[Management of patients with kidney cancer without distant metastases].

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.