Intravesical chemotherapy and immunotherapy: how do we assess their effectiveness and what are their limitations and uses?
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Administration, Intravesical↗
Biomedical subjects
H Akaza
Publications and source records attributed to H Akaza.
[High-dose chemotherapy with autologous bone marrow transplantation or peripheral blood stem cell transplantation--testicular cancer].
Through advances in chemotherapy with the appearance of the drug cisplatin, testicular cancer treatment has improved dramatically. Consequently, testicular cancer has become one of the group of tumors that can be completely cured. Even in advanced testicular cancer, a curative rate of approximately 70% is obtainable from first-line chemotherapy, commonly by BEP combination. The problem, however, is treatment of the remaining 30% of the patients who fail to respond to first-line chemotherapy or who relapse shortly after first-line chemotherapy. Supportive therapy strengthens the chemotherapy of testicular cancer, for example, high-dose chemotherapy with carboplatin and etoposide with autologus bone marrow rescue, either by autologus bone marrow transplantation or peripheral blood stem cell transplantation, which can cure 15% to 20% of patients whose disease has progressed during prior chemotherapy combined with cisplatin. Though more cases of relapse were observed with high-dose chemotherapy compared to first-line chemotherapy, and the long-term prognosis is unknown, we should evaluate the usefulness of high-dose chemotherapy as an initial treatment for testicular cancer patients with poor prognoses.
Antineoplastic Combined Chemotherapy Protocols↗
[The antiemetic effect, safety and usefulness of tropisetron capsule in the treatment of nausea and vomiting induced by lower multiple dose of cisplatin].
The antiemetic effect, safety and usefulness of once daily administration of tropisetron 5 mg capsule for 3 to 5 consecutive days was investigated in 37 cases of 12 stations in total, suffering from nausea and vomiting induced by a lower multiple dose of cisplatin. The efficacy ratings assessed every 24 hours on day 1, 2, 3, 4 and 5 were 88.6%, 85.7%, 82.9%, 74.1% and 76.9%, respectively. The final efficacy rating was 82.9% (29/35 cases). Although no adverse event was observed, increases in GOT and GPT, whose cause and relation to the investigational drug were unknown, were noted in 2 cases. Cases rated as useful or better were 82.9% (29/35 cases) of the overall. The above results reveal that tropisetron 5 mg capsule is significantly effective and highly safe in the treatment of nausea and vomiting induced by lower multiple dose of cisplatin. Tropisetron 5 mg capsule is thus deemed extremely useful antiemetic drug.
Antiemetics↗
A prognostic significance of nucleolar organizer region (AgNOR) in renal cell carcinoma.
PURPOSE: Evaluation of prognostic significance of nucleolar organizer regions (NORs) in renal cell carcinoma (RCC). MATERIALS AND METHODS: Nuclear organizer regions were quantified in a series of 59 cases of RCC by the silver colloid method, and the NOR index was obtained from the ratio between mean NOR counts in each neoplastic nucleus and in normal nucleus. The patients were staged pathologically and divided into 2 groups by average NOR index of all cases, which was 0.76. Correlations between the NOR index and other parameters were statistically analyzed, and the prognostic value of the NOR index was also examined. RESULTS: The NOR indices from each group were correlated with the survival curve. In low stage tumors (pT1 or 2 N0M0), the low NOR index group had a survival rate of almost 100 per cent while in those patients with higher NOR indices, there was a significantly increased mortality (p < 0.01). In patients presenting with high stage tumors (excluding pT1 and 2 N0M0), the survival rate was significantly improved in those patients with a low NOR index (p < 0.01). On the other hand, the patients with a low NOR index have a better prognosis than those with a high NOR index within each tumor grade (p < 0.01). Statistical analysis by the log rank test indicated NORs to be a significant predictor of survival over the whole series within low and high pathological stages and within each tumor grade. Analysis of the data with Cox's proportional hazard model showed that NOR index had a stronger hazard ratio than grade or stage of tumor (p = 0.0005). CONCLUSIONS: Our study has demonstrated that NOR index is a new prognostic indicator for patients with RCC (p = 0.0005).
