- 5. Otto U, Huland H, Baisch H i wsp:Transplantation of human renal cell carcinoma into NMRI nulnu mice. III. Effect of irradiation on tumor acceptance and tumor growth. J Urol 1985; 134: 170-175.
- 6. Saksela E, Alfthan O, Malmo K:Effect of preoperative radiotherapy on the growth of human renal carcinoma tissue in vitro. Scand J Urol Nephrol 1973; 11: 267-281.
- 7. Chiou RK, Vessella RL, Limas Cl i wsp: Monoclonal anti-body-targeted radiotherapy of renal cell carcinoma using a nude mouse model. Cancer 1988; 61: 1766-1775.
- 8. Finney R: The value of radiotherapy in the treatment of hypernephroma - a clinical trial. Brit J Urol 1973; 45: 258-269.
- 9. Finney R: An evaluation of postoperative radiotherapy in hypernephroma treatment: A clinical trial. Cancer 1973; 32:1332-1340.
- 10. Maciejewski B: Tolerancja tkanek zdrowych w radioterapii nowotworów. Gliwice: Centrum Onkologii Instytutu im. M. Skłodowskicj-Curie 1991.
- 11. Frydenberg M, Gunderson L, Halin G i wsp: Preoperative external beam radiotherapy followed by cytoreductivc surgery and intraoperative radiotherapy for locally advanced primary or recurrent renal malignancies. J Urol 1994; 152: 15-21.
- 12. Gibcrti C, Oneto F. Mortorana GS i wsp: Radical nephrectomy for renal cell carcinoma: long-term results and prognostic factors on a series of 328 cases. Eur Urol 1997; 31: 40-48.
- 13. Juusela H, Malmio K, Alfthan O i wsp: Preoperative irradiation in the treatment of renal adenocarcinoma. Scand J Urol Nephrol 1977; 11: 277-289.
- 14. Michalski JM: Kidney, renal pelvis, and ureter. W: Perez CA, Brady LW [red. ]: Principles and Practice of Radiation Oncology. Philadelphia: JB Lippincott 1997; 1525-1541.
- 15. Golimbu M, Joshi P, Sperber A i wsp:Renal cell carcinoma: Survival and prognostic factors. Urology 1986; 27:291-301.
- 16. Rabinovitch RA: Renal cell carcinoma. W: Leibel Philips:Textbook of Radiation Oncology. Philadelphia, Lippincott 1999; 711-723.
- 17. DeKernion JB, Ramming KP, Smith RB: The natural history of metastatic renal cell carcinoma: a computer analysis- J Urol 1978; 120: 148-152.
- 18. Fossa SD, Kjolseth I, Lund G:Radiotherapy of metastases from renal cancer. Eur Urol 1982; 8: 340-342.
- 19. Nickolisen R, Fallon B: Locally recurrent hypernephroma treated by radiation therapy and embolization. Cancer 1985; 56: 1049-1051.
- 20. Kao GD, Malkowicz SB, Whittington R i wsp: Locally advanced renal cell carcinoma: Low complication rate and efficacy of postnephrectomy radiation therapy planned with CT. Radiology 1994; 193: 725-730.
- 21. Makarewicz R, Zarzycka M, Kulińska G: The value of postoperative radiotherapy in advanced renal cancer. Neoplasma 1997: 44, 380-383.
- 22. Scheren E, Wirtz C: The role of postoperative radiotherapy in the treatment of hypernephroid carcinoma. Strahlenthcr Oncol 1988; 164: 371-385.
- 23. Stein M, Kutcn Ar Halperin J. i wsp: The value of postoperative irradiation in renal cell cancer. Radiother Oncol 1992; 24: 41-44.
- 24. Bassil B, Dosoretz DE, Prout GR:Validation of the tumor, nodes and metastasis classification of renal cell carcinoma. J Urol 1985; 134: 450-454.
- 25. Aref I, Bociek RG, Salhani D: Is post-operative radiation for renal cell carcinoma justifiied? Radiother Oncol 1997; 43: 155-157.
- 26. Radkowski A: Ocena wartości pooperacyjnej radioterapii chorych na raka nerki. Optymalizacja techniki napromieniania. Praca na stopień doktora nauk medycznych, Kraków, 1992.
- 27. Kjacr M, Frcderiksen PL, Engelholm SA: Postoperative radiotherapy in stage II and III renal adenocarcinoma: A randomized trial by the Copenhagen Renal Cancer Study Group. In I J Radiat Oncol Biol Phys 1987; 13: 665-672.
- 28. Werf-Mcssing B van der, lleul RO van der, Ledeboer RCH: Renal cell carcinoma trial. Cancer Clin Trials 1978; 1: 13-16.
correspondence
Malgor+ata Zarzycka
Regionalne Centrum Onkologii Oddziału Radoterapii
ul. t Romanowskiej 2
85-794 Bydgoszcz
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