Ureteroscopy during pregnancy has become increasingly recognized as a safe intervention. Performing it under local anesthesia and light sedation reduces the risks associated with general or regional anesthesia, such as difficult airway scenarios, hypothermia, and hypotension. In addition, this approach reduces the total amount of fetal exposure to medications and anesthetic agents. Performing ureteroscopy in this manner requires a number of adjustments and modifications to the standard technique. This article provides a summary in a step-by-step format, as well as an accompanying video demonstration.
Abstract Background: Antiangiogenic treatment, is currently first line therapy in metastatic renal cell carcinoma (RCC). Due to high drug costs and potentially serious side effects there is an urgent need for clinically useful predictive markers. We conducted a single center phase II clinical trial with sunitinib treatment for metastatic RCC. Study Design: Forty-five patients with metastatic or non-resectable clear cell RCC were included. Sunitinib was given in cycles of six weeks (four weeks of treatment, two weeks pause). Follow up was every six week. Primary endpoint was response rates (RECIST 1.1). Secondary endpoints were time to progression (TTP) and overall survival (OS). Toxicity and quality of life were recorded. Results: Twenty five (55 %) cases showed clinical benefit with complete response (CR): 1, partial response (PR): 6, stable disease (SD)>6months: 18. Twelve patients showed progressive disease (PD). Eight patients stopped treatment or were still under treatment prior to the first radiologic evaluation, and were recorded as non-evaluable. The following parameters were recorded at baseline; gender, age, ECOG-, WHO- and Karnofsky's performance status, Heng- and Motzer prognostic criteria, blood pressure, hemoglobin, white blood count, neutrophil count, platelets, sodium, potassium, creatinine, corrected calcium, C-reactive protein(CRP), albumin, lactate dehydrogenase, thyroid-stimulating hormone, thyroid hormones and D dimer, body mass index, use of antihypertensive medication, location of metastasis and tumor load. Of these, CRP ≤ 10 mg/L at baseline (vs CRP > 10 mg/L), was significantly associated with objective response (CR+PR) (Fisher's Exact test, p=0,030). Good performance status showed a significant association with clinical benefit (Fisher's Exact test, p=0,049). Toxicity data and quality of life data will be presented. Conclusion: Of the clinical markers under investigation, only CRP at baseline as well as performance status were found to be possible predictive markers of response to sunitinib in metastatic RCC. Our patient population is comparable to those in already reported studies and might be useful to further investigations of angiogenesis related predictive markers of response. Citation Format: Martin Pilskog, Christian Beisland, Oddbjørn Straume. C-reactive protein as a predictive marker of response to sunitinib treatment in metastatic clear cell renal carcinoma. [abstract]. In: Proceedings of the AACR Special Conference: Tumor Angiogenesis and Vascular Normalization: Bench to Bedside to Biomarkers; Mar 5-8, 2015; Orlando, FL. Philadelphia (PA): AACR; Mol Cancer Ther 2015;14(12 Suppl):Abstract nr A28.
Patients with bladder cancer need frequent controls over long follow-up time due to high recurrence rate and risk of conversion to muscle invasive cancer with poor prognosis. We identified cancer-related molecular signatures in apparently healthy bladder in patients with subsequent muscular invasiveness during follow-up. Global proteomics of the normal tissue biopsies revealed specific proteome fingerprints in these patients prior to subsequent muscular invasiveness. In these presumed normal samples, we detected modulations of proteins previously associated with different cancer types. This study indicates that analyzing apparently healthy tissue of a cancer-invaded organ may suggest disease progression.
Abstract Objective: To gain knowledge about when, where and how metastases after presumed radical treatment for renal cell carcinoma (RCC) are detected, and to use this information to establish a follow‐up programme for radically treated RCC. Further aims were to establish survival rates, together with identifying prognostic factors influencing survival for different groups of patients after recurrence of the disease. Material and Methods: A retrospective study of 305 pT1‐4N0M0/pT1‐4NxM0 (clinically N0) tumours treated with nephrectomy was performed. Results: A total of 89 patients (29.2%) developed metastases, with a median time to recurrence of 25.1 months. Within 5 years, 80% of the metastases had been detected. The lungs were the commonest metastatic site. A total of 34.8% of the recurrences were diagnosed as a result of routine follow‐up. Median cancer‐specific survival (CSS) after recurrence was 9.8 months. For patients with a disease‐free interval (DFI) ≥24 months the median CSS was 35 months. In a univariate analysis, performance status, DFI ≥24 months, metastases in a single organ, primary tumour size ≤70 mm, primary tumour stage pT1‐2 and age <65 years were all associated with better survival. In a multivariate analysis, performance status, DFI and number of organs affected were independent predictors of survival. Conclusion: The information from this material is used to suggest a simple, but adequate, follow‐up protocol. Easily accessible information can be used to identify groups with different prognoses regarding survival after recurrence of the disease.Keywordsfollow‐upmetastatic diseaserenal cell carcinomasurvival
Objective: The five Nordic countries comprise 25 million people, and have similar treatment traditions and healthcare systems. To take advantage of these similarities, a collaborative group (Nordic Renal Cancer Group, NORENCA) was founded in 2015.Materials and methods: A questionnaire of 17 questions on renal tumor management and surgical education was designed and sent to 91 institutions performing renal tumor surgery in 2015. The response rate was 68% (62 hospitals), including 28 academic, 25 central and nine district hospitals. Hospital volume was defined as low (LVH: < 20 operations), intermediate (IVH: 20–49 operations), high (HVH: 50–99) and very high (VHVH: ≥ 100). Descriptive statistics were performed.Results: Fifteen centers were LVH, 16 IVH, 21 HVH and 10 VHVH. Of all 3828 kidney tumor treatments, 55% were radical nephrectomies (RNs), 37% partial nephrectomies (PNs) and 8% thermoablations. For RN and PN, the percentages of open, laparoscopic and robotic approaches were 47%, 40%, 13% and 47%, 20%, 33%, respectively. The mean complication rate (Clavien–Dindo 3–5) was 4.9%, and 30 day mortality (TDM) was 0.5%. The median length of hospital stay was 4 days. Training with a simulator, black box or animal laboratory was possible in 48%, 74% and 21% of institutions, respectively.Conclusions: Despite some differences between countries, the data suggest an overall general common Nordic treatment attitude for renal tumors. Furthermore, the data demonstrate high adherence to international standards, with a high proportion of PN and acceptable rates for major complications and TDM.
The clinical presentation of Renal Cell Carcinoma (RCC) has changed dramatically over the last 50 years. In 1981, Hellsten et al. published two papers on a large autopsy series from Malmo during th...
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