35例肾癌术后放疗的临床分析

Clinical analysis of postoperative radiation in 35 patients with renal cell carcinoma

目的 :研究Ⅱ、Ⅲ期肾癌术后放疗的作用。方法 :1992年 1月— 1995年 1月 ,35例Ⅱ和Ⅲ期肾癌行术后放疗。照射范围包括肾瘤床、肾蒂、主动脉旁及下腔静脉旁淋巴结区 ,运用TPS技术 ,采用直线加速器 18MVX线照射 ,DT 45— 5 0Gy 5周。结果 :失访 2例按死亡处理 ,随访率 94.4% ,全组无复发病例 ,三年及五年生存率各为5 7% ( 2 0 35 )和 45 .7% ( 16 35 )。三年生存率Ⅱ期为 6 9.2 % ( 9 13)、Ⅲ期为 5 0 % ( 11 2 2 ) ,五年生存率Ⅱ期为 5 3.8% ( 7 13)、Ⅲ期为 41% ( 9 2 2 )。 88.2 % ( 15 17)死于远处转移。结论 :Ⅱ、Ⅲ期肾癌患者术后放疗可以改善生存 。

Purpose:To study the role of postoperative radiotherapy for Robsan's stage Ⅱ or Ⅲ renal cell carcinoma.Methods:From Jan 1992 to Jan 1995 35 patients with stage Ⅱ and Ⅲ renal cell carcinoma after nephrectomy were treated by conventional fractions with 18 MVX beams from linear accelerators to fields that include the renal fossa and tumor bed as well as the paraaortic and paracaval lymph nodes to a total dose of 45 Gy—50 Gy in 5 weeks.Results: 2 cases lost in follow up were treated as death. Follow up rate was 94.4 %. No patients with recurrence was found during follow up. The 3、5 year survival rates were 57%(20/35) and 45.7%(16/35), respectively. The 3 year survival rates were 69.2%(9/13) in stage Ⅱ and 50%(11/22) in stage Ⅲ. The 5 year survival rates were 53.8%(9/13) in stage Ⅱ and 41%(9/22) in stage Ⅲ. 88.2%(15/17) of the Patients died of distant metastasis.Conclusions:Postoperative radiotherapy in management of stage Ⅱ and Ⅲ renal cell carcinoma is believed to be of benefit. The distant metastasis is the main reason of failure in management of renal cell carcinoma.