The value of radiotherapy in the treatment of hypernephroma--a clinical trial.

Abstract

SUMMARY A randomised trial was started in 1961 in order to assess the value of postoperative radiotherapy in the treatment of hypernephromata. Crude survival figures covering 2 to 11 years following treatment reveal that those cases treated by surgery only did appreciably better than those treated by combined surgery and irradiation. Analysis in detail over the first 5 years revealed that the greatest differences in survival between the 2 groups occurred in the first 12 months. Radiotherapy did not influence the incidence of local recurrence or distant metastases. However, a considerable number of cases receiving radiotherapy died from coincidental causes including radiation liver damage. Those tumours with histological evidence of venous involvement showed no improvement in survival despite radiotherapy. Other factors associated with tumour prognosis-size, capsular involvement and node metastases demonstrated no advantage in terms of survival for cases having radiotherapy. Histological grading revealed that grade I tumours have a better prognosis than grade II. Definite evidence of liver damage was obtained in right-sided lesions irradiated as shown from biochemical liver function tests and isotope scans. Right-sided lesions did less well than left-sided lesions. The conclusion reached at this stage of the trial is that postoperative radiotherapy does not appear to have any value in the routine management of hypernephroma.