Mavrichev A S, Krasnyĭ S A, Sukonko O G, Poliakov S L, Panov O V
Urol Nefrol (Mosk). 1995 Nov-Dec(6):6-10.
The paper provides the analysis of treatment outcomes in 199 patients with local renal carcinoma. The highest effects were achieved in radical surgery followed by general hyperthermia with hyperglycemia and adriamycin chemotherapy. This approach allows to prolong the survival to 5 years in 94.3 +/- 5.5% of patients with renal carcinoma and tumor occlusion in the veins as well as in 60.9 +/- 10.4% of patients with metastases to the regional lymph nodes. These results are significantly better than in surgical and combined treatment including radiation. Preoperative large-fraction radiotherapy (14 Gy) significantly increases 5-year survival of renal cancer patients with tumor thrombus in the renal vein or inferior vena cava from 26.9 +/- 12.0 to 63.5 +/- 13.5% (p < 0.05). Additional postoperative radiotherapy in 2Gy fractions to total dose 40 Gy fails to affect survival of the above patients. Combined treatment using preoperative large-fraction (14 Gy) and postoperative radiation in routine fractions (40 Gy) significantly improves 5-year survival against surgical treatment (22.2 +/- 7.1 and 5.4 +/- 3.8%, respectively) in patients with renal carcinoma metastasizing to regional lymph nodes. Large-fraction preoperative radiotherapy only in these patients adds little to the treatment efficacy.
该论文对199例局限性肾癌患者的治疗结果进行了分析。根治性手术的效果最佳，其次是高血糖合并全身热疗及阿霉素化疗。这种方法可使94.3±5.5%的肾癌伴静脉肿瘤阻塞患者以及60.9±10.4%的有区域淋巴结转移患者的生存期延长至5年。这些结果明显优于包括放疗在内的手术及综合治疗。术前大分割放疗（14 Gy）可使肾静脉或下腔静脉有肿瘤血栓的肾癌患者的5年生存率从26.9±12.0%显著提高至63.5±13.5%（p<0.05）。术后以2 Gy分割追加放疗至总剂量40 Gy对上述患者的生存率无影响。对于转移至区域淋巴结的肾癌患者，术前大分割（14 Gy）联合术后常规分割放疗（40 Gy）的综合治疗显著提高了5年生存率，优于单纯手术治疗（分别为22.2±7.1%和5.4±3.8%）。仅对这些患者进行术前大分割放疗对治疗效果的提升不大。
