The role of stereotactic body radiotherapy in switching systemic therapy for patients with extracranial oligometastatic renal cell carcinoma.

BACKGROUND: Targeting oligometastatic lesions with metastasis-directed therapy (MDT) using stereotactic-body radiotherapy (SBRT) may improve treatment outcomes and postpone the need for second-line systemic therapy (NEST). We looked at the results of oligometastatic renal cell carcinoma (RCC) patients who had five or fewer lesions and were treated with SBRT. METHODS: We examined the treatment outcomes of 70 extracranial metastatic RCC (mRCC) patients treated at two oncology centers between 2011 and 2020. The clinical parameters of patients with and without NEST changes were compared. The prognostic factors for overall survival (OS), progression-free survival (PFS), and NEST-free survival were evaluated. RESULTS: Median age was 67 years (range 31-83 years). Lung and bone metastasis were found in 78.4% and 12.6% of patients, respectively. With a median follow-up of 21.1 months, median OS was 49.1 months and the median PFS was 18.3 months. Histology was a prognostic factor for OS, BED, and treatment switch for PFS in univariate analysis. In multivariate analysis, the significant predictor of poor OS was clear cell histology, and a lower BED for PFS. Following SBRT for oligometastatic lesions, 19 patients (27.2%) had a median NEST change of 15.2 months after MDT completion. There were no significant differences in median OS or PFS between patients who had NEST changes and those who did not. No patient experienced grade ≥ 3 acute and late toxicities. CONCLUSIONS: The SBRT to oligometastatic sites is an effective and safe treatment option for ≤ 5 metastases in RCC patients by providing favorable survival and delaying NEST change.

Oligo metastatic renal cell carcinoma: stereotactic body radiation therapy, if, when and how?

BACKGROUND AND PURPOSE: Renal cell carcinoma (RCC) has traditionally been considered radioresistant with a limited role for conventional fractionation as a local approach. Nevertheless, since the appearance of stereotactic body radiation therapy (SBRT), radiotherapy (RT) has been increasingly employed in the management of metastatic RCC (mRCC). The aim of this study was to evaluate the role of SBRT for synchronous and metachronous oligo metastatic RCC patients in terms of local control, delay of systemic treatment, overall survival and toxicity. PATIENTS AND METHODS: A Monocentric single institution retrospective data collection was performed. Inclusion criteria were: (1) oligo-recurrent or oligo-progressive disease (less than 5 metastases) in mRCC patients after radical/partial nephrectomy or during systemic therapy, (2) metastasectomy or other metastasis-directed, rather than SBRT not feasible, (3) any contraindication to receive systemic therapy (such as comorbidities), (4) all the histologies were included, (5) available signed informed consent form for treatment. Tumor response and toxicity were evaluated using the response evaluation criteria in solid tumors and the Common Terminology Criteria for Adverse Events version 4.03, respectively. Progression-free survival in-field and out-field (in-field and out-field PFS) and overall survival (OS) were calculated via the Kaplan-Meier method. The drug treatment-free interval was calculated from the start of SBRT to the beginning of any systemic therapy. RESULTS: From 2010 to December 2018, 61 patients with extracranial and intracranial metastatic RCC underwent SBRT on 83 lesions. Intracranial and extracranial lesions were included. Forty-five (74%) patients were treated for a solitary metastatic lesion. Median RT dose was 25 Gy (range 10-52) in 5-10 fractions. With a median follow-up of 2.3 years (range 0-7.15), 1-year in-field PFS was 70%, 2-year in-field PFS was 55%. One year out-field PFS was 39% and 1-year OS was 78%. Concomitant systemic therapy was employed for only 11 (18%) patients, for the others 50 (82%) the drug treatment-free rate was 70% and 50% at 1 and 2 years, respectively. No > G1 acute and late toxicities were reported. CONCLUSION: The pattern of failure was pre-dominantly out-of-field, even if the population was negatively selected and the used RT dose could be considered palliative. Therefore, SBRT appears to be a well-tolerated, feasible and safe approach in oligo metastatic RCC patients with an excellent in-field PFS. SBRT might play a role in the management of selected RCC patients allowing for a delay systemic therapy begin (one out of two patients were free from new systemic therapy at 2 years after SBRT). Further research on SBRT dose escalation is warranted.

