Radiotherapy for renal-cell carcinoma

Abstract

Renal cell carcinoma is a radioresistant tumor. Preoperative radiation therapy yields no survival advantage. Controversies exist concerning postoperative radiation therapy, but it may be considered in patients with perinephric fat extension, adrenal invasion, or involved margins. A dose of 45 Gy is delivered, with consideration of a boost. In this way, radiation therapy may be considered as primary therapy for palliation in patients whose clinical condition precludes surgery, because of either extensive disease or poor overall condition. In these cases, a dose of 45 gray (Gy) is delivered, with consideration of a boost up to 55 Gy. Moreover, palliative radiation therapy is often used for local or symptomatic metastatic disease, such as painful osseous lesions or brain metastasis, to preclude potential neurologic progression. Surgery should also be considered forsolitary brain or spine lesions, followed by postoperative radiotherapy. About 11% of patients develops brain metastasis during the course of their disease. Patients with untreated brain metastasis have a median survivaltime of 1 month, which can be improved with glucocorticoid therapy and brain radiation. Radiation treatment ofbrain metastasis improves quality of life, local control, and overall survival duration. Stereotactic radiosurgery is more effective than surgical extirpation for local control and can be performed on multiple lesions.