The Place of Irradiation

The dogma of radioresistance of cancer of the kidney is unacceptable. No patient has been "cured" by radiotherapy alone, but an adequate dose cannot be given to the kidney without damaging adjacent structures. Tumors vary in radiosensitivity according to their anaplasia and oxygenation. Some respond to irradiation. In one series,⁴³the five-year survival of 362 inoperable patients who were left untreated was 0.5%; in 83 who were treated by radiotherapy, it was 6%. Postoperative Irradiation Results.— Local irradiation after nephrectomy is used frequently. In the British Association of Urological Surgeons' series,⁴³the 5- and 10-year survivals in potentially curable patients were 30% and 17% after nephrectomy. With added postoperative irradiation, they were 49% and 27%. The gain was greatest in those with renal vein invasion. Flocks and Kadesky⁴⁴found similar improvement. In my series, 36 of 100 received postoperative irradiation. Improvement beyond three years was achieved only