Kidney-sparing whole abdominal irradiation in Wilms tumor: Potential advantages of VMAT technique.

PURPOSE: To present a preliminary clinical experience and a dosimetric comparison of kidney-sparing volumetric modulated arc therapy (VMAT) with three-dimensional conformal radiotherapy (3D-CRT) for whole abdominal irradiation (WAI), in the setting of Wilms tumor (WT) treatment. MATERIALS AND METHODS: From a total of 20 consecutive WT cases treated with adjuvant irradiation, seven were submitted to WAI with VMAT. Renal function and survival rates were evaluated, and, for comparison purposes, similar VMAT and 3D-CRT treatment plans were performed for WAI patients, and differences were dosimetrically evaluated regarding doses to the remaining kidney and other organs at risk and the planning target volume (PTV). RESULTS: After a median follow-up time of 40.8 months (35.3-52.2), no acute significant intestinal toxicity was observed, and median creatinine clearance was 110.1 and 103.3 mL/min/1.73 m², respectively, before treatment and at last follow-up for WAI patients (P = 0.128). For comparative plans, maximum and median doses were lower for the remaining kidney with VMAT than with 3D-CRT. VMAT was associated with better PTV coverage as compared with 3D-CRT, with superior results for all the evaluated parameters (D95, D2, V100%, V98%, V95%; P = 0.018). CONCLUSION: The use of VMAT technique is associated with lower radiation doses to the remaining kidney and better coverage to the PTV than 3D-CRT technique for WAI, with preliminary clinical experience showing a favorable toxicity profile. Long-term results from prospective studies might prove the ability of VMAT to spare renal function in the setting of WT treatment.

Analysis of the Abscopal Effect With Anti-PD1 Therapy in Patients With Metastatic Solid Tumors.

Abscopal effect is a rare phenomenon characterized by tumor regression of untreated metastatic lesions after a local therapy (eg, radiotherapy). We studied the probability of abscopal effect with radiotherapy associated with anti-programmed death cell 1 (PD1) therapy after progression on anti-PD1. This study is a retrospective analysis of patients treated with nivolumab or pembrolizumab for melanoma, non-small cell lung cancer (NSCLC) and renal cancer at Antônio Ermírio de Moraes Oncology Center, Brazil. To be eligible for this analysis, patients must have had unequivocal evidence of disease progression on anti-PD1 therapy and subsequent radiotherapy for any tumor site while still receiving anti-PD1. The abscopal effect was characterized as a response outside the irradiated field after radiotherapy plus anti-PD1. Sixteen patients were evaluated, including 12 metastatic melanoma, 2 metastatic NSCLC, and 2 metastatic renal cell carcinoma. The median time to disease progression on anti-PD1 was 3 months. The radiotherapy field included lung, lymph nodes, and bones, with a median total dose of 24 Gy (1-40 Gy), usually in 3 fractions (1-10 fractions). Three patients with melanoma developed an abscopal effect at a rate of 18.7% (25% among melanoma patients). Of note, one of them achieved a remarkable complete response lasting >6 months. Three patients with melanoma obtained a significant local response after radiotherapy, despite no response in distant metastases. Eleven patients presented disease progression after radiotherapy. No increased toxicity was observed. In conclusion, no patients with NSCLC or renal cancer showed abscopal effect, but 25% of patients with melanoma showed regression of nonirradiated lesions when anti-PD1 was continued after radiation to a tumor site that had progressed on anti-PD1 monotherapy.

