Eight years of experience with preoperative angiographic and lymphographic staging of bladder cancer.
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Biomedical subjects
Publications and source records attributed to Z Wajsman.
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The alkaline phosphatase isoenzymes in 105 patients with stage D carcinoma of the prostate who entered the National Prostatic Cancer Study were analyzed and these values were correlated to clinical response. Only patients with at least 3 measurements of alkaline phosphatase were evaluated. In 91% of patients with metastatic bone disease, bone alkaline phosphatase was elevated. Those patients with higher pre-treatment levels of alkaline phosphatase generally showed a poorer response to therapy. The results of alkaline phosphatase isoenzyme estimation indicate that these biological markers may be used in the evaluation of patients with metastatic prostatic cancer to predict and monitor their response to chemotherapy. The evaluation of bone and liver alkaline phosphatase isoenzymes in earlier stages also may be valuable.
The effect of papaverine on transplantable C1300 murine neuroblastoma model was evaluated. Subcutaneous inoculation of A/J mice with 10(6) C1300 cells resulted in predictable tumor growth and animal death in 36 +/- 5 days. In 33% of control animals, lung and liver metastases were observed. Subcutaneous injections of papaverine prior to tumor inoculation and during the tumor growth failed to show any detectable effect on local growth of the tumor. Benign transformation of the primary tumor was not observed. However, papaverine injection 21 days after tumor inoculation was associated with only 9% incidence of metastatic development. Papaverine treatment, when started one day prior to tumor inoculation or 10 days after tumor implant, resulted in complete prevention of all detectable metastatic growth, while having no apparent effect on local tumor growth. Further study of papaverine effect in the neuroblastoma murine model is indicated.
The effect of Levamisole was studied in an animal model of Wilms' tumor. No tumoridical effect of Levamisol could be documented in this tumor model, and no effect was shown on prevention of tumor, when Levamisole was given before tumor implantation. In previous experience with Wilms' tumor model, a good correlation between the human and animal tumor was found in regard to treatment with different drugs. The fact that Levamisole had no effect on our animal model and its reported immunosuppressive effect at some doses, should be considered in planning clinical trials.
The effects of exposure of experimental murine Wilm's tumor to increased atmospheric concentrations of carbon dioxide were studied. Local tumor growth was not affected by concentrations of 76% and 55% of carbon dioxide applied for 10 and 30 minutes. There was no difference in survival of animals and weight of the tumor between the control and the experimental groups. Ten per cent of the animals treated with concentrations of 55% and 76% carbon dioxide developed metastases in contrast to 30% of metastatic growth detected in the control group. This observation, although without statistically significant difference, may lead toward further study of the carbon dioxide effect in different tumor models. Additional tumor models and different animals species will be studied.
The effects of high concentrations of CO2 on experimental murine neuroblastoma tumor were studied. Similar to the experience with the animal model of Wilms' tumor, the local growth of this neuroblastoma model was not affected by concentrations of 76% and 55% of CO2 applied for 10 and 30 minutes. The tumor bearing animals exposed to different CO2 concentrations tended to develop metastases more frequently than the control groups, although no change in survival was noted. Different animals and additional tumor models could be used by others to study the effects of different CO2 concentrations at different exposure times.
Estramustine has been shown previously to be an effective drug in the treatment of metastatic prostatic cancer, demonstrating significant objective and subjective responses in long-term non-randomized trials and in other randomized trials. In this study prednimustine alone has shown a minimal over-all objective response rate of 12.9 percent of the cases, although with marked subjective improvement of pain relief and patient performance status. The combination of prednimustine with estramustine did not result in improvement of objective or subjective response parameters. The effects in terms of responses or in terms of toxicity for either agent were not additive when they were given in combination. Cross-over for those patients whose disease progressed on prednimustine therapy to estramustine had some benefit in over-all survival. Prednimustine alone or in combination with estramustine may be used safely and could improve markedly the quality of life for irradiated patients with advanced prostatic cancer who failed on hormonal treatment and have too poor a bone marrow reserve to be treated by other currently available myelosuppressive agents.
