Carcinoma of the kidney

Between the end of 1965 and 1972, 141 cases with carcinoma of the kidney were admitted to the Rotterdam Carcinoma of the Kidney Trial. To half of the cases preoperative irradiation was given consisting of 3000 rad to the kidney region in the over-all period of 3 weeks. In each P-category preoperative irradiation did not improve prognosis. In the P3-category incomplete removal of the growth, i.e. residual growth, was more frequent in the case of nephrectomy only. Survival of this group was poor as compared with patients whose growth could be removed completely during operation: the incidence of metastasis was higher, metastases became clinically evident at an earlier stage, and survival after the metastases had become clinically evident was shorter, suggesting a decreased host resistance in case of residual growth. In the irradiated patients who attended the joint radio-urologic followup clinic, thus submitted to a double alertness and competence, metastases were discovered at an earlier stage than in those patients who attended only the urology followup clinic, although the total incidence of metastasis was about the same in both groups. However, in cases of metastasis, prognosis of the irradiated group was better during the first 2 years, suggesting that immediate treatment of metastases can prolong life—a life worth living. Eventually prognosis in cases of metastasis becomes equally poor in both those groups.