Contemporary Trends in the Utilization of Radiotherapy in Patients With Renal Cell Carcinoma.

OBJECTIVE: To examine the utilization of radiation therapy (RT) in patients with renal cell carcinoma (RCC) using a large national tumor registry. MATERIALS AND METHODS: Patients diagnosed with RCC were identified using the National Cancer Data Base. Our primary objective was to assess temporal trends in the utilization of RT. Our secondary objective was to identify patient and treatment factors associated with receipt of RT. The Cochran-Armitage test was used for trend analysis. Multivariable logistic regression was performed to identify factors associated with RT use. RESULTS: A total of 279,427 patients were diagnosed with RCC from 1998 to 2010. A total of 233,572 (83.6%) had localized or locally advanced disease, whereas the remaining 45,855 (16.4%) had metastatic disease. There was a decrease in radiotherapy across all patients during this period (1.5%-0.6%, P <.001); as salvage or adjuvant therapy with surgery (1.3%-0.3%, P <.001), and in patients with metastatic disease (33.3%-28.5%, P <.001). Factors associated with increased RT use in patients with nonmetastatic RCC included male gender, receipt of systemic therapy, higher stage, higher grade, nonacademic treatment facility, facility location, and sarcomatoid or other histology. CONCLUSION: In the National Cancer Data Base, we observed a decrease in the use of RT for patients with RCC from 1998 to 2010. Patients with more aggressive disease characteristics were more likely to receive RT. Well-designed clinical trials are needed to clarify the role of RT in the management of these patients.

Rare renal metastases from differentiated thyroid carcinoma: early clinical detection and treatment based on radioiodine.

OBJECTIVE: The aim of this study was to explore the clinical characteristics of renal metastatic cancer, the methods for its detection by radioiodine (131)I, and the response to (131)I treatment in fourteen patients with renal metastases from differentiated thyroid carcinoma (DTC). SUBJECTS AND METHODS: DTC patients (n = 2,955) that received treatment with (131)I were retrospectively analyzed. Scans ((131)I-WBS, (31)I-SPECT/CT and/or (18)F-FDG-PET/CT) were performed after an oral therapeutic dose of (131)I. Therapeutic efficacy was evaluated based on changes in Tg and anatomical imaging changes at renal lesions. RESULTS: Among these 14 patients, 11 had avidity for (131)I, but three patients did not accumulate (131)I after (131)I treatment. In the 11 (131)I-positive renal lesions, 10 cases were detected by (131)I-SPECT/CT combined with another imaging modality and one case by (131)I-WBS combined with ultrasonography (US). In the three (131)I-negative renal lesions, two cases were detected by 18F-FDG-PET/CT and one case by computed tomography (CT). In 11 patients with (131)I-avid renal metastases, Serum Tg levels in 81.82% (9/11) patients showed a gradual decline, and 18.18% (2/11) of the patients showed a significant elevation. There was no marked difference in serum Tg before the last (131)I treatment (Z = 0.157; p = 0.875). Only one patient presented partial response, eight patients exhibited stable disease, and renal metastases progressed in two patients showing progressive disease. No patients reached complete response. CONCLUSION: (131)I-SPECT/CT, combined with another imaging modality after (131)I-WBS, can contribute to the early detection of renal metastases of DTC. (131)I therapy is a feasible and effective treatment for most DTC renal metastases with avidity for (131)I.

