There is no standard second-line or salvage treatment for advanced urothelial carcinoma (UC). Here we investigated the efficacy and safety of gemcitabine, cisplatin, and paclitaxel (GCP) combination chemotherapy as salvage chemotherapy for advanced UC. We retrospectively analyzed the cases of 23 patients with advanced UC who showed progression or recurrence after cisplatin-based chemotherapy. Gemcitabine (1000 mg/m2), and paclitaxel (80 mg/m2) were administered on days 1 and 8. Cisplatin (70 mg/m2) was administered on day 1. The 3-week cycle regimen was repeated until disease progression if it had no intolerable toxicity. The overall response rate was 61% (95%CI, 41-78%). The median overall survival and progression-free survival times were 14 months and 5.5 months, respectively. Of the already known risk factors of chemotherapy for advanced UC, only the performance status was a prognostic factor for OS. Overall, 16 of the 23 patients (70%) experienced grade 3/4 toxicities, and no fatal adverse events were observed. GCP therapy was a promising option as second-line or salvage therapy for advanced UC.
Background: This study investigated the effect of mannitol administration on postoperative renal function during robot-assisted partial nephrectomy (RAPN) in patients with renal cell carcinoma (RCC). Methods: Patients with RCC who underwent RAPN at eight Japanese facilities between March 2016 and November 2023 were enrolled. In this study, patients were categorized into two groups according to those who received mannitol during RAPN (Group I) and those who did not receive mannitol (Group II). Differences in covariates between the two groups were adjusted using propensity score matching (PSM). Results: The study included 1530 patients with RCC who underwent RAPN. PSM was performed on 531 participants in each group. No difference was observed in perioperative outcomes between the two groups in terms of length of hospital stay, surgical outcomes, achievement ratio of Trifecta, and estimated glomerular filtration rate at 28 days, 90 days, and 1 year postoperatively. Conclusions: Intraoperative mannitol administration during RAPN for improving renal function may be unnecessary.
To determine health-related quality of life (HRQOL) after radical retropubic prostatectomy (RRP) or permanent prostate brachytherapy (BT), third party-conducted QOL surveys were prospectively compared. Between 2004 and 2005, 37 patients underwent RRP and 36 were treated with BT. A QOL survey consisting of the Medical Outcomes Study 36-Item Short Form (SF-36), the University of California, Los Angeles, Prostate Cancer Index (UCLA-PCI) and the International Prostate Symptoms Score (IPSS) was completed prospectively by a research coordinator at baseline, and at 1, 3, 6 and 12 months after treatment. The RRP patients scored well in general QOL except at 1 month after surgery, with their mental health better than at baseline by 6 months after surgery. Disease-specific QOL in RRP patients received a low score at 1 month for both urinary and sexual function, though urinary function rapidly recovered to baseline levels. BT patient QOL was not affected by the therapy except in the IPSS score. However, general and mental health scores in BT patients were inferior to those in RRP patients. This prospective study revealed differences in QOL after RRP and BT. These results will be helpful in making treatment decisions.
From January 2004 to March 2007, 308 patients with clinically localized prostate cancer were treated using iodine-125 (125I) seed implantation (permanent brachytherapy) at Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences. We evaluated the treatments efficacy and morbidity in 300 prostate cancer patients who were followed up for more than 1 month after brachytherapy. Based on the National Comprehensive Cancer Network (NCCN) guidelines, patients with a prostate volume of less than 40 ml in transrectal ultrasound imaging were classified as low or intermediate risk. The median patient age was 67 years (range 50 to 79 years), the median prostate-specific antigen (PSA) value before biopsy was 6.95 ng/ml (range 1.13 to 24.7 ng/ml), and the median prostate volume was 24.33 ml (range 9.3 to 41.76 ml). The median follow-up was 18 months (range 1 to 36 months) and the PSA levels decreased in almost all patients after brachytherapy. Although 194 of 300 patients (64.7%) complained of difficulty in urination, pollakisuria/urgency, miction pain, and/or urinary incontinence, all of which might be associated with radiation prostatitis during the first month after brachytherapy, these symptoms gradually improved. 125I seed implantation brachytherapy is safe and effective for localized prostate cancer within short-term follow up.
