1
|
Local recurrence of renal cell carcinoma after partial nephrectomy: applicability of the apparent diffusion coefficient of MRI as an imaging marker - a multicentre study. Pol J Radiol 2022; 87:e325-e332. [PMID: 35892067 PMCID: PMC9288198 DOI: 10.5114/pjr.2022.117593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/13/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose The goal of the study was an assessment of the diagnostic performance of diffusion-weighted images (DWI) and apparent diffusion coefficient (ADC) of magnetic resonance imaging (MRI) in distinguishing local recurrence (LR) of renal cell carcinoma (RCC) from benign conditions after partial nephrectomy. Material and methods Thirty-nine patients after partial nephrectomy for solid RCC were enrolled in the study. Patients were followed up using MRI, which included DWI sequence (b = 800 s/mm2). All patients with MRI features of LR were included in the main group (n = 14) and patients without such features – into the group of comparison (n = 25). Apparent diffusion coefficient (ADC) values of suspicious lesions were recorded. In all patients with signs of locally recurrent RCC, surgical treatment was performed followed by pathologic analysis. Results The mean ADC values of recurrent RCC demonstrated significantly higher numbers compared to benign fibrous tissues and were 1.64 ± 0.15 × 10-3 mm2/s vs. 1.02 ± 0.26 × 10-3 mm2/s (p < 0.001). The mean ADC values of RCCs’ LR and benign post-op changes in renal scar substantially differed from mean ADC values of healthy kidneys’ parenchyma; the latter was 2.58 ± 0.05 × 10-3 mm2/s (p < 0.001). In ROC analysis, the use of ADC with a threshold value of 1.28 × 10-3 mm2/s allowed us to differentiate local recurrence of RCC from benign postoperative changes with 100% sensitivity, 80% specificity, and accuracy: AUC = 0.980 (p < 0.001). Conclusions The apparent diffusion coefficient of DWI of MRI can be used as a potential imaging marker for the diagnosis of local recurrence of RCC.
Collapse
|
2
|
Kim HK, Pyun JH, Cho S, Kang SG, Lee JG, Kim JJ, Cheon J, Park HS, Kang SH. Tumor-specific immunity induced by cryoablation in a murine renal cell carcinoma model. Korean J Urol 2014; 55:834-40. [PMID: 25512819 PMCID: PMC4265719 DOI: 10.4111/kju.2014.55.12.834] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 10/23/2014] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate tumor-specific immunity and define the mechanisms involved in the cryoimmunologic response, we compared the tumor control efficacy and immunologic responses of cryoablation with those of surgical excision in a tumor rechallenge model. Materials and Methods Sixty BALB/c mice with RENCA tumors that were generated in the left flank area underwent cryoablation or radical excision. The mice successfully treated were rechallenged with RENCA or an undifferentiated colon carcinoma cell line, CT26, in the contralateral right flank area. The recurrence rate after tumor rechallenge in each group was then observed. To assess the immunologic response of each treatment modality, fluorescent-activated cell sorting (FACS) analysis and a cytotoxicity assay using 51Cr release were performed. Results After reinoculation of the RENCA cells, the rate of tumor growth was significantly higher in the surgical excision group than in the cryoablation group (94.4% vs. 11.1%, p=0.001). In the cryoablation group, the tumor growth rate was significantly increased after rechallenge of CT26 cells compared with RENCA (94.1% vs. 11.1%, p=0.001). The cryoablation group showed an elevated CD3, CD4, CD8 T, and natural killer cell count in the FACS analysis and also showed significantly increased cytotoxicity in the 51Cr release assay compared with the excision group. Conclusions These results showed that cryoablation, compared to surgical resection, was more effective in preventing tumor growth after rechallenge with RENCA cells and that this response was tumor-specific, because the CT26 cells did not have the same effect.
Collapse
Affiliation(s)
- Hyung Keun Kim
- Department of Urology, Korea University Anam Hospital, Seoul, Korea
| | - Jong Hyun Pyun
- Department of Urology, Korea University Anam Hospital, Seoul, Korea
| | - Seok Cho
- Department of Urology, Korea University Anam Hospital, Seoul, Korea
| | - Sung Gu Kang
- Department of Urology, Korea University Anam Hospital, Seoul, Korea
| | - Jeong Gu Lee
- Department of Urology, Korea University Anam Hospital, Seoul, Korea
| | - Je Jong Kim
- Department of Urology, Korea University Anam Hospital, Seoul, Korea
| | - Jun Cheon
- Department of Urology, Korea University Anam Hospital, Seoul, Korea
| | - Hong Seok Park
- Department of Urology, Korea University Guro Hospital, Seoul, Korea
| | - Seok Ho Kang
- Department of Urology, Korea University Anam Hospital, Seoul, Korea
| |
Collapse
|
3
|
Fayek IS, Habashy HF, Habashy NF. Isolated loco-regional recurrence after radical nephrectomy for renal cell carcinoma: A study of 22patients. J Egypt Natl Canc Inst 2014; 26:161-6. [DOI: 10.1016/j.jnci.2014.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 05/23/2014] [Accepted: 05/29/2014] [Indexed: 01/15/2023] Open
|
4
|
Masarapu V, Kim HL. Initial experience with arterial spin-labeling MR imaging to assess histology of renal masses. Quant Imaging Med Surg 2013; 3:130-1. [PMID: 23833725 DOI: 10.3978/j.issn.2223-4292.2013.06.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Accepted: 06/25/2013] [Indexed: 11/14/2022]
Abstract
It is standard practice to presume that solid renal tumors are malignant and perform a nephrectomy without a biopsy. In many clinical situations, renal biopsies lack sufficient diagnostic accuracy to justify altering management. Lanzman and colleagues propose the use of arterial spin-labeling magnetic resonance imaging to assess renal histology and grade. They used histopathologic data as the reference standard, and reported a statistically significant difference in measured tumor perfusion between papillary renal tumor, oncocytomas, and all other histologic subtypes examined. If confirmed in larger studies, this imaging modality may play a role in triaging patients with solid renal masses for surgery or renal biopsy.