Carcinoma, Renal Cell↗
Renal oncocytoma mimicking hemorrhagic renal cyst.
A case of oncocytoma, the radiological findings of which resembled a hemorrhagic renal cyst, is reported. Cyst fluid analysis demonstrated extremely high levels of carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9). Preoperatively the lesion was regarded a malignant cyst, and radical nephrectomy was performed. Pathological diagnosis was renal oncocytoma with cystic degeneration. Although cystic change occasionally has been mentioned in oncocytoma, a high level of CEA and CA 19-9 in the cyst fluid of the cystic oncocytoma have not been reported. We discuss the variant forms of oncocytoma and tumor markers in the cyst fluid.
Adenoma, Oxyphilic↗
The effect of dose intensity on M-VAC therapy for advanced urothelial cancer.
M-VAC therapy (methotrexate, vinblastine, Adriamycin, and cisplatin) has improved the treatment results of urothelial cancer patients. However, it is sometimes complicated by drug toxicities, including bone marrow suppression. We analyzed the relative dose intensity in each patient undergoing M-VAC chemotherapy in relation to the chemotherapeutic effect and survival. In addition, the role of granulocyte colony-stimulating factor (G-CSF) in the dose intensity of M-VAC therapy was analyzed. Between June 1988 and March 1993, 29 patients with advanced urothelial cancer were treated with M-VAC therapy in our institution. Of 18 patients with evaluable lesions, 2 (11.1%) showed a complete response (CR) and 7 (38.9%) showed a partial response (PR), and the overall response rate was 50.0%. The median follow-up period for these 18 patients was 14.6 months and the median survival was 8.7 months, with 12 of the 18 patients being alive at the time of analysis. The relative dose intensity (RDI) for these 18 patients was 0.81 for methotrexate, 0.80 for vinblastine, 0.92 for Adriamycin, and 0.91 for cisplatin, for a mean RDI of 0.87. There was no correlation between the chemotherapeutic effect and the RDI. When we calculated the RDI for all 29 patients who underwent M-VAC therapy, G-CSF increased the RDI of Adriamycin significantly. The results of this retrospective study indicate that a dose intensity for M-VAC therapy in the range of 0.61-1.00 is unlikely to correlate with the chemotherapeutic effect, although G-CSF contributes to increasing the RDI of Adriamycin.
Adenocarcinoma↗
Prophylactic chemotherapy with intravesical instillation of adriamycin and oral administration of 5-fluorouracil after surgery for superficial bladder cancer. The Japanese Urological Cancer Research Group for Adriamycin.
The Japanese Urological Cancer Research Group for Adriamycin has conducted a series of clinical trials to investigate the efficacy and safety of prophylactic intravesical chemotherapy for superficial bladder cancer. In the third trial, reported herein, patients with recurrent bladder cancer or multiple primary cancer were selected and randomized to one of four groups using the envelope method after complete resection of the original tumors. Group A was given Adriamycin alone, group B received oral 5-fluorouracil (5-FU), group C was given Adriamycin and oral 5-FU, and group D served as the control group. Of the 544 patients registered, 331 were evaluable for the purpose of this study. The administration of 5-FU (group B) failed to prevent the recurrence of bladder tumors. Although group C (both Adriamycin and 5-FU) did not fare better than group A (Adriamycin only), Adriamycin was effective in preventing the recurrence of tumors, especially in high-risk patients with recurrent and multiple tumors. The risk of recurrence was reduced to 0.21 (95% confidence interval, 0.10-0.44) relative to the control group. There was no indication of a synergistic effect between 5-FU and Adriamycin. As side effects, cystitis syndrome was observed in 23%-30% of the patients in the Adriamycin groups and mild myelosuppression was observed in the 5-FU groups.
Administration, Intravesical↗
A new tumor marker for bladder cancer.