Rare renal metastases from differentiated thyroid carcinoma: early clinical detection and treatment based on radioiodine / Metástases renais raras de carcinoma diferenciado da tireoide: detecção clínica precoce e tratamento com radioiodoterapia

Objective : The aim of this study was to explore the clinical characteristics of renal metastatic cancer, the methods for its detection by radioiodine (131I), and the response to 131I treatment in fourteen patients with renal metastases from differentiated thyroid carcinoma (DTC).Subjects and methods : DTC patients (n = 2,955) that received treatment with 131I were retrospectively analyzed. Scans (131I-WBS, 31I-SPECT/CT and/or 18F-FDG-PET/CT) were performed after an oral therapeutic dose of 131I. Therapeutic efficacy was evaluated based on changes in Tg and anatomical imaging changes at renal lesions.Results : Among these 14 patients, 11 had avidity for 131I, but three patients did not accumulate 131I after 131I treatment. In the 11 131I-positive renal lesions, 10 cases were detected by 131I-SPECT/CT combined with another imaging modality and one case by 131I-WBS combined with ultrasonography (US). In the three 131I-negative renal lesions, two cases were detected by 18F-FDG-PET/CT and one case by computed tomography (CT). In 11 patients with 131I-avid renal metastases, Serum Tg levels in 81.82% (9/11) patients showed a gradual decline, and 18.18% (2/11) of the patients showed a significant elevation. There was no marked difference in serum Tg before the last 131I treatment (Z = 0.157; p = 0.875). Only one patient presented partial response, eight patients exhibited stable disease, and renal metastases progressed in two patients showing progressive disease. No patients reached complete response.Conclusion : 131I-SPECT/CT, combined with another imaging modality after 131I-WBS, can contribute to the early detection of renal metastases of DTC. 131I therapy is a feasible and effective treatment for most DTC renal metastases with avidity for 131I. Arq Bras Endocrinol Metab. 2014;58(3):260-9.

Objetivo : O objetivo deste estudo foi analisar as características clínicas de metástases renais, os métodos para sua detecção por radioiodo (131I) e a resposta ao tratamento com 131I em 14 pacientes com metástases renais de carcinoma diferenciado da tireoide (DTC).Sujeitos e métodos Pacientes com DTC (n = 2.955) que receberam tratamento com 131I foram analisados retrospectivamente. 131I-PCI, 31I-SPECT/CT e/ou 18F-FDG-PET/CT foram feitos após uma dose terapêutica oral de 131I. A eficácia terapêutica foi baseada nas alterações da Tg e nas imagens anatômicas das lesões renais.Resultados : Dos 14 pacientes, 11 apresentaram lesões ávidas por 131I, mas três pacientes não acumularam 131I depois do tratamento com 131I. Nas 11 lesões renais positivas para 131I, 10 casos foram detectados por 131I-SPECT/CT combinado com outra modalidade de exame de imagem e um caso por 131I-WBS combinado com US. Nas três lesões renais negativas para 131I, dois casos foram detectados por 18F-FDG-PET/CT e um caso por tomografia computadorizada (TC). Em 11 pacientes com metástases renais ávidas por 131I, os níveis séricos de Tg em 81,82% (9/11) dos pacientes mostraram um declínio gradual e 18,18% (2/11) apresentaram uma elevação significativa. Não houve diferenças marcadas na Tg sérica antes do último tratamento com 131I (Z = 0,157; p = 0,875). Apenas um paciente apresentou resposta parcial, oito pacientes apresentaram doença estável e as metástases renais progrediram em dois pacientes que apresentaram doença progressiva. Nenhum dos pacientes apresentou resposta completa.Conclusão : 131I-SPECT/CT, combinada com outra modalidade de diagnóstico por imagem após 131I-PCI, pode contribuir para a detecção precoce de metástases renais de DTC. O tratamento ...

La radiothérapie guidée à l'aide de l'imagerie par résonance magnétique (IRM) en temps réel / Guided radiotherapy using real-time magnetic resonance imaging (MRI)