Collapse
Affiliation(s)
- Venkat Masarapu
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, 8635 West Third Street, Suite 1070, Los Angeles, CA 90048, USA
| | | |
Collapse
|
5
|
Bradford TJ, Montie JE, Hafez KS. The Role of Imaging in the Surveillance of Urologic Malignancies. Urol Clin North Am 2006; 33:377-96. [PMID: 16829272 DOI: 10.1016/j.ucl.2006.03.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Urologic malignancies are common, accounting for approximately 25% of all new cancer cases in the United States. Patients with urologic malignancies require long-term surveillance to detect progression or recurrence as early as possible. The urologist is faced with the task of balancing patient safety and cost-effectiveness, while finding the most practical follow-up regimen. For each urologic malignancy, this article reviews the commonly used radiologic techniques for surveillance and offers recommended follow-up schedules.
Collapse
Affiliation(s)
- Timothy J Bradford
- Department of Urology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0330, USA
| | | | | |
Collapse
|
6
|
Janzen NK, Kim HL, Figlin RA, Belldegrun AS. Surveillance after radical or partial nephrectomy for localized renal cell carcinoma and management of recurrent disease. Urol Clin North Am 2004; 30:843-52. [PMID: 14680319 DOI: 10.1016/s0094-0143(03)00056-9] [Citation(s) in RCA: 555] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Surveillance after surgery for RCC is important because approximately 50% of these patients will develop a disease recurrence, two thirds of who will recur within the first year. Although the prognosis is generally poor in these patients, some may respond favorably to immunotherapy. The small subset of patients who develop solitary metastases has the greatest chance to achieve long-term survival. Aggressive surgical resection is an integral part of this success. Proposed surveillance protocols using a stage-based approach or an integrated approach combining stage with other important prognostic factors attempt to provide a rational approach to identifying treatable recurrences while minimizing unnecessary examinations and patient anxiety. However, strict adherence to follow-up guidelines may not be appropriate for all patients. Factors including patient comorbidities and patient willingness to pursue aggressive management in the event of recurrence may alter the follow-up for each individual.
Collapse
Affiliation(s)
- Nicolette K Janzen
- Department of Urology, University of California at Los Angeles School of Medicine, 10833 Le Conte Avenue, CHS 66-118, Los Angeles, CA 90095-1738, USA
| | | | | | | |
Collapse
|
7
|
Embolotherapy: Pre-operative and Definitive Treatment for Bone Tumors. J Vasc Interv Radiol 2003. [DOI: 10.1016/s1051-0443(03)70246-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
8
|
Weisse C, Clifford CA, Holt D, Solomon JA. Percutaneous arterial embolization and chemoembolization for treatment of benign and malignant tumors in three dogs and a goat. J Am Vet Med Assoc 2002; 221:1430-6, 1419. [PMID: 12458612 DOI: 10.2460/javma.2002.221.1430] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The term bland arterial embolization refers to catheter-directed delivery of particulate material for the purpose of embolizing selected arteries. This technique is used in humans to treat a number of conditions, including arteriovenous malformations, uterine fibroids, and epistaxis. The term chemoembolization refers to selective intra-arterial delivery of chemotherapeutic agents in conjunction with particulate material for the purpose of embolizing arteries supplying blood to a tumor. Compared with traditional modes of drug delivery, chemoembolization increases local concentration and dwell time of the chemotherapeutic agent, augments tumor ischemia, and minimizes systemic toxic effects. In humans, the technique has shown encouraging results in the treatment of a variety of nonresectable tumors. The present report describes techniques for percutaneous bland arterial embolization and chemoembolization in dogs and goats and results of these techniques in 3 dogs and a goat. Bland arterial embolization was performed in 2 dogs and the goat. The goals of treatment included pain palliation, reduction of tumor growth, and control of hemorrhage, and each animal was considered to have benefited from the procedure on the basis of the preprocedural goals. Chemoembolization was performed in 1 dog for treatment of a nonresectable hepatocellular carcinoma. Unfortunately, this dog did not live long enough to identify any response to treatment. Results for animals studied illustrate the feasibility of bland arterial embolization and chemoembolization in veterinary patients and suggest that embolization may provide an alternative method of treatment for animals with inoperable lesions.
Collapse
Affiliation(s)
- Chick Weisse
- Section of Small Animal Surgery, Department of Clinical Studies-Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104-6010, USA
| | | | | | | |
Collapse
|
9
|
Flanigan RC, Salmon SE, Blumenstein BA, Bearman SI, Roy V, McGrath PC, Caton JR, Munshi N, Crawford ED. Nephrectomy followed by interferon alfa-2b compared with interferon alfa-2b alone for metastatic renal-cell cancer. N Engl J Med 2001; 345:1655-9. [PMID: 11759643 DOI: 10.1056/nejmoa003013] [Citation(s) in RCA: 1234] [Impact Index Per Article: 53.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The value of nephrectomy in metastatic renal-cell cancer has long been debated. Several nonrandomized studies suggest a higher rate of response to systemic therapy and longer survival in patients who have undergone nephrectomy. METHODS We randomly assigned patients with metastatic renal-cell cancer who were acceptable candidates for nephrectomy to undergo radical nephrectomy followed by therapy with interferon alfa-2b or to receive interferon alfa-2b therapy alone. The primary end point was survival, and the secondary end point was a response of the tumor to treatment. RESULTS The median survival of 120 eligible patients assigned to surgery followed by interferon was 11.1 months, and among the 121 eligible patients assigned to interferon alone it was 8.1 months (P=0.05). The difference in median survival between the two groups was independent of performance status, metastatic site, and the presence or absence of a measurable metastatic lesion. CONCLUSIONS Nephrectomy followed by interferon therapy results in longer survival among patients with metastatic renal-cell cancer than does interferon therapy alone.
