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Biomedical subjects

W F Whitmore

Publications and source records attributed to W F Whitmore.

At least 55 records · Page 3Linked to original sources
PubMed1989

Intravesical bacillus Calmette-Guerin therapy for in situ transitional cell carcinoma involving the prostatic urethra.

A total of 23 patients presenting with multifocal superficial bladder cancer and concomitant in situ transitional cell carcinoma of the prostatic urethra (mucosal in 19 and ductal in 4) underwent transurethral resection and intravesical bacillus Calmette-Guerin therapy. Median followup was 51.6 months (range 6 to 105 months). Of the 23 patients 13 (48 per cent) had a complete response with a median followup of 43.7 months without recurrence. Progression of some type (local, muscle invasion or metastasis) occurred in 10 patients (44 per cent); none occurred in the prostatic urethra. Median interval free of progression was 55.7 months; 7 of 10 patients required cystectomy for progression or refractory disease in the bladder (prostate negative for transitional cell carcinoma). A trial of complete transurethral resection plus intravesical bacillus Calmette-Guerin is a viable alternative to immediate radical cystectomy for patients with mucosal and/or ductal involvement of the prostatic urethra with in situ transitional cell carcinoma.

Administration, Intravesical↗
PubMed1989

Flow cytometry as a predictor of response and progression in patients with superficial bladder cancer treated with bacillus Calmette-Guerin.

Simultaneous bladder wash flow cytometry, voided urinary cytology and cystoscopic examinations were performed at 3-month intervals during a median of 18 months (range 5.5 to 50 months) in 65 patients receiving intravesical bacillus Calmette-Guerin treatment for superficial bladder cancer. Of the 65 patients treated 36 (56 per cent) had a complete response, 12 (18 per cent) had no response and 17 (26 per cent) had progression. Results of examinations at 6 months suggested that a negative bladder wash flow cytometry (29 of 36 patients, r equals 0.73, p less than 10(-7) is a strong predictor of response to bacillus Calmette-Guerin, comparable with cytological (r equals 0.60, p less than 10(-7) or cystoscopic (r equals 0.38, p less than 0.005) examinations alone or combined with cytology (r equals 0.74, p less than 10(-7)). At 6 months a positive bladder wash flow cytometry (r equals 0.44, p less than 0.0005) is as strong a predictor of disease progression as a positive cystoscopic examination (r equals 0.43, p less than 0.0005). The combination of bladder wash flow cytometry and voided urinary cytology is not superior to positive bladder wash flow cytometry alone. Median estimated interval to progression for these patients treated with bacillus Calmette-Guerin was 38 months. In the subgroup with positive bladder wash flow cytometry at 6 months the median interval to progression was 30 months. With a negative bladder wash flow cytometry at 6 months the probability of survival free of progression at 30 months was 85 per cent (p less than 0.01). Thus, negative bladder wash flow cytometry at 6 months is a strong predictor of response to bacillus Calmette-Guerin and also survival free of progression.

Administration, Intravesical↗
PubMed1989

Chemotherapy in the management of bladder tumours.

For patients with superficial bladder tumours intravesical treatment or prophylaxis with thiotepa, doxorubicin, mitomycin C or Bacillus Calmette-Guerin has added a useful dimension to management, although the precise indications for each regimen remain to be better defined. For patients with metastatic bladder cancer cisplatin and methotrexate (amethopterin), and to a lesser extent vinblastine and doxorubicin, are active single agents. Combinations of cisplatin and doxorubicin (adriamycin), and cisplatin and methotrexate +/- vinblastine +/- doxorubicin appear to induce complete remission in 20 to 35% of cases and partial remission in an additional 20 to 40% of cases. In some patients, complete remission has persisted from 2 to more than 10 years. Few randomised Phase III studies have been carried out to determine the relative effectiveness of different drug combinations, but the results of Phase II trials have encouraged investigations of adjuvant and neoadjuvant programmes combining such regimens with radiation or surgery, or both, in patients with clinically localised muscle infiltrating tumours.

Antineoplastic Agents↗
PubMed1988

Anticarcinoma activity of rhodamine 123 against a murine renal adenocarcinoma.

