Need for a new trial to evaluate postoperative radiotherapy in renal cell carcinoma: a meta-analysis of randomized controlled trials.
BACKGROUND
A meta-analysis was conducted to assess the impact of postoperative radiotherapy (PORT) in renal cell carcinoma (RCC) on overall survival (OS), disease-free survival (DFS) and locoregional failure (LRF).


METHODS
The Medline, CANCERLIT, Cochrane library database and search engines were searched to identify randomized controlled studies comparing radical nephrectomy alone with radical nephrectomy followed by PORT for localized RCC. Further, radiotherapy techniques and associated side-effects were evaluated.


RESULTS
Seven controlled trials with a total patient population of 735 were identified. Pooled results from these trials showed a significant reduction of LRF in patients treated with PORT (P < or = 0.0001). However, there was no difference in OS (P = 0.29) and DFS (P = 0.14). The majority of patients was treated with larger field sizes with parallel-opposed anteroposterior fields. PORT was generally well tolerated; in total, six PORT-related deaths were seen. The resultant funnel plot was broader (Egger test P = 0.14) due to low number of patients.


CONCLUSIONS
PORT significantly reduces LRF but has no effect on OS and DFS. However, due to poor patient accrual and older radiotherapy techniques in previous studies, there is a need for a new trial to evaluate PORT using conformal and intensity-modulated radiotherapy techniques.
Tunio
M A
MA
Departments of Radiation Oncology. Electronic address: drmutahirtonio@hotmail.com.
Hashmi
A
A
Urology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
Rafi
M
M
Departments of Radiation Oncology.
D002292:Carcinoma, Renal Cell / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D007680:Kidney Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D011184:Postoperative Period; D050397:Radiotherapy, Intensity-Modulated; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D015996:Survival Rate