Collapse
Affiliation(s)
- R C Flanigan
- Loyola University Stritch School of Medicine, Maywood, Ill., USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Onishi T, Oishi Y, Suzuki Y, Asano K. Prognostic evaluation of transcatheter arterial embolization for unresectable renal cell carcinoma with distant metastasis. BJU Int 2001; 87:312-5. [PMID: 11251521 DOI: 10.1046/j.1464-410x.2001.00070.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To evaluate the efficacy of transcatheter arterial embolization (TAE) in patients with unresectable renal cell carcinoma (RCC) and distant metastasis at the time of diagnosis. PATIENTS AND METHODS The study included 54 patients with histologically defined RCC (by biopsy in 28 and autopsy in 26) who were unable to undergo nephrectomy mainly because their performance status was poor (score > or = 2). The patients were classified into two groups; 24 patients who underwent TAE with ethanol and 30 patients who did not. The two groups were compared for several clinical factors, mainly focusing on the prognosis. RESULTS There were no significant differences in the clinical factors, including performance status, tumour diameter, vascular invasion, lymph node involvement, adjuvant therapy, metastatic organs or the number of metastases between the groups. However, the proportion of patients with para-neoplastic signs in those undergoing TAE was greater than that in those not, and the difference was significant (chi squared 0.35, P < 0.05). The median survival of the two groups was 229 days (TAE) and 116 days (no TAE). The 1-, 2- and 3-year survival rates in the TAE group were 29%, 15% and 10%, respectively, and in those not undergoing TAE were 13%, 7% and 3%, respectively. Those undergoing TAE had a significantly better prognosis than those who did not (P = 0.019). The adverse effects in patients undergoing TAE with ethanol included fever, back pain on the affected side, nausea and vomiting, but all the patients recovered from these adverse effects. CONCLUSION TAE with ethanol is a safe and effective treatment for patients with unresectable disseminated RCC and a poor performance status; TAE with ethanol not only induces ablation of the primary tumour, but also prolongs survival.
Collapse
Affiliation(s)
- T Onishi
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | | | | | | |
Collapse
|
11
|
Reinecke P, Schmitz M, Schneider EM, Gabbert HE, Gerharz CD. Multidrug resistance phenotype and paclitaxel (Taxol) sensitivity in human renal carcinoma cell lines of different histologic types. Cancer Invest 2001; 18:614-25. [PMID: 11036469 DOI: 10.3109/07357900009032828] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We compared the effects of paclitaxel (Taxol) in human renal cell carcinoma (RCC) of different histologic types. The growth inhibitory effects of paclitaxel on 34 human RCC cell lines of strictly defined different histologic types were determined by 3-[4,5-dimethylthiazolyl]-2,5-diphenyltetrazoliumbromide (MTT) assays. Paclitaxel-induced morphologic alterations were visualized by light and immunofluorescence and by transmission electron microscopy. The expression and function of P-glycoprotein and multidrug resistance-associated protein (MRP) were defined by reverse transcriptase polymerase chain reaction and fluorescence-activated cell sorting (FACS) analysis, respectively. Modulation of P-glycoprotein function was performed by verapamil or Cremophor EL. A significant (p < 0.05) dose-dependent paclitaxel-induced growth inhibition could be demonstrated in all cell lines, with the effects of paclitaxel dissolved in Cremophor EL/ethanol (= Taxol) exceeding the effects of paclitaxel dissolved in dimethyl sulfoxide. The extent of response markedly varied between the different cell lines, although chromophilic RCCs exhibited a more pronounced response to Taxol (IC50: 0.03-0.38 microM) than clear cell RCCs (IC50: 0.01-36.69 microM). Exposure to paclitaxel/Taxol induced an increase of microtubule bundles in the clear cell and the chromophobe RCCs but not in the chromophilic RCCs. The expression of the MRP was low in RCC cell lines and was not found to be related to paclitaxel/Taxol sensitivity. In contrast, the expression level of P-glycoprotein was much more pronounced and showed a positive correlation (p < 0.05) with the response to paclitaxel. Reversal of P-glycoprotein function by verapamil or Cremophor EL enhanced the growth inhibitory effects of paclitaxel and further supported the role of P-glycoprotein for paclitaxel sensitivity of human RCCs. Paclitaxel/Taxol effectively inhibits proliferation of human RCCs in vitro, irrespective of their histologic types. Moreover, expression and function of P-glycoprotein markedly contribute to paclitaxel responsiveness, although other as yet undefined drug resistance mechanisms are effective in human RCCs as well.
