[Prostate cancer incidence on specimen of cystoprostatectomy for infiltrative bladder cancer].
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Adenocarcinoma↗
Biomedical subjects
Marc Zerbib
Publications and source records attributed to Marc Zerbib.
Chromophobe renal cell carcinoma: analysis of 61 cases.
BACKGROUND: Chromophobe renal cell carcinoma (CRCC) is often associated with a favorable prognosis. However, to the authors' knowledge, only few clinical data are available regarding this variant of tumor. In the current study, the authors report their experience with CRCC over the last 14 years. METHODS: Since 1989, 61 patients have been treated at the study institution for CRCC. Tumor characteristics and patient outcome were analyzed retrospectively. Data were obtained from the patients' medical records. RESULTS: The mean age of the patients was 58 years. Of the 61 tumors, 68.8% were discovered incidentally. The mean tumor size was 6.9 cm. Fifty-seven patients (93.4%) were treated with radical nephrectomy and 4 patients (6.6%) underwent partial nephrectomy. According to the 1997 TNM classification, the pathologic tumor stage was T1 in 65.6% of cases, T2 in 31.1% of cases, and T3a in 3.3% of cases. All tumors were staged as N0M0. Nuclear grade was low (1 or 2) in 88.5% of cases. In no case of CRCC was a sarcomatoid component observed. At a mean follow-up of 49.5 months (range, 5-135 months), no patient had experienced tumor recurrence or disease progression, and none had died of renal carcinoma. CONCLUSIONS: In the authors' experience, CRCC carries an excellent prognosis, possibly due to the high rate of low-stage and low-grade tumors.
Adult↗
Surgical management of infiltrating bladder cancer in elderly patients.
OBJECTIVES: To review the surgical therapeutic options in elderly patients with infiltrating bladder cancer. METHODS: A review of the literature relevant to cystectomy and transurethral resection for infiltrating bladder cancer in elderly patients was conducted using Medline Services. RESULTS: Thanks to progress in anaesthesia, intensive care and surgery, cystectomy now forms part of the classical treatments for bladder cancer in elderly patients, with acceptable mortality and morbidity rates. The recent series of cystectomies performed in patients over 75 years old report a mortality rate associated with the procedure of less than 4.5%. The global mortality rate in the same population ranges from 10 to 50%. These rates are now similar to those reported in the general population. The mean survival after cystectomy in patients over 75 years old is more than 2 years. Global survival at 5 years is between 37 and 68%. It is acknowledged by most authors that resection alone is associated with higher relapse and progression rates than cystectomy. CONCLUSIONS: Cystectomy appears to be reasonable in elderly people who have a life expectancy of more than 2 years, provided that a rigorous pre-operative assessment and anaesthetic management are performed. Transurethral resection alone should be proposed only to patients with poor health status and/or very advanced age.
Age Factors↗
Concurrent chemoradiotherapy for clinical stage T2 bladder cancer: report of a single institution.
OBJECTIVES: To report our experience with concurrent chemoradiotherapy for clinical Stage T2 bladder cancer. METHODS: From 1996 to 2002, 43 patients were treated with concurrent chemotherapy and radiotherapy for clinical Stage T2 bladder cancer. After complete bladder transurethral resection, all patients underwent chemotherapy, consisting of one daily infusion of cisplatin at a dose of 15 mg/m2 and 5-fluorouracil at a dose of 400 mg/m(2) on days 1 to 3 (first cycle) and days 15 to 17 (second cycle). Pelvic irradiation was administered at a dose of 24 Gy, using two daily fractions of 3 Gy on days 1, 3, 15, and 17. Random biopsies were performed 6 weeks after the end of the first two cycles. Patients with persistent invasive tumor underwent cystectomy; others received two additional cycles of concurrent chemoradiotherapy. RESULTS: The mean follow-up was 36.3 months (range 3 to 72). Nine patients underwent early cystectomy for nonresponse, and 2 patients underwent delayed cystectomy. The overall rate of cystectomy was 25.6%. The rate of specific survival at 3 and 5 years was 75% and 60%, respectively. The overall rate of recurrence-free survival at 3 and 5 years was 63% and 33%, respectively. Two factors correlated with patient survival: the presence of carcinoma in situ at first resection (P = 0.01) and the response after the first two cycles (half dose; P = 0.004). CONCLUSIONS: In our experience, concurrent chemoradiotherapy is less effective than primary cystectomy for clinical Stage T2 bladder cancer. This treatment may be unwarranted in patients with concomitant carcinoma in situ at the first resection.
Adult↗
Stripping technique for endoscopic management of distal ureter during nephroureterectomy: experience of 32 procedures.
