POSTOPERATIVE RADIATION-THERAPY IN 26 PATIENTS WITH INVASIVE TRANSITIONAL-CELL CARCINOMA OF THE UPPER URINARY-TRACT - NO IMPACT ON SURVIVAL

Purpose: To evaluate the role of adjuvant radiation therapy in invasiv e transitional cell carcinoma of the upper urinary tract, we retrospec tively reviewed a series of 26 patients who underwent radical surgery plus postoperative prophylactic irradiation for such a tumor. Material s and Methods: Between February 1980 and October 1993, 18 men and 8 wo men (mean age 65 +/- 9 years, standard deviation) were treated for an invasive transitional cell carcinoma of the upper urinary tract. Tumor location was the renal pelvis in 15 patients (58%). The tumor was pat hological stage B in 11 patients (42%) and stage C in 15 (58%). Tumor grade was 2 in 10 patients, 3 in 15 and unknown in 1. One patient had epidermoid metaplasia of urothelial cancer and 9 had node involvement. All patients underwent surgery followed by radiation therapy to a tot al dose of 45 Gy. to the tumor bed (23) and/or regional nodes (18). Re sults: After a mean followup of 45 months 13 patients (50%) were alive and 11 were disease-free at analysis. Local tumor relapse, nodal recu rrence and metastasis were noted in 1, 4 (15%) and 14 (54%) patients, respectively. All patients with nodal recurrence had metastasis. A sec ondary location was noted frequently (6 bladder, 1 contralateral renal pelvis and 1 urethral tumors). Overall 5-year survival rate and 5-yea r survival rate with no evidence of disease were 49% and 30%, respecti vely. Overall 5-year survival rates were 60% for stage B and 19% for s tage C disease (p = 0.07), 49% for node-negative versus 15% for node-p ositive cancer (p = 0.04), and 90% for grade 2 and 0% for grade 3 tumo rs (p < 0.01). Conclusions: In our trial using a radio-surgical approa ch, local control of disease and survival rates were similar to those reported previously in surgical series. Prophylactic postoperative rad iation therapy is not recommended except in prospective randomized stu dies.