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One hundred and fifteen patients with penile cancer were treated at Roswell Park Memorial Institute from 1952 to 1975. A full follow-up is reported and factors involving the prognosis are analyzed. Although the clinical error of staging was near 30%, the lymphography results suggest that this study may result in added improvement in preoperative staging. Early diagnosis, adequate surgical resection, and lymph node dissection will improve the survival significantly. When dealing with an individual patient the prognosis is poor when any one or more of the follow factors are present: the lesion involves the shaft; there is a positive margin at the surgical resection; total penectomy is necessary to obtain tumor-free margin; lymphography is positive for tumor involvement of lymph nodes; lymph node dissection has not been performed; positive lymph nodes are found on surgical exploration. The good prognostic factors include: a lesion confined to the glans and partial penectomy is sufficient to obtain a tumor-free margin of resection; no clinical evidence (including lymphography) of lymph node invovlement; performance of lymph node dissection. The histological grading of the tumor should not influence the clinical decision for treatment in our opinion at this time, based on our current results. Further prospective studies of different factors involved in etiology, diagnosis, and treatment of penile cancer are suggested.
Blood group distribution in 264 Stage D relapsing patients from the National Prostatic Cancer Project was analyzed. No significant differences were found in distribution of blood groups in prostatic cancer patients as compared to the control population. This study does not support the observation of others of a relationship between blood group A and susceptibility to carcinoma of the prostate. Other patient groups may, however, be of value in searching for this relationship.
Twenty-five patients subjected to pelvic node dissection for urologic malignancies underwent bilateral pedal lymphangiography preoperatively. Postoperatively, 50 samples of the nodes selectively removed from the regions surrounding the obturator nerve were radiographed. All 50 samples revealed the presence of radiopaque dye. The lymph nodes surrounding the obturator nerve represent the first point of lymphatic metastases in carcinoma of the prostate and the bladder. Their visualization by lymphangiography emphasizes the importance of such a diagnostic study for the correct clinical staging of these diseases. The lymphatic anatomy of the pelvis is reviewed and compared to the radiological findings in lymphangiography.
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Our experience with the preoperative staging of bladder cancer by bilateral selective hypogastric arteriography has been accumulated since 1968. More than 150 patients have been studied by selective angiography before radical cystectomy. Our latest series of 52 patients (1972 to 1976) compares to our previous experience demonstrating angiographic staging accuracy to detect bladder invasion and occult metastases at a rate exceeding that of clinical staging alone. Arteriographic staging of D lesions, when supplemented with lymphography, approaches 100 per cent accuracy. Falsely negative lymphograms currently are extremely uncommon (1.9 per cent). In several illustrated instances angiographic staging was proved to be even more accurate than the pathologic staging of a limited cystectomy specimen. The over-all angiographic and lymphangiographic staging accuracy in our most recent series of cystectomy patients was 78.8 per cent. The techniques and reliability of the data are discussed in detail, including the factors that interfere with the exact arteriographic staging of bladder cancer. However, these factors are more troublesome in early stage lesions. These studies demonstrate the role and value as well as areas of limitation of preoperative arteriography and lymphography in the evaluation of invasive bladder cancer.
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Nineteen patients with advanced testicular carcinomas (Stage III) were treated by a combination of multisequential chemotherapy with vinblastine, bleomycin, platinum, adriamycin, cytoxan, actinomycin D, and reductive surgery. Of the sixteen patients who were operated on 10 patients are alive and free of disease from 5 to 15 months. Two patients are alive with residual disease and four patients died. (Three were free of malignant tumor and one had residual malignant disease.) Three patients are still receiving preoperative chemotherapy. Pathology reported benign tumors in 8 out of 16 patients operated on. All these patients were previously treated with multiple chemotherapy. Several facts emerge from this study: (1) the great effectiveness of the combination of multisequential chemotherapy and reductive surgery to produce complete clinical remission in advanced testicular carcinomas (63.6%, 13 out of 19 patients); (2) the possibility of benign transformation of these tumors (50%, 8 out of 16); (3) the importance of the second-look surgery in testicular tumors.
A case of hemangiopericytoma arising in the urinary bladder is presented. Initial symptoms included hematuria and frequency of urination. Hemangiopericytoma is a vascular tumor of pericyte origin which occurs primarily in several organs and can be benign or malignant. Reports in the literature of genitourinary system involvement are reviewed. It is concluded that genitourinary tumors of this type should be considered malignant and treated aggressively.
Twenty-one patients with gram-negative urinary tract infections were treated with sisomicin, a new aminoglycoside antibiotic. Bacteriologic cure was achieved in 62 per cent of patients, and improvement in another 33 per cent. Mild transient elevation of serum creatinine occurred in 3 patients. No other toxicity was observed. Further clinical trials with more frequent dose administration and in combination with other antibiotics is suggested.
Twenty-five patients with disseminated renal cell carcinoma have been followed for eleven months. These patients have been treated with CCNU, bleomycin, methotrexate, and platinum in various combinations. The results have been discussed in light of other studies using chemotherapeutic agents against this disease process.