Background and Objectives: We aimed to examine the relationship between the inflammation-related parameters, such as the neutrophil-to-lymphocyte ratio (NLR), and the pathological findings and biochemical recurrence (BCR) in patients with prostate cancer (PCa) undergoing robot-assisted radical prostatectomy (RARP). Materials and Methods: A retrospective multicenter cohort study of patients with PCa who underwent RARP at 10 institutes in Japan was conducted. This study enrolled 3195 patients. We focused on patients undergoing RARP who underwent the preoperative measurement of their inflammation-related parameters and who did not receive any neo- or adjuvant therapy. Data on the pre- and postoperative variables for the enrolled patients were obtained. The primary endpoint of this study was the association between BCR and the inflammation-related parameters after RARP. The secondary endpoint was the association between the inflammation-related parameters and the pathological diagnosis of PCa. Results: Data from 2429 patients with PCa who met the study’s eligibility criteria were analyzed. The median follow-up period was 25.1 months. The inflammation-related parameters were divided into two groups, and cutoff values were determined based on the receiver operating characteristics. There were no statistically significant differences in biochemical recurrence-free survival for any of the parameters. In the univariate analysis, the NLR was predictive of pathological T3 and lymphovascular invasion; however, there were no significant differences in the multivariate analysis. Conclusions: The inflammation-related parameters did not significantly affect the incidence of BCR, at least among patients with PCa who underwent RARP.
321 Background: A clinical impact of salvage lymphadenectomy after chemotherapy in urothelial carcinoma patients with metastatic lymphnodes swelling is controversial. We verified a clinical role of salvage lymphadenectomy with analyzing long-term outcome after salvage surgery in the patients treated with cisplatin/gemcitabine-based chemotherapy. Methods: From 2003 to 2011, 20 of 28 (71%) urothelial carcinoma patients with metastatic lymphnodes showed objective responses (CR in 2, PR in 18) after multiple courses of the chemotherapy. Thirteen of the PR patients underwent salvage lymphadenectomy after the chemotherapy (9 male and 4 female, median 64.0 years old). Seven of the patients underwent radical surgeries for primary lesions as well. Remaining 5 patients denied salvage surgery. Progression free survival and overall survival of the patients were analyzed retrospectively in comparison with those of patients without salvage surgery. Results: All 13 patients could achieve surgical CR. Pathological findings showed pathological CR in 9 patients. In median follow-up 26.9 months (range: 4.5-74.6), progression free survival and cause specific survival in patients with salvage lymphadenectomy showed better trends in comparison with those in 5 PR patients without the surgery (63.5% vs 20.0%, and 85.7% vs 40.0% at 2 years, p=0.0907 and 0.0229; log-rank test). Conclusions: Although this study was retrospective and nonrandomized, salvage lymphadenectomy in patients with residual tumor after GCP chemotherapy could have an impact on cancer survival. Surgical CR should be achieved in an affordable patient who is responder of GCP therapy.
The efficacy and toxicity of adenoviral vectors that express Herpes Simplex Virus-thymidine kinase (HSV-tk) gene under the transcriptional control of caveolin-1 promoter (cav.-1-tk) was compared to Cytomegalovirus (CMV) promoter or Rous sarcoma virus (RSV) promoter HSV-tk for prostate cancer. The cav.-1-tk demonstrated the strong cytotoxicity in vitro for mouse human prostate cancer cell line (178BMA) and human prostate cancer cell line (PC-3), which overxpress caveolin-1 levels. On the other hand, the cytotoxicity was weak for mouse (178PA) and human (LNCaP) prostate cancer cell line, which express low caveolin-1 levels. The antitumor efficacy was observed in each vector in vivo orthotopic model using 178BMA prostate cancer cell line. The immunohistochemical analysis results indicated that not only cancer cells but also tumor vasculature were destroyed by cav.-1-tk. The serum AST levels of cav.-1-tk was minimal change following intravenous injection. Taken together, adenovirus-mediated HSV-tk in situ gene therapy under the transcriptional control of caveolin-1 promoter may be effective and safe for prostate cancer compared to CMV or RSV promoter HSV-tk adenoviral vectors.
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