Biochemical assay and immunohistochemical staining of neutral endopeptidase were performed on bladder cancer cells. In superficial bladder cancer the enzyme activity and immunohistochemical intensity of staining were high, while invasive bladder cancer showed only a low level of activity. This finding suggests that neutral endopeptidase is expressed at a certain stage of cell differentiation, during the neoplastic process in the bladder. Gene expression is assumed to be closely correlated with this mechanism. From the results of this study neutral endopeptidase will serve as a new tumor marker for bladder cancer as well as acute lymphatic leukemia.
Biomarkers, Tumor↗
Inhibitory effects of bestrabucil, a conjugate of chlorambucil and estradiol, on the production of androgen-induced growth factor(s) by Shionogi carcinoma 115 cells.
It is known that diffusible trophic factors play an important role in both the normal and cancerous growth regulatory processes of hormone-responsive cells such as are found in the prostate and mammary glands. Consequently, it is important to identify whether the production of such growth factors is affected by administration of therapeutic agents. We examined the effect of bestrabucil, a benzoate of an estradiol-chlorambucil conjugate, on the production of growth factor(s) by Shionogi carcinoma 115 (SC-115) cells, an androgen-responsive cultured cancer cell line. We then investigated whether the inhibitory effect found was specific to bestrabucil, or if it was also produced by a mixture of the 2 compounds, estradiol and chlorambucil. Bioassay employing BALB/3T3 cells demonstrated the presence of two kinds of growth factor in the conditioned medium obtained by culturing SC-115 cells in medium containing 10(-8) M testosterone; these factors could be separated by heparin-sepharose column chromatography using 0.5 M NaCl and 1.1 M NaCl. When the SC-115 cells were cultured in medium containing bestrabucil, at a concentration of 10(-5) M, no growth factor activity was detected in the fraction eluted from the heparin-sepharose column by 1.1 M NaCl. At bestrabucil concentrations of 10(-5)-10(-7) M, concentration-dependent inhibition of growth factor production by SC-115 cells could be demonstrated by 3H-thymidine uptake assay. However, this inhibitory effect could not be demonstrated using only a mixture of estradiol and chlorambucil.(ABSTRACT TRUNCATED AT 250 WORDS)
Androgens↗
[Transabdominal ultrasonography for detection of urologic diseases in the general health check].
From August, 1989 to December, 1992, 11,386 individuals consisting of 6,981 males and 4,405 females were examined in the general health check at Mito Saiseikai general hospital. Occult blood in dipstick urinalysis was detected in 190 of 6,981 males (2.7%) and 503 of 4,405 females (11.4%). Two renal cell carcinomas and ten bladder carcinomas were found out, but prostatic carcinoma could not be found out. None of these tumors were symptomatic. Two renal cell carcinomas, of which all patients had negative occult blood, were confirmed by computed tomography and angiography. Revealing the locally-confined tumor (Stage I) in the radiologic study, both tumors were resected with radical nephrectomy, and the pathological specimens showed pT2pNOpVO in both tumors. Of 10 bladder carcinomas seven transitional cell carcinomas, of which 6 patients had negative occult blood and one had positive occult blood, were confirmed by cystoscopy and TUR-BT. All of them were low-grade and low-stage tumors. Other three bladder carcinomas were detected by ultrasonography and cystoscopy, but these patient rejected TUR-BT. All of them had negative occult blood. We consider that the transabdominal ultrasonography is a very useful test for detecting the early stage of renal cancer and superficial bladder cancer. We recommend that transabdominal ultrasonography involving the kidney and the lower urinary tract should be performed in the general health check.
Adult↗
[Fibroepithelial polyp of the prostatic urethra: report of two cases and review of the literature].
Two cases of Fibroepithelial polyp in 47-and 74-year-old males complaining of gross hematuria are described. In the foreign literature, this polyp most commonly occurs in infancy and childhood in the first decade of life, but rarely occurs in aged male. Ten cases of this disease could be accumulated in the Japanese literatures, in which this polyp more commonly occurs in older generation compared with younger one. Urethral polyp should be considered in the differential diagnosis of gross hematuria.