INTRODUCTION: La radiothérapie guidée à l'aide de l'imagerie par résonance magnétique (IRM) est une modalité d'intervention en oncologie qui utilise l'IRM en temps réel pour guider l'irradiation des tissus cancéreux. Ce nouveau type d'intervention a été développé depuis le milieu des années 2000 pour améliorer la précision de la radiothérapie. MÉTHODOLOGIE: La Direction québécoise de cancérologie a déposé une requête à l'Institut national d'excellence en santé et en services sociaux (INESSS) concernant l'examen de la pertinence et de l'efficacité du traitement des tumeurs par la radiothérapie guidée par l'IRM en temps réel. Une revue de la littérature a été réalisée en limitant les dates de publication à la période située entre 2004 et 2013. Une recherche de la littérature grise a aussi été faite pour obtenir de l'information sur l'opinion de certains organismes officiels à propos de cette modalité de traitement. Un total de 64 références ont été repérées parmi lesquelles 12 ont été retenues pour les fins de notre analyse. RÉSULTATS: Les résultats ont montré qu'il n'existe pas d'essai clinique randomisé (ECR) publié à l'heure actuelle, ni d'ECR en cours recensé. Quelques études de simulation ont examiné la faisabilité de cette technologie, mais aucune d'entre elles n'a porté sur l'efficacité du traitement, jusqu'à ce jour. Les paramètres de faisabilité testés ont traité de l'effet du champ magnétique sur la radiothérapie, l'adaptation aux mouvements dus à la respiration, la planification du traitement, le recalage des images et l'irradiation des organes à risque. CONCLUSIONS: Deux constats peuvent être tirés de la littérature examinée. D'abord, les quelques études de simulation réalisées sur des séries de cas de petite taille montrent que la radiothérapie guidée par l'IRM en temps réel pourrait être utilisée pour le traitement de certains types de cancer comme le cancer du col utérin, le cancer du sein, le cancer du rein ou le cancer du poumon. De plus, ces études soutiennent que la radiothérapie guidée par l'IRM serait susceptible de diminuer l'irradiation des tissus sains adjacents. Le niveau de preuve de ces études est toutefois faible. Finalement, le manque de preuves concernant l'efficacité de la technologie ne permet pas de conclure sur cet aspect pour le moment. Bien qu'un type d'appareil soit disponible commercialement, les publications montrent que la plupart des technologies de radiothérapie guidée par l'IRM en sont actuellement à l'étape de la mise au point technique et elles demeurent au stade expérimental. Il n'est donc pas possible à cette étape-ci de supputer le coût, le coût-bénéfice ou le nombre de patients qui pourraient bénéficier de cette technologie.

Resultado del tratamiento del tumor de Wilms en población pediátrica / Treatment results of Wilms'tumor in pediatric population

Introducción: El tumor de Wilms (TW) es el tumor renal maligno más frecuente en la infancia, su tratamiento incluye, según su estadio y forma de presentación, cirugía precoz, radioterapia (RT) y quimioterapia (QT) según el protocolo PINDA. El objetivo es conocer los resultados de la serie histórica del Instituto Nacional del Cáncer (INC). Pacientes y Método: Revisión retrospectiva de todos los pacientes tratados con el diagnóstico de TW en el INC. Se describe la población de pacientes, tratamiento de RT recibidos, resultados de sobrevida global y factores pronósticos. Resultados: Desde septiembre de 1993 hasta diciembre de 2010 se trataron con RT 110 niños. La mediana de edad al diagnóstico fue de 3,6 años. La mediana de seguimiento fue de 128 meses desde el fin de RT. A junio de 2012, del total de 107 pacientes con seguimiento, 22 habían fallecido, 19 por progresión de enfermedad. Todos los pacientes que fallecieron lo hicieron antes de tres años desde el tratamiento. La sobrevida global a 2, 4, 12 años fue de 82 por ciento, 78 por ciento, 78 por ciento respectivamente. En análisis multivariado, cada día después de la cirugía sin comenzar la RT disminuye las probabilidades de sobrevida (p = 0,04). Conclusiones: El tratamiento del TW tiene un excelente pronóstico. La sobrevida, luego de los 3 años se estabiliza sin presentar eventos, indistintamente del grupo al que pertenezca el paciente. Dentro de los factores pronósticos, en pacientes con indicación de RT, esta se debe iniciar precozmente, al parecer lo más cercano a la cirugía.

