Radiation induced renal cell cancer: a report of 4 cases and review of the literature.

PURPOSE

During clinical care in the University of Chicago renal cell carcinoma program there was 1 case of prior radiation therapy for a neuroblastoma (patient age 16 months). After this index case was found our investigation was conducted to identify other cases with apparent radiation therapy induced renal cell carcinoma and review the literature on the subject.

MATERIALS AND METHODS

The clinical summaries of 573 cases from the University of Chicago renal cell carcinoma program from 1992 through 1998 were reviewed.

RESULTS

Four cases (3 men and 1 woman) of renal cell carcinoma, including the index case, were identified with prior therapeutic radiation therapy. Of the patients 3, 32, 35 and 36 years old, had been radiated for neuroblastoma 31, 32 and 35 years, respectively, before diagnosis of renal cell carcinoma and 1 (age 64 years) had been radiated for testicular seminoma 25 years earlier. The 32-year-old patient had 2 primary renal cell carcinomas in the remaining kidney and an associated leiomyosarcoma. He was alive and disease-free on dialysis 8 years after diagnosis. The 35-year-old patient had localized well differentiated renal cell carcinoma and was disease-free for 24 months. The 36-year-old patient had relapse 7 years after nephrectomy and had progressive refractory disease 12 years after diagnosis. The 64-year-old patient had relapse in 2.5 years but was alive with metastatic disease 4 years later. A literature review documented 4 other patients with renal cell carcinoma of those with neuroblastoma treated with radiation therapy.

CONCLUSIONS

Radiation therapy induced renal cell carcinoma is rare (less than 1% of renal cell carcinoma cases), and in our 4 cases it occurred 25 to 35 years after radiation. The risk of renal cell carcinoma should be considered during long-term followup of patients exposed to radiation therapy.