In the treatment of primary renal disease, radiotherapy has been used as a preoperative (17,18,19) or postoperative (20) surgical adjuvant, but has not gained wide acceptance in either scenario due to toxicity and questionable efficacy (21). More contemporary literature describing three-dimensional conformal radiotherapy methodology again suggests benefit with post-operative adjuvant treatment in high-risk RCC patients, such as those with perinephric fat invasion and positive surgical margins (22).

Definitive radiotherapy by itself has not been used in the primary curative treatment of RCC, due to the perceived or actual radioresistance of these lesions, and the exquisite sensitivity of normal renal parynchema and adjacent GI tissue to radiation, which has limited the applied dose to a sub-curative level when conventional techniques have been used.

The larger experience with radiotherapy for RCC has been gained against symptomatic metastatic disease, where there seems to be a dichotomy of reported responses. A high frequency of favorable responses against painful bone metastatic lesions has been reported by multiple authors (12,14, 15), whereas uniformly dismal results have been reported for conventional palliative radiotherapy for RCC metastatic to brain (12,13,16). In the treatment of metastatic disease, there remains uncertainty as to the appropriateness of the term “radioresistant,” as some authors have described a dose response curve favoring higher dose regimens (14), while others have reported response rates in excess of 80% with conventional palliative radiotherapy doses (12,15).