OBJECTIVES: To assess the results of the stripping technique for endoscopic management of the distal ureter during nephroureterectomy. METHODS: Since 1995, 32 patients have undergone open nephroureterectomy involving stripping of the distal ureter for upper urinary tract carcinoma. After endoscopic placement of a Chevassu ureteral catheter, nephrectomy was performed using a lumbotomy approach. The catheter tip was tied to the top of the ureteral extremity. At the end of the intervention, the catheter was pulled out transurethrally to intussuscept the distal ureter. Endoscopic resection through the bladder muscular wall was performed around the everted ureteral orifice, then the distal ureter was stripped and removed with a bladder cuff. RESULTS: The mean operative time was 180 minutes, and the mean blood loss was 220 mL. The stripping failed in 6 patients (18.7%), requiring an iliac incision. The reasons for failure were a retained ureter in 5 cases and ureteral breakage in 1 case. The mean duration of urethral catheterization was 5 days, and the mean hospital stay was 8 days. The complication rate was 3.1%. At a median follow-up of 35.2 months, 9 patients (28.1%) had experienced recurrence: 6 with superficial bladder tumors, 2 with renal fossa recurrence, and 1 with asynchronous liver metastases. The disease-specific mortality rate was 9.4%. CONCLUSIONS: These results confirm that the stripping technique for endoscopic management of the distal ureter during open nephroureterectomy is a simple and safe procedure.
Aged↗
Development of a bladder stone following a tension-free vaginal tape intervention.
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Female↗
[Review of the value of BCG maintenance therapy in superficial bladder tumours].
This article reviews the benefits of BCG maintenance therapy in ment patients with superficial bladder tumours. The rare published studies conclude on contradictory results. These differences can probably be explained by the variability of the protocols used, the small number of patients included, and the heterogeneity of the series (presenting tumours of different stages and grades). In the largest series, that reported by the Southwest Oncology Group SWOG), maintenance therapy significantly reduced the risk of tumour recurrence and progression in carcinomas in situ and recurrent Ta or T1 tumours. The treatment recommended by the SWOG consists of a weekly instillation for 3 weeks 3, 6, 12, 18, 24, 30 and 36 months after induction therapy.
Adjuvants, Immunologic↗
[Treatment of biological recurrence after treatment of localized prostatic cancer].
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Humans↗
[Advances in diagnosis and treatment of renal cell carcinoma].
Over the last two decades, several improvements have been made in the diagnosis and treatment of renal carcinoma. In the past, renal cancer was usually discovered after hematuria, pain, or palpation of a lumbar mass, and required total nephrectomy. Today, about 40% of renal tumors are discovered incidentally by ultrasonography or computed tomography. Therefore, the majority of renal carcinomas are discovered at an early stage. Partial nephrectomy has been developed for polar and small tumors. This surgery can now be performed using a laparoscopic approach, thereby decreasing morbidity and shortening the hospital stay.
Carcinoma, Renal Cell↗
[Polycythaemia and renal cancer. Report of 5 cases].
The authors report 5 cases of polycythaemia associated with renal cancer. This paraneoplastic syndrome is present in less than 5% of all renal cancers. It is considered to be a factor of poor prognosis, as it is often associated with metastatic and/or high-grade cancer Polycythaemia, secondary to secretion of erythropoietin (EPO) by the tumour, is reversible after nephrectomy. The persistence or recurrence of polycythaemia after nephrectomy may indicate incomplete local resection or the presence of EPO-secreting metastases.
Humans↗
[Sexual function after radical prostatectomy does not affect global patient satisfaction].
OBJECTIVES: To evaluate the quality of life after retropubic radical prostatectomy (RP) and its impact on global patient satisfaction concerning the treatment received. PATIENTS AND METHODS: 142 questionnaires were sent to patients treated for a localized prostate cancer by RP alone, with a minimum follow-up of 2 years. The questionnaire was the validated French version of the "UCLA-Prostate Cancer Index". A question concerning global patient satisfaction with treatment was added. RESULTS: 102 questionnaires were returned and analysed. The mean age of the patients at the time of RP was 63.8 years and the mean follow-up was 48 months. Evaluation of global satisfaction showed that 35/102 (343%) patients were very satisfied, 45/102 (44.1%) were satisfied, 15/102 had no opinion, 4/102 (3.9%) were dissatisfied and 3/102 (29%) were very dissatisfied. General quality of life scores ranged from 72 to 87 on a scale from 1 to 100 (where 100 corresponds to the best quality of life). For specific quality of life, the mean scores for sexual function and dysfunction were 27.5 and 25.1, respectively. The mean scores for urinary function and dysfunction were 72.5 and 67.8, respectively. Urinary function scores and seven of the nine general quality of life items were significantly correlated with better global patient satisfaction, but sexual function was not related to global satisfaction. CONCLUSIONS: Although sexual function is markedly altered after RP, it does not affect global patient satisfaction with the treatment received. Urinary function and general quality of life are significantly correlated with global satisfaction.