Aged↗
[TNM classification].
Stage classification of cancer is a method for objectively describing the status of a tumor. For more than 30 years, the TNM classification system was applied on various kind of malignant neoplasms, whose basic principles were: 1) applicability to all anatomic sites; 2) independence from treatment, and 3) susceptibility to further modification on the basis of information supplied by surgery and histopathological description. Thus far, TNM classification system has made a great contribution to 1) aid the clinician in the planning of treatment; 2) give some indication of prognosis; 3) assist in evaluation of the results of treatment; 4) facilitate the exchange of information between treatment centers; 5) contribute to the continuing investigation of human cancer. However, the publication of the fourth edition of the TNM classification has caused great consternation to urologists because of lack of logic for its complete revision. In this review analyses were done on the changes in the TNM classification of the genitourinary tumors described in the 3rd, 4th and 4th revision. Discussion was also made in relation to the TNM systems and classification systems in the general rules for clinical and pathological studies on urological malignancy of Japanese Urological Association.
Humans↗
[Adult Wilms's tumor with histologically dissisimilar lung metastasis].
A 41-year-old man incidentally found to have a right renal and left large lung tumor in the course of screening for liver dysfunction was admitted to our hospital. Needle biopsy of each tumors revealed histologically renal cell carcinoma and pulmonary blastoma. The renal tumor grew rapidly and soon he died of DIC. Autopsy was performed and the final diagnosis was adult Wilms' tumor and its metastasis to the lung. Histological findings of each large tumors showed different histologic pattern. The renal tumor revealed diffuse nephroblastic subtype and the lung tumor showed epitherial type. This is a rare case of Wilms' tumor in terms of its adult onset and different histologic pattern between the primary tumor and its metastatic lesion.
Adult↗
[Clinical study of the advanced testicular tumor non-achieved complete response by primary chemotherapy and relapse cases. The East Japan Testicular Tumor Study Group].
The East Japan Testicular Tumor Study group has studied advanced testicular tumors. Treatment and prognosis of the patients who did not achieved complete response on the primary chemotherapy were discussed in this paper. Also 8 patients who had once reached complete response by primary treatments and relapsed later have been clinically analyzed. 1. Concerning the patients non-achieving complete response on the primary chemotherapy: Two cases who had resection of the residual tumors and 4 cases who had radiation therapy had reached NED in 7 cases of seminoma stage II. Nine of 10 cases in non-seminoma stage II reached NED on resection of the residuals. Moreover, 10 out of 17 cases in stage III showed NED on excision of the residuals. On the other hand, recuperating was very difficult in the cases who could not have excision of residual tumor. The histological findings of the residual tumors after chemotherapy were necrosis and fibrosis in 13 cases, viable cells in 4 cases, teratoma in 6 cases and other 2 cases were not clear. Five out of 15 who had teratoma in the primary lesion had teratoma in the resected residuals on metastatic lesion. On the other hand 5 patients who did not have teratoma originally had no any teratoma elements in the residuals. 2. Concerning the relapse cases by primary treatments: Although relapses were possible in any stages, they were more common with stage IIIB and IIIC cases. Those who achieved complete response after chemotherapy alone fewer relapse than those who had partial response after chemotherapy and there after had excision of residual tumor.(ABSTRACT TRUNCATED AT 250 WORDS)
Combined Modality Therapy↗
[Influence of Lactobacillus casei on rat bladder carcinogenesis].