Collapse
MESH Headings
- ATP Binding Cassette Transporter, Subfamily B, Member 1/analysis
- ATP Binding Cassette Transporter, Subfamily B, Member 1/physiology
- ATP-Binding Cassette Transporters/analysis
- ATP-Binding Cassette Transporters/physiology
- Antineoplastic Agents, Phytogenic/pharmacology
- Carcinoma, Renal Cell/drug therapy
- Carcinoma, Renal Cell/pathology
- Cell Division/drug effects
- Drug Resistance, Multiple
- Drug Resistance, Neoplasm
- Humans
- Kidney Neoplasms/drug therapy
- Kidney Neoplasms/pathology
- Multidrug Resistance-Associated Proteins
- Paclitaxel/pharmacology
- Phenotype
- Tumor Cells, Cultured
Collapse
Affiliation(s)
- P Reinecke
- Institute of Pathology, University Hospital of Düsseldorf, Germany
| | | | | | | | | |
Collapse
|
12
|
|
13
|
|
14
|
Miki T, Nonomura N, Takaha N, Nishimura K, Kojima Y, Sawada M, Okuyama A. Antitumor effect of irinotecan hydrochloride (CPT-11) on human renal tumors heterotransplanted in nude mice. Int J Urol 1998; 5:370-3. [PMID: 9712447 DOI: 10.1111/j.1442-2042.1998.tb00369.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND There has been a paucity of antitumor drugs that are active against renal tumors. Irinotecan hydrochloride (CPT-11), a DNA topoisomerase type 1 inhibitor, has demonstrated antitumor activity against human tumors, however, no antitumor effect of CPT-11 on renal tumors has been reported. The antitumor effect of CPT-11 was investigated on 2 human renal tumors (OUR-10 and OUR-20) heterotransplanted into nude mice. METHODS Tumor-bearing nude mice were given daily intraperitoneal injections of multiple anticancer drugs suspended in 0.2 mL of phosphate-buffered saline (PBS) 3 times at 3-day intervals. Control mice were injected with 0.2 mL of PBS. The antitumor effects were evaluated by calculating the T/C ratio (treated tumors/controls) of the tumor volume. RESULTS Among the 10 anticancer drugs tested, 50 mg/kg of CPT-11 showed an active antitumor effect on OUR-20 (T/C ratio 34). However, all drugs tested on OUR-10 failed to show antitumor activity. CONCLUSION Since CPT-11 was effective in 1 of 2 renal tumors examined without severe toxicity, this drug could be a candidate for chemotherapy of renal cell carcinoma.
Collapse
Affiliation(s)
- T Miki
- Department of Urology, Osaka University Medical School, Suita, Japan
| | | | | | | | | | | | | |
Collapse
|
15
|
Bower M, Ma R, Savage P, Abel P, Waxman J. British urological surgery practice: 2. Renal, bladder and testis cancer. BRITISH JOURNAL OF UROLOGY 1998; 81:513-7. [PMID: 9598618 DOI: 10.1046/j.1464-410x.1998.00615.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the management of urological malignancies in the United Kingdom. METHODS A postal survey of consultant urologists and general surgeons with an interest in urology was conducted to examine current clinical practice in urological malignancies. RESULTS Completed questionnaires were received from 273 consultant surgeons who saw an estimated total of 13241 new patients with renal, bladder or testis cancer per year; 82% had access to on-site oncology services and in general there was a consensus in the answers given. Most respondents advised active treatment of an asymptomatic primary renal cancer in the presence of metastases and a significant proportion of patients with metastases were not prescribed immunotherapy nor were offered a multidisciplinary approach for their condition. Forty-six per cent of patients with testis cancer received no advice to store sperm before chemotherapy and there were varied opinions as to the need for surgical resection of residual masses after completion of chemotherapy. CONCLUSION This survey showed minor variations in the management of renal, bladder and testis tumours in the UK. Consensus management guidelines for urological malignancies and a change in the working relationships between urologists and oncologists is required, to improve the outcome of patients with urological malignancy.
Collapse
Affiliation(s)
- M Bower
- Department of Clinical Oncology, Hammersmith Hospital, Imperial College of Medicine, London, UK
| | | | | | | | | |
Collapse
|
16
|
Abstract
PURPOSE To assess the effect of preoperative embolization on blood loss during surgical repair of bone metastases from renal cell carcinoma and provide long-term follow-up. PATIENTS AND METHODS Sixteen patients with bone metastases underwent preoperative embolization. Polyvinyl alcohol (PVA) particles were used for 13 patients (three with additional coils), and coils alone were used in three patients. Surgery was performed within 24 hours in four patients, and within 36-120 hours in 12 patients. Bone healing was evaluated radiographically and clinically. RESULTS Tumor stain was obliterated by more than 70% in 12 patients, 51%-69% in two patients, and less than 50% in two patients. Estimated blood loss (EBL) during surgery ranged from 100 to 1,000 mL (mean, 533 mL). EBL was significantly less when more than 70% of the tumor stain was obliterated (460 mL vs 750 mL; P < .01 ). There were no significant differences in EBL between the patients who underwent surgery within 24 hours (575 mL) and those who underwent surgery more than 36 hours after embolization (402 mL) when PVA was used. Bone healing was achieved in all patients. Survival ranged from 3 to 56 months (median, 12 months). CONCLUSION Preoperative embolization reduced intraoperative blood loss without adverse effects on healing. Best results were achieved when more than 70% of the tumor stain was obliterated.
Collapse
Affiliation(s)
- S Sun
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City 52242, USA
| | | |
Collapse
|
17
|
Reinecke P, Corvin J, Gabbert HE, Gerharz CD. Antiproliferative effects of paclitaxel (Taxol) on human renal clear cell carcinomas in vitro. Eur J Cancer 1997; 33:1122-9. [PMID: 9376193 DOI: 10.1016/s0959-8049(97)00069-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The aim of this study was to analyse the direct antiproliferative effects of paclitaxel on 20 different renal clear cell carcinoma (RCCC) cell lines comparing the effects of paclitaxel dissolved in either DMSO or Cremophor EL/ethanol (Taxol). The MTT assay was used to determine the growth inhibition of the cell lines by paclitaxel. In addition, micronuclei and microtubule alterations were examined by light and immunofluorescence microscopy. A significant (P < 0.05) dose-dependent inhibition of proliferation was evident in 19 out of 20 cell lines after exposure to paclitaxel dissolved in DMSO and in all cell lines after exposure to paclitaxel in Cremophor EL/ethanol. The extent of response markedly varied between the different cell lines ranging from modest effects to reduction of cell viability down to 1-2% of the control. The effects of paclitaxel in Cremophor EL/ethanol proved to be more pronounced than the effects of paclitaxel dissolved in DMSO. This observation could be explained by additional growth inhibitory effects of Cremophor EL alone. Light microscopy revealed extensive micronucleus formation after treatment with paclitaxel. However, the failure to demonstrate differences of micronucleus formation in paclitaxel-responsive and non-responsive RCCC cell lines argued against a causal relationship between micronucleus formation and growth inhibition. Immunofluorescence microscopy revealed no differences in the formation of abnormal microtubules in cell lines responsive or non-responsive to the growth inhibitory effects of paclitaxel. Further investigations, therefore, are needed to understand the mechanisms determining the response of RCCCs to paclitaxel treatment.