Introduction: Wilms tumor (WT) is the most common form of malignant kidney tumor in childhood. According to PINDA protocols, its treatment includes, depending on stage and presentation, early surgery, radiotherapy (RT) and chemotherapy (CT). The objective of this work is to review the results of all patients of the National Cancer Institute (NCI) with this condition. Patients and Method: A retrospective review of all patients diagnosed with WT at the NCI was conducted. Patient population, RT treatment received and overall survival results were described and prognostic factors were searched. Results: From September 1993 to December 2010, 110 children were treated with RT. The median age at diagnosis was 3.6 years old. Median follow-up was 128 months after RT. In June 2012, out of a total of 107 patients with follow up, 22 had died, 19 due to disease progression. All deaths occurred within three years of treatment. Overall survival at 2, 4 and 12 years old was 82 percent, 78 percent, 78 percent respectively. A multivariate analysis showed that each day after surgery and without starting RT, the chances of survival decreased (p = 0.04). Conclusions: WT treatment has an excellent prognosis. Survival after 3 years stabilizes without presenting complications, regardless of the group to which the patient belongs. Among the prognostic factors for patients with RT prescription, this radiation should be started early, as close to the surgery as possible.

Leiomyosarcoma of the kidney: case report.

BACKGROUND: Renal sarcomas represent 1-2% of malignant kidney tumors in adults; 50% of renal sarcomas are composed of leiomyosarcomas. These tumors generally arise from the renal capsule, smooth muscle tissue of the renal pelvis and intrarenal vessels. They are indistinguishable from other renal masses prior to surgery and are associated with an adverse prognosis. CLINICAL CASE: We report the case of a 58-year-old female with a clinical course characterized by asthenia, weakness, generalized attack to her health status and pain in the left renal fossa. Computed axial tomography was performed where a left retroperitoneal tumor was diagnosed. Left radical nephrectomy was performed. The histopathology report demonstrated leiomyosarcoma originating from the renal sinus vessels. The patient was successfully treated with adjuvant radiotherapy. CONCLUSIONS: Renal leiomyosarcomas usually have an aggressive biological behavior with poor prognosis, accounting for surgical treatment with wide resection associated with adjuvant chemotherapy and radiotherapy as the only therapeutic option.

Cáncer renal metastásico (célula claras): tratamiento y resultados en pacientes del Hospital Nacional "Edgardo Rebagliati Martins". Essalud enero 2000 - diciembre 2005 / Metastatic kidney cancer (clear cell) patient treatment and outcomes in the National Hospital Edgardo Rebagliati Martins. Essalud January 2000 - December 2005

Objectivo: El principal objetivo fue determinar si la bioquimioterapia (tratamiento estándar) para los pacientes con Cáncer Renal de Células Claras Metastásico en el HNERM ofrece mayores respuestas y beneficio en la sobrevida con respecto a las otras modalidades de tratamiento empleadas en la misma institución. Pacientes y métodos. El presente estudio tuvo como población a pacientes con Cáncer Renal de Células Claras Metastásico, quienes fueron diagnosticados y tratados en Hospital Nacional “Edgardo Rebagliati Martins” - EsSalud, entre 2000 a 2005. Se evaluaron 50 pacientes, quienes fueron sometidos o no a nefrectomía y que posteriormente recibieron algún tipo de tratamiento médico como bioquimioterapia, corticoterapia, hormonoterapia, inmunoterapia y radioterapia, esta última como tratamiento único o en combinación con alguna otra modalidad anteriormente señalada. Estudio observacional. Resultados. La mayoría de los pacientes con Cáncer Renal de Células Claras Metastásico fue mayor de 60 años (68 por ciento) y del sexo masculino (76 por ciento). Los sitios más frecuentes de metástasis fueron a nivel pulmonar y óseo (46 por ciento). De la totalidad de pacientes, el 60 por ciento fue sometido a nefrectomía, el 74 por ciento recibió algún tipo de tratamiento médico y hasta el 22 por ciento pasó a cuidados paliativos por pobre status performance al momento del diagnóstico. Los pacientes recibieron bioquimioterapia hasta en 24 por ciento, corticoterapia en 8 por ciento, hormonoterapia e inmunoterapia, 12 por ciento; y radioterapia en 38 por ciento (en su mayoría combinada con alguna de las anteriores). La mediana de sobrevida libre de progresión y sobrevida global fue de 8.2 m. La sobrevida global de los pacientes nefrectomizados fue de 20.3 m vs. 4 m. de los no nefrectomizados (diferencia estadísticamente significativa), de los nefrectomizados más bioquimioterapia fue 14.2 m. vs. 20.3 m. de los nefrectomizados que recibieron cualquiera de las otras ...