Aged↗
[Renal cancer presenting as an isolated cutaneous metastasis].
The authors report a case of renal cell carcinoma presenting as an isolated cutaneous metastasis of the scalp. This rare presentation is often associated with a poor prognosis. This case emphasizes the importance of looking for a primary renal cancer in the case of a cutaneous secondary clear cell adenocarcinoma.
Aged↗
[Bellini renal cell carcinoma. Diagnosis and treatment].
The Bellini collecting duct carcinoma is a very rare form of renal cell carcinoma (1%). It presents at the stage of metastases in the very great majority of cases. The diagnosis should be considered in patients presenting with marked deterioration of the general status and/or the presence of a very large invasive renal tumour on abdominal CT scan. The overall 2-year survival rate of Bellini carcinoma is about 20%. As the prognosis is very poor, even despite radical nephrectomy, biopsy may be performed as the first-line procedure when the diagnosis is suspected. In the case of primary metastatic Bellini carcinoma, radical nephrectomy alone appears to be useless and dangerous except for analgesic purposes or in the context of new multicentre chemotherapy protocols, combining gemcitabine and cisplatin, currently under evaluation.
Carcinoma, Renal Cell↗
Salvage radiotherapy for biochemical recurrence after radical prostatectomy: a study of 62 patients.
OBJECTIVES: To determine the predictive factors of prostate-specific antigen (PSA) recurrence after salvage radiotherapy (RT) for biochemical recurrence following radical prostatectomy (RP) to identify patients who may benefit from this treatment. METHODS: From June 1992 to January 2002, 62 patients experiencing PSA recurrence after RP were treated with RT at a dose of 65 Gy. No patient received hormonal therapy. PSA recurrence after RT was defined as three consecutive increased PSA measurements. The risk of experiencing PSA recurrence after RT was analyzed according to 10 factors: patient age, pre-RP PSA level, pathologic stage, Gleason score, surgical margin status, PSA nadir after RP, time to PSA recurrence after RP, pre-RT PSA level, PSA nadir after RT, and length of follow-up after RT. RESULTS: With a mean follow-up of 44 months (range 3 to 110), 23 patients (37.1%) experienced PSA recurrence after RT. Using univariate analysis, six factors were found to be predictive of PSA recurrence after RT: the length of follow-up after RT (P <0.0001), PSA nadir after RP (P = 0.0004), time to PSA recurrence after RP (P = 0.003), pre-RP PSA level (P = 0.008), Gleason score (P = 0.011), and pre-RT PSA level (P = 0.028). Using multivariate analysis, only the Gleason score (P = 0.015) and length of follow-up after RT (P = 0.02) were found to be predictive of PSA recurrence after RT. A Gleason score greater than 7 was a significant predictor of PSA recurrence after salvage RT (P = 0.04). CONCLUSIONS: In our experience, the Gleason score and length of follow-up were the sole independent predictors of PSA recurrence after salvage RT. Our findings suggest that patients with a Gleason score of 7 or less are more likely to benefit from salvage RT after RP and that the durability of the PSA response may be only transient.
Adenocarcinoma↗
The value of a second transurethral resection in evaluating patients with bladder tumours.
OBJECTIVES: To evaluate the usefulness of a second transurethral resection for superficial and muscle-invasive bladder tumours. METHODS: A review of the literature relevant to repeat resection for bladder tumours was conducted using Medline Services. RESULTS: Transurethral resection of the bladder has two shortcomings: underestimating clinical stage, and overlooking other lesions. A second transurethral resection, when performed 2-6 weeks after the initial resection, corrects clinical staging errors in 9-49% of cases and detects residual tumour in 26-83% of cases. A second resection is particularly warranted for T1 tumours since 2-28% of them prove to be muscle-invasive, thus requiring a change in management. For muscle-invasive tumours, a second resection may be performed only if bladder sparing is being considered, as it helps to exclude the presence of tumour sites contra-indicating conservative treatment. CONCLUSIONS: A second transurethral bladder resection may be warranted for T1 tumours, and for invasive tumours when a bladder preservation is planned.
Cystectomy↗
Intravesical bacillus Calmette-Guerin therapy for stage T1 grade 3 transitional cell carcinoma of the bladder: recurrence, progression and survival in a study of 57 patients.