Collapse
Affiliation(s)
- P Reinecke
- Institute of Pathology, Heinrich-Heine-University, Düsseldorf, Germany
| | | | | | | |
Collapse
|
18
|
Sokoloff MH, Belldegrun A. Immunotherapy and Gene Therapy for Genitourinary Malignancies. Int J Urol 1996. [DOI: 10.1111/j.1442-2042.1996.tb00336.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
19
|
Affiliation(s)
- S H Goey
- Department of Medical Oncology, Rotterdam Cancer Institute (Daniel den Hoed Kliniek), The Netherlands
| | | | | |
Collapse
|
20
|
Immunochemotherapy for Metastatic Renal Cell Carcinoma Using a Regimen of Interleukin-2, Interferon-alpha and 5-fluorouracil. J Urol 1996. [DOI: 10.1097/00005392-199607000-00004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
21
|
Hofmockel G, Langer W, Theiss M, Gruss A, Frohmuller H. Immunochemotherapy for Metastatic Renal Cell Carcinoma Using a Regimen of Interleukin-2, Interferon-alpha and 5-fluorouracil. J Urol 1996. [DOI: 10.1016/s0022-5347(01)65926-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- G. Hofmockel
- Department of Urology, University of Wurzburg Medical School, Wurzburg, Germany
| | - W. Langer
- Department of Urology, University of Wurzburg Medical School, Wurzburg, Germany
| | - M. Theiss
- Department of Urology, University of Wurzburg Medical School, Wurzburg, Germany
| | - A. Gruss
- Department of Urology, University of Wurzburg Medical School, Wurzburg, Germany
| | - H.G.W. Frohmuller
- Department of Urology, University of Wurzburg Medical School, Wurzburg, Germany
| |
Collapse
|
22
|
Sokoloff MH, Belldegrun A. Immunotherapy and Gene Therapy for Genitourinary Malignancies. Int J Urol 1996; 3:S4-18. [DOI: 10.1111/j.1442-2042.1996.tb00081.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
23
|
Imai T, Katagiri A, Saito K, Tomita Y. Interferon-alpha-induced protection of renal cell cancer cell line from lysis by natural killer cells and increase of susceptibility by treatment with 5-fluorouracil. Cancer Lett 1995; 94:191-7. [PMID: 7634247 DOI: 10.1016/0304-3835(95)03849-r] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We have shown previously that interferon (IFN)-alpha reduces the sensitivity of renal cell cancer (RCC) cell lines ACHN and KRC/Y to lysis by lymphokine-activated killer (LAK) cells. The close relationship between natural killer (NK) cells and LAK cells prompted us to investigate whether IFN-alpha pretreatment also affects the sensitivity of ACHN cells to lysis by NK cells or IFN-alpha-activated NK cells. A 51Cr-release cytotoxicity assay demonstrated that pretreatment of ACHN with IFN-alpha decreased their susceptibility to NK cells and IFN-alpha-activated NK cells in a dose-dependent manner. Moreover, to investigate the usefulness of 5-fluorouracil (5FU) for combination with IFN-alpha therapy, we examined the effect of preincubation with 5FU on the susceptibility of ACHN. IFN-alpha-induced protection of ACHN from lysis by IFN-alpha-activated NK cells weakened in the presence of 5FU at 0.2 microgram/ml. An adhesion assay showed that preincubation of ACHN with 5FU and IFN-alpha did not alter the adhesion of IFN-alpha-activated NK cells. A cold target competition analysis did not show any difference between untreated and 5FU and/or IFN-alpha-treated competitors. These results suggest that one of the mechanisms of 5FU for combination with IFN-alpha therapy might depend on changes of RCC cells in intrinsic lysability involving a post-binding stage of the lytic cycle to NK cells.
Collapse
Affiliation(s)
- T Imai
- Department of Urology, Niigata University School of Medicine, Japan
| | | | | | | |
Collapse
|
24
|
Affiliation(s)
- S B Malkowicz
- School of Medicine, University of Pennsylvania, Philadelphia 19104, USA
| |
Collapse
|
25
|
Fayers PM, Cook PA, Machin D, Donaldson N, Whitehead J, Ritchie A, Oliver RT, Yuen P. On the development of the Medical Research Council trial of alpha-interferon in metastatic renal carcinoma. Urological Working Party Renal Carcinoma Subgroup. Stat Med 1994; 13:2249-60. [PMID: 7846423 DOI: 10.1002/sim.4780132106] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This paper describes the steps taken by the British Medical Research Council (MRC) in developing the MRC RE01 trial, a randomized clinical trial for patients with metastatic renal cancer; we discuss the reasons for adopting a triangular sequential design and the impact that this has upon the monitoring of the trial. It had been suggested to the MRC that a trial of biological agents for metastatic renal carcinoma should be initiated. The Cancer Therapy Committee (CTC) of the MRC, through its associated site specific working parties, is responsible for designing and co-ordinating randomized trials of alternative treatments in cancer in solid tumours. Since no MRC working party for renal carcinoma existed at that time, development began by the formation of an ad hoc group set up under the auspices of the CTC. They assessed, by means of a postal questionnaire, U.K. interest in the trials of, and modalities utilized for, treatment of renal cancer. The responses focused attention on the important questions to ask and indicated the level of potential collaboration. These responses and related clinical and statistical issues suggested a protocol to compare medroxy-progesterone acetate (MPA) against alpha-interferon (alpha-IFN). In view of the special problems of comparing an expensive and potentially toxic therapy with an inexpensive and non-toxic standard, a sequential design was used rather than a fixed sample size design. Statistical issues raised and solutions provided are described. The method of establishing the trial data monitoring committee and a brief review of mortality from renal carcinoma in England and Wales are also included. The trial opened to patient recruitment on 1 January 1992. The formal statements regarding statistical issues that appear in the formal trial protocol (RE01) are set out in the Appendix.