The mitochondria of carcinoma cells retain the permeant cationic compound rhodamine 123 longer than the mitochondria of normal epithelial cells. The possibility of exploiting this difference in the chemotherapy of a murine renal adenocarcinoma was investigated. Rhodamine 123 exhibited anticarcinoma activity in mice and this activity was potentiated by 2-deoxyglucose and methylglyoxal bis(guanylhydrazone), a chemotherapeutic agent that is toxic to mitochondria. Prolonged retention of rhodamine 123 by renal tumor cells compared with normal renal epithelial cells was demonstrated by flow cytometry, perhaps explaining its antitumor activity. A combination of both mitochondrial toxins, rhodamine 123 and methylglyoxal bis(guanylhydrazone) produced the longest survival and had the greatest antitumor effect.

Adenocarcinoma↗
PubMed1988

Flutamide and other antiandrogens in the treatment of advanced prostatic carcinoma.

The various clinical trials suggest that the qualitative and quantitative responses of patients with Stage D prostatic carcinoma to antiandrogens are similar to those achieved with conventional endocrine therapy. These antiandrogens appear generally safe and many avoid the increased risks of cardiovascular or thromboembolic complications seen with estrogen therapy. Further, flutamide appears to have a lesser adverse effect on libido and sexual potency than do alternative therapies. Antiandrogens offer an alternative mode of therapy for previously untreated patients with advanced prostatic cancer but have produced no convincing benefits in hormonally refractory patients.

Androgen Antagonists↗
PubMed1988

Primary signet-ring cell carcinoma of urinary bladder.

A case of primary signet-ring cell carcinoma of the urinary bladder is described clinically and pathologically. In this rare neoplasm the characteristic cells contain large amounts of cytoplasmic mucin which compresses the nucleus to one side. This tumor demonstrates nicely the ability of bladder epithelium to undergo metaplasia. Most previously described cases have pursued a relentlessly progressive and fatal course despite varied forms of therapy.

Adenocarcinoma, Mucinous↗
PubMed1988

Flow cytometry and cytology as response indicators to M-VAC (methotrexate, vinblastine, doxorubicin and cisplatin).

We evaluated 23 patients treated with neoadjuvant methotrexate, vinblastine, doxorubicin and cisplatin for muscle invasive bladder carcinoma with serial bladder wash flow cytometry and serial urinary cytology. The sensitivities of bladder wash flow cytometry and cytology in detecting bladder cancer were 74 and 47 per cent, respectively, based on subsequent diagnosis from biopsy and cystectomy specimens. Exclusion of those cases without surface carcinoma increased the sensitivities of bladder wash flow cytometry and cytology to 93 and 60 per cent, respectively. Persistently positive bladder wash flow cytometry and cytology correctly predicted residual disease in 88 and 100 per cent, respectively. However, negative bladder wash flow cytometry and cytology after chemotherapy were not reliable indicators of disease-free status.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1988

Detection of carcinoma in the post-cystectomy urethral remnant by flow cytometric analysis.

Following radical cystoprostatectomy for bladder cancer patients must be monitored for carcinoma of the urethral remnant. Cytological examination of urethral washings has proved to be a useful alternative to urethroscopy and urethrography. Urethral irrigation specimens also can be evaluated objectively by flow cytometry. In each of 4 patients in whom carcinoma developed in the urethral remnant analysis of urethral irrigation by flow cytometry was positive and comparable to results of urethral irrigation cytology. Flow cytometry is an objective and apparently reliable diagnostic test for malignancy in the urethral remnant.

Aged↗
PubMed1988

Neoadjuvant M-VAC (methotrexate, vinblastine, doxorubicin and cisplatin) for extravesical urinary tract tumors.

A total of 11 patients with stage T2-4N0M0 extravesical tumors (prostate, prostatic urethra, urethra and ureter) received 1 to 4 cycles of neoadjuvant methotrexate, vinblastine, doxorubicin and cisplatin. Of 10 evaluable patients 4 (40 per cent) had downstaging to T0 disease with a clinical complete remission observed in 3 of 5 (60 per cent) with transitional cell tumors of the prostate and prostatic urethra. Four patients with urethral tumors of mixed or nontransitional histology failed to achieve a complete remission. The disease was staged pathologically in 4 patients: 1 had a partial remission and 3 had progression (all 4 had residual disease). Because therapy with methotrexate, vinblastine, doxorubicin and cisplatin induced only significant tumor regression of transitional cell elements of extravesical tumors and because it was ineffective against mixed histological tumors and in preventing new stage Tis lesions, surgical resection of such lesions is required.

