Renal cell carcinoma.Natural history and results of treatment

Abstract

Two hundred forty-four histologically proven renal cell adenocarcinomas are reviewed. Seventy-two percent of the patients died with disease, most (167 of 176) with distant metastasis and only 9 with local recurrence alone. The difficulty in diagnosing local recurrence is discussed; and the importance of angiography is stressed. Patients suffering from metastases in one site, e.g., the lungs or bones, appear to live a relatively shorter time than those with metastases in multiple regions. There is no apparent relationship between the involvement of renal vein, renal pelvis, or capsule and the incidence of distant metastases. Results of treatment and the factors which affect those results are discussed. Patients receiving postoperative radiotherapy show a significantly better 5- and 10-year survival. Postoperative radiotherapy seems to be most profitable when the capsular tissues or renal pelvis are involved. The beneficial effect of postoperative radiotherapy on the rate of local recurrence is shown. The rationale and effect of preoperative radiotherapy are described; the effect of radiation may reach a maximum only after the passage of a relatively long period—12 months in one of our cases.