The inhibitory effect of Lactobacillus casei (L. casei) in superficial bladder tumors was investigated in an experimental study using N-butyl-N (4-hydroxybutyl) nitrosamine (BBN)-induced rat bladder cancer as an experimental system. The study consisted of two experiments; in a short-term experiment, the inhibitory effect of 6-week treatment with L. casei was assessed in vitro in terms of the capacity for agglutination by concanavalin A (Con A) of bladder epithelial cells in their incipient stage of malignant transformation induced by 1-week exposure to BBN. As a result, the number of bladder epithelial cell aggregates caused by Con A was significantly smaller in the L. casei-treated group than in the non-L. casei-treated group (p < 0.001). In a long-term experiment, treatment with L. casei of varying duration was investigated for effectiveness against bladder tumors induced by 7-weeks exposure to BBN that arose 22 weeks. The results indicate that both bladder weight and tumor volume per organ were significantly lower in the L. casei-treated than non-L. casei-treated group (p < 0.05). The inhibitory effect on these parameters was more pronounced with treatment with L. casei of longer duration. While there was no significant difference among the treatment groups in the degree of extension of induced malignancy, tumors with a high degree of extension (T1b, T2) developed only in the non-L. casei-treated group. The degree of malignancy of induced tumors was significantly lower in those groups receiving L. casei while BBN was being administered as compared to the non-L. casei-treated group (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Effect of recombinant human granulocyte colony-stimulating factor in patients receiving methotrexate/vinblastine/doxorubicin/cisplatin therapy for the treatment of transitional cell carcinoma of the urinary tract.
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Animals↗
[Treatment of elderly patients with urological cancer].
The number of elderly patients with urological cancer is increasing, and it is becoming very difficult for urologists to decide on an appropriate treatment modality for each patient. Physical and socioeconomical problems make it impossible for the patients to accept a standard treatment for their disease. Between 1987 and 1992, 498 patients with urological cancer were hospitalized in our institute. Among them, 51 patients (10%) were 80 years of age or older. The average age of these older patients was 83.2 (80-93) years. There were 41 men, and 10 women. These older patients included 30 with bladder cancer, 15 with prostate cancer, three with renal cancer, and three with renal pelvic and ureteral cancer. The incidence of patients aged 80 or older was 18.5% for prostate cancer and 15.9% for bladder cancer. Eighty percent of these patients had complications such as cardiovascular disease, and fewer patients could be adapted treatment because of their physical condition. The median survival period was 21.6 months, with only 18 of the patients still living at the time of the analysis. Only 11 of the initial 51 patients (22%) still received follow-up treatment in the outpatient clinic of our institute, 10 of whom were lost during the follow-up. Our observations indicate that we should consider both the medical aspects and quality of life when we choose the suitable type of treatment.
Aged↗
Preliminary results of bladder-preserving therapy with definitive radiotherapy and intraarterial infusion of chemotherapy.
PURPOSE: For management of muscle-invading bladder cancer (clinical stages T2 to T4), combined treatment of definitive radiotherapy (RT) and intraarterial (IA) administration of chemotherapy was carried out for local cure and bladder preservation. METHODS AND MATERIALS: Between 1987 and 1990, a pilot study (Protocol-1) was initially conducted in 16 patients to investigate the efficacy of chemoradiotherapy where RT was combined with TURB and continuous IA infusion of cisplatin. We then performed a regimen of possible bladder-preservation treatment (Protocol-2) in which 19 patients were treated with combination of TURB, full-dose RT and one-shot IA infusion of cisplatin and methotrexate. In RT small pelvis irradiation was performed with x-rays followed by proton beam boost irradiation to the original tumor site. RESULTS: Among patients treated on Protocol-1, a tumor-free bladder was observed in 50% (2/4) after 50-76 Gy but only 8% (1/14) after 30-40 Gy. In this regimen, planned cystectomy was performed in 10 patients and 13 patients (81%) are alive. Among 19 patients treated on Protocol-2, 17 patients (89%) are alive and 13 patients (68%) retained intact bladders without any recurrence. There were 3 cystectomies performed because of persistent tumors. Using a conformal mode of proton beam irradiation, a total dose of 60-80 Gy was safely administered with acceptable morbidities. CONCLUSION: In the light of good complete response and survival rates achieved in the patients treated on Protocol-2, the combined treatment of definitive RT and IA administration of chemotherapy is considered as an effective bladder-preserving strategy.
Aged↗