Aged↗
PubMed1988

Clinical management of prostatic cancer. An overview.

A historical and contemporary overview of the clinical management of prostatic cancer reviews the basis for current uncertainties regarding treatment, indicates representative results with different major treatments, proposes some relevant questions, and suggests the basic needs for resolving current issues.

Combined Modality Therapy↗
PubMed1988

Bacillus Calmette-Guérin therapy alters the progression of superficial bladder cancer.

The effectiveness of BCG in preventing disease progression in patients with superficial bladder cancer is evaluated. Long-term follow-up of high-risk patients treated in a previously reported randomized control trial of intravesical plus percutaneous BCG shows that progression occurred in 41/43 (95%) of control and 23/43 (53%) of BCG-treated patients. Muscle invasive and/or metastatic disease occurred with equal frequency in the two groups, but was significantly delayed by BCG treatment (P = .012). Cystectomies were required in 18/43 (42%) control and 11/43 (26%) BCG-treated patients. Median time to cystectomy was 8 months for control v 24 months for BCG-treated patients. Based on initial treatment, survival was improved by BCG therapy (P = .032) (median follow-up 6 years). These results suggest that in high-risk patients intravesical BCG can delay disease progression, prolong the period of bladder preservation, and increase overall survival.

Administration, Intravesical↗
PubMed1988

Advanced seminoma: the role of chemotherapy and adjunctive surgery.

STUDY OBJECTIVE: To determine the effectiveness of chemotherapy and adjunctive surgery in managing patients with advanced seminoma. DESIGN: Nonrandomized prospective clinical trial of chemotherapy in a cohort of patients with advanced seminoma. SETTING: Referral cancer hospital. PATIENTS: Consecutive sample of 62 patients with primary extragonadal, stage IIC (greater than 5-cm retroperitoneal adenopathy) and stage III seminoma; 45 patients were previously untreated, 13 had received radiotherapy, and 4 had previously received radiotherapy and chemotherapy. INTERVENTION: Cisplatin-based chemotherapy (100 to 120 mg/m2 body surface area per cycle of treatment); 45 patients received vinblastine, bleomycin, cisplatin, dactinomycin, and cyclophosphamide; 15, etoposide and cisplatin; and 2, both regimens. MEASUREMENTS AND MAIN RESULTS: Fifty-three of the sixty (88%) evaluable patients achieved a complete remission, and only 6 patients had relapses. Fifty-three of the sixty-two patients (85%) remain alive and disease-free. The regimen of etoposide and cisplatin was equivalent to regimens using more drugs. An elevated level of human chorionic gonadotropin at the initiation of treatment was associated with a worse prognosis. CONCLUSIONS: Cisplatin-based chemotherapy is effective treatment for patients with extragonadal, stage IIC, and stage III seminoma and should be considered as initial therapy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1988

Consensus Development Conference on the Management of Clinically Localized Prostate Cancer. Overview: historical and contemporary.

Recognition of the clinical importance of prostate cancer undoubtedly was delayed by the failure of clinicians or pathologists to distinguish consistently between benign and malignant prostatic growths until well into the 19th century. White used castration for prostatic enlargements in 1895, but Huggins and Hodges first placed endocrine therapy on a rational basis in 1941. Although a number of surgeons had attempted excision of prostate cancer, Young is credited with planning and performing the first radical perineal prostatectomy in 1904. Orthovoltage irradiation and various techniques of interstitial and intracavitary radium therapy were used in the treatment of prostate cancer early in the 20th century, but it was the development of megavoltage irradiation that reopened the door to the exploration of irradiation for localized prostate cancer following World War II. Endocrine manipulation, surgery, and irradiation remain the keystones of treatment. The management of prostate cancer is controversial for several reasons: 1) The disease occurs in an age range in which competing causes of mortality are high. 2) The natural evolution of the disease is varied, often long, and not consistently predictable. 3) Long-term survival has been reported for each of the principal modes of therapy, but randomized controlled studies have been limited. Uniformity in histologic grading, clinical staging, and evaluation of response to treatment would improve the quality of the data. Predictions of host life expectancy, tumor growth rate, metastatic potential, and tumor responsiveness to irradiation and endocrine therapy would enhance the rationale of treatment.

Humans↗