PREOPERATIVE EXTERNAL-BEAM RADIOTHERAPY FOLLOWED BY CYTOREDUCTIVE SURGERY AND INTRAOPERATIVE RADIOTHERAPY FOR - LOCALLY ADVANCED PRIMARY ORRECURRENT RENAL MALIGNANCIES

Patients with local persistence or local regional recurrence of cancer after nephrectomy for renal cell cancer are unlikely to respond well to systemic therapy or external irradiation alone. In this analysis, p atients with locally recurrent (9) or persistent (2) cancer following nephrectomy (renal cell cancer in 8, transitional cell or squamous cel l cancer in 3) usually received 4,500 to 5,040 cGy. preoperative exter nal beam irradiation followed by maximal surgical debulking and intrao perative electron irradiation (1,000 to 2,500 cGy.). Of 8 renal cell c ancer patients 6 were alive and 4 were without disease progression at 15 to 50 months (3 of 4 at 29 months or longer). One patient died free of disease at 10.5 months and 3 had metastases (regional in 1 and dis tant in 3). Of the 3 transitional or squamous cell carcinoma patients 1 died free of disease 28.5 months after initiation of treatment for r ecurrence and 2 died of disease progression (liver in 1 and local in I ). It appears that select patients with solitary local recurrence or p ersistence following radical nephrectomy for renal cell cancer may ben efit from an aggressive local treatment approach using irradiation (pr eoperatively and intraoperatively) plus maximal surgical debulking. In patients with locally advanced high grade transitional cell cancer th e locally aggressive approach should probably be combined with multi-d rug chemotherapy because of increased systemic risks. For both groups (renal cell carcinoma and transitional/squamous cell carcinoma) the mo st ideal patient for such treatment is one who has not received prior chemotherapy or external irradiation to the site of relapse, since 3 o f 5 patients with disease progression after our aggressive approach ha d received chemotherapy (2) or external beam irradiation (2) elsewhere before referral.