Collapse
Affiliation(s)
- P M Fayers
- MRC Cancer Trials Office, Cambridge, U.K
| | | | | | | | | | | | | | | |
Collapse
|
26
|
|
27
|
Fujioka T, Yoshida N, Hasegawa M, Ishikura K, Suzuki Y, Kubo T. Interleukin-2 expanded tumor-infiltrating lymphocytes and their response to preoperative alpha-interferon in patients with renal cell carcinoma. J Urol 1994; 152:852-6. [PMID: 8051734 DOI: 10.1016/s0022-5347(17)32589-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
To determine whether interferon-alpha could augment antitumorigenic effect of the tumor-infiltrating lymphocytes expanded with interleukin-2, we evaluated the properties of interleukin-2 expanded tumor-infiltrating lymphocytes in 24 patients with renal cell carcinoma with or without treatment with interferon-alpha. Tumor-infiltrating lymphocytes containing tumor cells were separated from nephrectomy specimens by enzymatic digestion and Percoll gradient centrifugation, and were cultured in the serum-free medium containing interleukin-2. The number of lymphocytes increased by 10 to 1,000-fold by day 28 of culture. There was no difference in the proliferation of tumor-infiltrating lymphocytes between interferon-alpha treated patients and controls. On day 14 tumor-infiltrating lymphocytes in the treated patients contained significantly more activated cells (HLA-DR+) and suppressor T cells (CD8+11+) than those in the controls. No significant difference was noted, however, in the cytotoxicity of tumor-infiltrating lymphocytes against autologous and allogenic renal cell carcinoma, K-562 or Daudi cells between the experimental and control groups on day 14 or 28. No specific effects on the major histocompatibility antigens, such as modulation of the expression attributable to the preoperative treatment with interferon-alpha, were observed on renal cell carcinoma tissue when determined by immunohistochemical staining. These findings suggest that interferon-alpha does not consistently produce a beneficial effect on interleukin-2 expanded tumor-infiltrating lymphocytes in patients with renal cell carcinoma.
Collapse
Affiliation(s)
- T Fujioka
- Department of Urology, Iwate Medical University School of Medicine, Morioka, Japan
| | | | | | | | | | | |
Collapse
|
28
|
Frydenberg M, Gunderson L, Hahn G, Fieck J, Zincke H. Preoperative external beam radiotherapy followed by cytoreductive surgery and intraoperative radiotherapy for locally advanced primary or recurrent renal malignancies. J Urol 1994; 152:15-21. [PMID: 8201647 DOI: 10.1016/s0022-5347(17)32805-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Patients with local persistence or local regional recurrence of cancer after nephrectomy for renal cell cancer are unlikely to respond well to systemic therapy or external irradiation alone. In this analysis, patients with locally recurrent (9) or persistent (2) cancer following nephrectomy (renal cell cancer in 8, transitional cell or squamous cell cancer in 3) usually received 4,500 to 5,040 cGy. preoperative external beam irradiation followed by maximal surgical debulking and intraoperative electron irradiation (1,000 to 2,500 cGy.). Of 8 renal cell cancer patients 6 were alive and 4 were without disease progression at 15 to 50 months (3 of 4 at 29 months or longer). One patient died free of disease at 10.5 months and 3 had metastases (regional in 1 and distant in 3). Of the 3 transitional or squamous cell carcinoma patients 1 died free of disease 28.5 months after initiation of treatment for recurrence and 2 died of disease progression (liver in 1 and local in 1). It appears that select patients with solitary local recurrence or persistence following radical nephrectomy for renal cell cancer may benefit from an aggressive local treatment approach using irradiation (preoperatively and intraoperatively) plus maximal surgical debulking. In patients with locally advanced high grade transitional cell cancer the locally aggressive approach should probably be combined with multi-drug chemotherapy because of increased systemic risks. For both groups (renal cell carcinoma and transitional/squamous cell carcinoma) the most ideal patient for such treatment is one who has not received prior chemotherapy or external irradiation to the site of relapse, since 3 of 5 patients with disease progression after our aggressive approach had received chemotherapy (2) or external beam irradiation (2) elsewhere before referral.
Collapse
Affiliation(s)
- M Frydenberg
- Department of Urology, Mayo Clinic, Mayo Foundation, Rochester, Minnesota 55905
| | | | | | | | | |
Collapse
|
29
|
Berlin J, King AC, Tutsch K, Findlay JW, Kohler P, Collier M, Clendeninn NJ, Wilding G. A phase II study of vinblastine in combination with acrivastine in patients with advanced renal cell carcinoma. Invest New Drugs 1994; 12:137-41. [PMID: 7860231 DOI: 10.1007/bf00874444] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Renal cell carcinoma exhibits chemoresistance attributable in part to the P-glycoprotein drug efflux mechanism. Acrivastine is a hydrophylic antihistamine that has been shown in vitro to reverse this form of resistance. After five patients were treated on a dose-finding study, seventeen patients with metastatic or unresectable renal cell carcinoma were entered into a phase II study of vinblastine in combination with acrivastine. Patients received oral acrivastine at doses of 400 mg every 4 hours for 6 days and a 96-hour continuous infusion of vinblastine at a dose of 1.6 mg/m2/24 h. Of 15 evaluable patients, no tumor responses were seen. The regimen was well-tolerated with the majority of toxicities being gastrointestinal and hematologic. Serum levels of acrivastine, its principal metabolite (270C81) and vinblastine were measured during the study. Based on in vitro data, the plasma levels of acrivastine were within a range adequate to block P-glycoprotein activity. High doses of acrivastine were well-tolerated clinically, however, the combination of acrivastine and vinblastine was not active against renal cell carcinoma.