Objectives: The main objective was to determine if the immunochemotherapy (treatment standard) for the patients with renal cancer of cells clear metas-tatic in HNERM offers bigger answers and benefit in the survival with regard to the other treatment modalities used in the same institution. Patient and meto-dos. Patients with renal cancer of cells clear metastatic who were diagnosed and treaties in the HNERM-EsSalud, among 2000 at 2005. 50 patients were evaluated who were subjected or not to nephrectomy and that later on they received some medical treatment type Results. Most of patient with cancer renal of cell clear metastatic was bigger than 60 years (68 per cent) and of the mascu-line (76 per cent) sex. The most frequent places in metastatic went at lung and bone (46 per cent) level. Of the entirety of patient 60 per cent was subjected to nephrectomy 74 per cent received some medical treatment type and until 22 per cent it went to cares palliatives by poor status performance to the moment of the diagnosis. The patients received immunochemotherapy until 24 per cent, corticotherapy 8 per cent, hormonotherapy and immunotherapy, 12 per cent; and radiotherapy 38 per cent (in their majority combined with some of the previous ones). The disease-free survival and median overall survival was of 8.2 m.The overall survival of the patient treated with a nephrectomy was of 20.3 m. vs. 4 m. of the without nephrectomy (differs statistically significant), of the patient treated with a nephrectomy more immunochemotherapy it was 14.2m vs 20.3m of the withoutnephrectomy that they received anyone of the other treatment ( differs not statistically significant) modalities. Conclusions. The immunochemotherapy is the mostly suitable treatment for patient with renal cancer of cells clear metastatic in HNERM; however she was not advantages as for answer and survival regarding the other treatment modalities. Also it was evidenced that the overall survival increases significantly ...

[Localized renal adenocarcinoma. Prognostic factors and influence of postoperative irradiation on survival]. / Adenocarcinoma renal localizado. Factores de pronóstico e influencias de la irradiación postoperatoria en la supervivencia.

Presentation of our experience and results in the treatment of localized renal adenocarcinoma with radiotherapy supplementary to surgery. The influence of post-operative radiotherapy in the subsequent occurrence of relapse and survival is analyzed. Also, the predictive value in our series of pre-surgery VSG, FA and LDH determinations is analyzed.

Hepatotoxicity of chemotherapy following nephrectomy and radiation therapy for right-sided Wilms tumor.

Two children developed hepatotoxicity during treatment for right-sided Wilms Tumor. Treatment consisted of nephrectomy, irradiation, and chemotherapy with actinomycin D and vincristine. Hepatic enlargement, thrombocytopenia, and abnormalities in liver function and seen on the liver scan occurred at the time of the course of chemotherapy administered 20 days after completion of irradiation. These abnormalities disappeared when treatment was temporarily suspended. Vincristine and actinomycin D were subsequently reintroduced without evidence of hepatotoxicity. Actinomycin D after irradiation for right-sided Wilms tumor may produce severe liver toxicity.