PURPOSE: Stage T1 grade 3 transitional cell carcinoma of the bladder is associated with a high risk of tumor recurrence and progression. We report our experience with stage T1 grade 3 bladder tumors treated with bacillus Calmette-Guerin (BCG) therapy in the last 10 years. MATERIALS AND METHODS: We analyzed the outcome in 57 consecutive patients treated with intravesical BCG for stage T1 grade 3 bladder cancer between 1991 and 2001. After initial transurethral resection all patients received a 6-week course of BCG therapy consisting of 1 instillation weekly. All patients underwent systematic biopsies at the end of the first BCG course. Patients with negative biopsies received maintenance BCG therapy, consisting of intravesical instillations each week for 3 weeks given 3, 6, 12, 18, 24, 30 and 36 months after the first course. Patients with residual tumor received a second course of 6 weekly instillations. Time to tumor recurrence and progression, and the rate of patient survival were retrospectively analyzed. RESULTS: Median followup was 53 months (range 9 to 110). Minimum followup was 2 years in 36 cases (63.2%) and 5 years in 28 (49.1%). After the first BCG course 50 patients (87.7%) had no residual disease, while 7 (12.3%) had residual tumor. The recurrence and progression rates were 42.1% and 22.8%, respectively. The rate of delayed cystectomy was 14%. The rate of disease specific survival was 87.7%. CONCLUSIONS: Our study confirms that BCG therapy is effective conservative treatment for patients with stage T1 grade 3 bladder tumors.
Administration, Intravesical↗
[Testicular germ cell tumors: prognosis].
OBJECTIVES: To assess the prognosis of germ cell tumours of the testis based on a series of 60 patients. MATERIAL AND METHODS: The files of 60 patients consecutively operated for germ cell tumour of the testis between February 1988 and January 2002 were reviewed. Tumours were classified as 35 seminomas (S) and 25 non-seminomatous germ cell tumours (NSGCT). In the S group, 32 patients received either prophylactic (28 pT1N0M0 tumours and 2 pT2N0M0 tumours) or therapeutic (1 pN2M0 tumour) adjuvant radiotherapy. The other 3 patients received BEP chemotherapy (1 pT3N0M0 tumour and 2 pN2M0 tumours). In the NSGCT group, 15 patients received adjuvant BEP chemotherapy (1 pT1N0M0 tumour, 5 pT2N0M0 tumours, and 7 pN2-3 and/or M+ tumours). Primary lymph node dissection was not performed in any patient, but 7 patients underwent lymph node dissection for residual masses after chemotherapy. RESULTS: The mean follow-up after orchidectomy was 85.2 months. One patient in the S group developed left supraclavicular recurrence of a pT1N0M0 tumour, requiring 3 complementary cycles of BEP. All patients were in complete remission at the end of follow-up. In the NSGCT group, there was one recurrence after secondary lymph node dissection, requiring 3 complementary cycles of BEP. Only one death (4%) occurred after 18 months. All other patients were in complete remission at the end of follow-up. CONCLUSIONS: The mortality rate of germ cell tumour of the testis was low in this series (0% for S and 4% for NSGCT at 7 years). These results are comparable to those reported in the literature. In our experience, stage pT1N0M0 NSGCT may be suitable for close surveillance, with no adjuvant therapy. It also does not appear justified to perform primary lymph node dissection in seminomas with lymph node involvement.
Antineoplastic Agents↗
[UCLA/RAND Cancer Prostate Index quality of life questionnaire after external beam radiotherapy for localized prostate cancer: repercussions of complications and quality of life in general].
INTRODUCTION: This study was designed to evaluate the quality of life after external beam radiotherapy for localized prostate cancer using the UCLA/RAND Cancer Prostate Index questionnaire. MATERIAL AND METHODS: An accurate translation of the questionnaire was retrospectively sent to 108 patients treated for localized prostate cancer by exclusive external beam radiotherapy between 1989 and 1999. The reference values adopted for comparison were those observed by Litwin in a control population without prostate cancer. Patient subgroups were constituted according to the presence or absence of neoadjuvant endocrine therapy and laboratory signs of progression (ASTRO). RESULTS: The response rate was 61.1%, the mean age of the patients was 71.9 years and the mean follow-up was 46.5 months. The percentage of patients "living in a couple" or with "a serious relationship" was 93.4% Three quarters of the population declared that they were "satisfied" or "very satisfied" with the treatment performed. General quality of life scores were comparable to those of Litwin's control population. A functional alteration and decreased tolerance of impairment were observed, in decreasing order, for the sexual, gastrointestinal and urinary factors. CONCLUSION: External beam radiotherapy essentially alters quality of life related to gastrointestinal and sexual functions, while the only aspect of urinary function studied by this questionnaire is continence.
Aged↗