Collapse
Affiliation(s)
- J Berlin
- Department of Human Oncology, University of Wisconsin Comprehensive Cancer, Madison
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Fujioka T, Nomura K, Hasegawa M, Ishikura K, Kubo T. Combination of lymphokine-activated killer cells and interleukin-2 in treating metastatic renal cell carcinoma. BRITISH JOURNAL OF UROLOGY 1994; 73:23-31. [PMID: 8298895 DOI: 10.1111/j.1464-410x.1994.tb07451.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To study the properties of lymphokine-activated killer (LAK) cells and the effect of immunotherapy with a combination of autologous LAK cells and interleukin-2 (IL-2) [LAK therapy] in 10 patients with metastatic renal cell carcinoma (RCC). MATERIALS AND METHODS The LAK cells were generated from peripheral blood lymphocytes (PBL) by incubation in a serum-free medium (AIM-V) supplemented with IL-2 for 4 days and killer cells were administered intravenously twice a week. The LAK cells showed cytotoxicity against allogenic RCC cell lines and augmented NK and LAK activities. Their phenotypes were CD25+, HLA-DR+, CD3+, and CD16+. Furthermore, LAK cells released IFN-gamma, IL-1 beta, and TNF-alpha. The total number of LAK cells administered ranged from 3.8 x 10(9) to 52.6 x 10(9) cells and the total amount of IL-2 ranged from 150 x 10(5) to 900 x 10(5) U. The effect on pulmonary metastasis in response to LAK therapy was studied. RESULTS The outcome was complete response (1), partial response (1), minor response (2), no change (4) and disease progression (2). Toxic effects were transient and no serious side-effects occurred. Evaluation of host immune parameters indicated that a clinical response was expected in patients with increasing proportions of CD16+, CD25+, CD57+, HLA-DR+ and CD3+DR+ cells among PBL and with augmentation of NK and LAK activities. Brain metastases were detected in three patients during or after treatment. CONCLUSION LAK therapy appears to be effective in treating some patients with RCC and pulmonary metastasis. The potential for inducing brain metastasis, however, should be taken into account.
Collapse
Affiliation(s)
- T Fujioka
- Department of Urology, Iwate Medical University School of Medicine, Morioka, Japan
| | | | | | | | | |
Collapse
|
31
|
Gore ME, Galligioni E, Keen CW, Sorio R, Loriaux EM, Grobben HC, Franks CR. The treatment of metastatic renal cell carcinoma by continuous intravenous infusion of recombinant interleukin-2. Eur J Cancer 1994; 30A:329-33. [PMID: 8204354 DOI: 10.1016/0959-8049(94)90251-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Between March 1989 and June 1990, 133 patients were treated with interleukin 2 (rIL-2) for metastatic renal cell carcinoma (RCC) in a multicentre open non-randomised study. The results show an objective response rate of 14% (95% confidence interval 8-21) with 4 patients achieving a complete remission. This is in keeping with the data from previous studies using rIL-2 by continuous infusion. It is of interest that 87% of objective responses occurred in hospitals that entered 5 or more patients.
Collapse
Affiliation(s)
- M E Gore
- Department of Medicine, Royal Marsden Hospital, London, U.K
| | | | | | | | | | | | | |
Collapse
|
32
|
Vleeming R, Dabhoiwala NF, Bosch DA. Ten years survival after recurrent intracranial metastases from a renal cell carcinoma. Br J Neurosurg 1994; 8:229-31. [PMID: 7917099 DOI: 10.3109/02688699409027974] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The clinical behaviour of renal cell carcinoma is often unpredictable. We report a patient who underwent three palliative resections over 10 years for recurrent intracerebral metastases from a renal cell carcinoma.
Collapse
Affiliation(s)
- R Vleeming
- Department of Urology, Academic Medical Centre, Amsterdam, The Netherlands
| | | | | |
Collapse
|
33
|
Hofmockel G, Bassukas ID, Heimbach D, Wirth M, Maurer-Schultze B. Treatment of a human renal cell carcinoma in nude mice with recombinant human tumor necrosis factor alpha and etoposide. J Urol 1993; 150:1974-9. [PMID: 8230548 DOI: 10.1016/s0022-5347(17)35949-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The effect of treating a human renal cell adenocarcinoma xenografted into Balb/c-nu/nu (nude) mice with recombinant human tumor necrosis factor alpha (TNF alpha) and the cytostatic agent etoposide (ETP) as monotherapy or combination has been studied. Antitumor effects were evaluated by determining growth of the tumor implants by external caliper measurements and tumor cell proliferation by determining the labelling index (LI) after pulse labelling with 3H-thymidine. The toxicity of the treatment with TNF alpha and/or ETP was also studied by measuring the animal weight. Monotherapy with TNF alpha had no effect on tumor growth or proliferation. Treatment with ETP as a single agent, TNF alpha plus ETP applied concurrently and TNF alpha plus ETP two days later led to a slight inhibition of tumor growth and also to a slight decrease of the LI. In contrast to a monotherapy with TNF alpha, all therapeutic modalities containing ETP showed an increased toxic effect on the animals represented by a distinct weight loss. This suggests that the minute efficacy of the treatment observed could well be due solely to its toxicity. In contrast to two other studies, no additive or synergistic effect of the antineoplastic activity of TNF alpha and/or ETP was found. The intertumoral variation of human renal cell carcinomas could be one reason for the different results with this therapeutic regimen.
