Radiotherapy Of Urological Carcinoma

PartⅠ:POST-OPERATIVE RADIOTHERAPY FOR ADVANCED RENAL CELL CARCINOMA:RETEROSPECTIVE ANALYSIS OF 55 PATIENTSBackground and Purpose:To evaluate the efficacy of post-operative radiotherapy and prognosis of advanced renal cell carcinoma(RCC).Materials and Methods:Between 1998 and 2006,55 advanced renal cell carcinoma patients underwent nephrectomy at our institution.According to TNM classification(UICC2005) the pathological stage was:Ⅲin 33 patients(60%),Ⅳin 22(40%).Post-operative irradiation,with a median dose of 50Gy in 25 Fractions over 5 weeks was given to patients in 2～4 weeks after surgery,using AP-PA opposing portals or oblique portals.Results:The 5-year survival rates in the irradiated patients(S+Rt) was 42.6%, but in the non-irradiated patients(S) 21.5%,this difference is statistically significant(P=0.022).Diseases recurred locally in a total of 9 patients(16.4%),and diseases metastasis in a total of 30 patients(54.5%).Local recurrence in S+Rt was 10.3%and that of S was 26%,metastasis in S+Rt was 44.8%and that of S was 77%. No patients died from radiotherapy-induced complications.Conclusions:In advanced renal cell carcinoma,post-operative radiotherapy is beneficial in both local control and survival.PartⅡ:ADJUVANT RADIOTHERAPY FOR TRANSITIONAL CELL CARCINOMA OF THE RENAL PELVIS AND URETERBackground and Purpose:Transitional cell carcinoma(TCC) of the upper urinary tract is a relatively uncommon malignancy.The role of post-operation adjuvant radiation therapy is not well defined.We retrospectively reviewed the records of 74 patients who underwent surgery followed with or without adjuvant radiotherapy to evaluate the efficacy of post-operative irradiation in patients with TCC of the renal pelvis and/or ureter.Materials and Methods:Between 1999 and 2006,37 of 74 patients with transitional cell carcinoma of the upper urinary tract(renal pelvis in 19,ureter in 55) were treated with postoperative irradiation.Most patients(58 of 74) had T3/4 and/or N+ disease.The median radiation dose was 50 Gy/25Fx.Twenty-two patients received radiation therapy focus on tumor bed only,15 patients were irradiated to both renal bed and whole upper urinary tract(ureteral bed/bladder).Results:Median survival in all patients was 32 months and total survival rates was 44.3%.Of 74 patients,47(63.5%) patients experienced disease relapse,including 29(39.2%) with bladder recurrences and 17(23%) with distant metastasis.5-year overall survival,locoregional control rates were 46%and 57%in patients with adjuvant radiotherapy group, 5-year overall survival,locoregional control rates were 38%and 40%in the patients without postoperative irradiation.The difference is not significant(p=0.672).However the median recurrent-free survival were 27 months,6 months and 8.5 months(p=0.006) among 15 patients with renal bed/ureteral bed/ bladder radiation,22 patients with the tumor bed radiation and 37 patients without adjuvant radiotherapy,respectively.Conclusions:In transitional cell carcinoma of the renal and ureter, our results suggest that adjuvant radiotherapy is beneficial in reducing the locoregional recurrence and postponing tumor recurrence in bladder.PartⅢ:ADJUVANT RADIOTHERAPY FOR INTERMEDIATE AND ADVACED PROSTATE CARCINOMA UNDERWENT ORCHIECTOMY Background and purpose:We retrospectively reviewed the records of 142 patients to evaluate the therapeutic effects of post-operative irradiation in combination with hormonotherapy in the treatment of intermediate and advanced prostate carcinoma.Materials and methods:Between 2000 and 2006,142 intermediate and advanced prostate carcinoma patients underwent bilateral orchiectomy at our institution.42 of all patients were treated with adjuvant radiotherapy,with a median dose of 60Gy in 30 Fractions over 6～7 weeks was given in 2 months after surgery.21 patients received salvage radiotherapy being of biochemical relapse.Results:The median follow-up duration was 34 months(3～78 months).The overall biochemical-free survival(BFS) was 69%in 42 patients underwent orchiectomy before adjuvant radiation therapy group,the overall biochemical-free survival in 100 patients underwent orchiectomy group was 59%,and the BFS of salvage radiotherapy group was 33.3%,the difference is significant(p＜0.000).The median time of biochemical relapse in adjuvant radiation therapy group and orchiectomy group and salvage radiotherapy group were 506 days and 387 days and 204 days(p＜0.000).Conlusions:The outcome of radiation therapy for patients with intermediate and advanced prostate carcinoma is beniful to biochemical controlled,and the therapeutic effects of adjuvant irradiation is better than that of salvage irradiation.