Locally advanced renal cell carcinoma: low complication rate and efficacy of postnephrectomy radiation therapy planned with CT.

Purpose: To determine the usefulness of computed tomography (CT) in planning radiation therapy for locally advanced renal cell carcinoma after nephrectomy.

Materials And Methods: The authors retrospectively analyzed the treatment records and follow-up status of 12 consecutive patients who underwent radical nephrectomy and postoperative radiation therapy for locally advanced renal cell carcinoma. Records' of 12 consecutive patients who underwent only radical nephrectomy were also analyzed.

Results: None of the patients who received radiation therapy after nephrectomy had local-regional recurrence, despite disease at the surgical margins in six patients; the actuarial disease-free survival at 5 years was 75%. In contrast, the 5-year actuarial local failure rate in the surgery-only group was 30% (significant difference at P < .01) and the disease-free survival rate was 62% (mean and median follow-up was 4.6 and 5.1 years, respectively).

Conclusion: With CT, radiation can be delivered to the renal bed safely and without undue morbidity. Given the lack of chronic complications associated with the side effects of radiation therapy and uniform local control of cancer in these patients, the role of radiation therapy in patients at high risk for local failure may be reconsidered.