Collapse
Affiliation(s)
- G Hofmockel
- Department of Urology, University of Würzburg, Germany
| | | | | | | | | |
Collapse
|
34
|
Belldegrun A, Pierce W, Kaboo R, Tso CL, Shau H, Turcillo P, Moldawer N, Golub S, deKernion J, Figlin R. Interferon-alpha primed tumor-infiltrating lymphocytes combined with interleukin-2 and interferon-alpha as therapy for metastatic renal cell carcinoma. J Urol 1993; 150:1384-90. [PMID: 8411405 DOI: 10.1016/s0022-5347(17)35785-3] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Murine models demonstrate therapeutic synergy for the combination of interleukin-2, interferon-alpha and tumor-infiltrating lymphocytes. We treated 11 patients with metastatic renal cell carcinoma with a novel regimen consisting of in vivo primed tumor-infiltrating lymphocytes, interferon-alpha and interleukin-2. Patients received interferon-alpha before radical nephrectomy; in vivo primed tumor-infiltrating lymphocytes were isolated and expanded in vitro. Low dose continuous infusion interleukin-2 at a dose of 2 x 10(6) units per m.2 per day was administered for 96 hours during each treatment week and interferon-alpha was administered as a subcutaneous injection at a dose of 6 x 10(6) units per m.2 per day on days 1 and 4 of the interleukin-2 infusion. No therapy was given during the last 3 days of a treatment week. One course of therapy consisted of 3 weeks of therapy followed by 3 weeks of rest. Patients were treated until maximal response, disease progression or dose limiting toxicity. A maximum of 6 courses of therapy were administered. Eleven patients underwent interferon-alpha priming and subsequent radical nephrectomy. In vivo primed tumor-infiltrating lymphocytes were successfully expanded in all 11 patients with an expansion index of greater than 170. In vivo primed tumor-infiltrating lymphocytes maintained their lytic activity for greater than 5 to 8 weeks in culture as demonstrated in the 4-hour 51chromium release assay. Ten patients underwent multimodality biological therapy and 3 (30%, 95% confidence interval 6 to 65%) have achieved complete response (2 clinical and 1 surgical) with durations of 24+, 23+ and 5+ months. Patients with stable disease received no additional therapy. No deaths and no grade 4 toxicities occurred. Immunotherapy using a combination of interferon-alpha primed tumor-infiltrating lymphocytes, low dose continuous infusion interleukin-2 and interferon-alpha can induce significant and durable antitumor responses in some patients with advanced renal cell carcinoma.
Collapse
|
35
|
Pound CR, Partin AW, Epstein JI, Simons JW, Marshall FF. Nuclear morphometry accurately predicts recurrence in clinically localized renal cell carcinoma. Urology 1993; 42:243-8. [PMID: 8379023 DOI: 10.1016/0090-4295(93)90611-d] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Despite careful clinical staging, as many as 30 percent of patients with pathologically, specimen-confined renal cell carcinoma (RCC) have unpredictable recurrence following surgery. Present pathologic and clinical staging systems cannot accurately predict those patients with high risk of disease recurrence from those who are cured by surgery alone. Advances in immunotherapy including gene therapy for RCC have dictated the need to identify RCC patients for adjuvant therapy protocols who have a high probability of recurrence following nephrectomy. Nuclear morphometric techniques developed at our institution have predicted prognosis for a variety of genitourinary tumors; it was used to predict recurrence among patients undergoing nephrectomy for localized RCC. This report is a retrospective study of 26 patients with RCC of similar age, stage (pT1-pT3), and grade. Fifteen were free of disease at a mean of 75.2 months, and 11 had distant disease recurrence at a mean of 27.1 months. Statistical analysis of a variety of nuclear shape descriptors accurately separated this group of patients based on disease recurrence. No nuclear shape descriptor predicted disease recurrence when nuclei within the region of the tumor with the highest grade were analyzed. However, the range of nuclear ellipticity (p = 0.007) best predicted disease recurrence when nuclei were selected in a random fashion. Multivariate analysis of the four best shape descriptors better predicted disease recurrence (p = 0.002) with a sensitivity of 73 percent and specificity of 100 percent. These results are encouraging and suggest that this technique might be used in identifying patients for adjuvant gene therapy.
Collapse
Affiliation(s)
- C R Pound
- Department of Urology, Johns Hopkins Medical Institution, Baltimore, Maryland
| | | | | | | | | |
Collapse
|
36
|
|
37
|
Papac RJ, Keohane MF. Hormonal therapy for metastatic renal cell carcinoma combined androgen and provera followed by high dose tamoxifen. Eur J Cancer 1993; 29A:997-9. [PMID: 8499154 DOI: 10.1016/s0959-8049(05)80209-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The purpose of this phase II study was to determine the effectiveness of hormonal therapy with combined high dose androgen and provera or tamoxifen in patients with advanced renal cell carcinoma. 30 patients with metastatic renal cell carcinoma received testosterone propionate 100 mg intramuscularly (i.m.) 5 times weekly plus provera 400 mg (i.m.) twice weekly until disease progression developed. 20 patients, most of whom had previously failed to respond to androgen and provera, received tamoxifen 100 mg/m2 daily. Of the 30 patients treated with androgen and provera, 3 (10%) developed partial responses of brief duration. 2 of 20 patients (10%) experienced tumour response with tamoxifen, one instance of complete disappearance of pulmonary metastases in a patient whose primary tumour was questionably persistent at post mortem and another case demonstrating disease stability. Combined hormonal therapy offers very little therapeutic advantage in advanced renal cell carcinoma. Tamoxifen, in high dose, exerts anti-tumour effects in a small cohort of cases.
Collapse
Affiliation(s)
- R J Papac
- Section of Oncology, Yale University School of Medicine, New Haven, Connecticut 06510
| | | |
Collapse
|
38
|
Murphy BR, Rynard SM, Einhorn LH, Loehrer PJ. A phase II trial of interferon alpha-2A plus fluorouracil in advanced renal cell carcinoma. A Hoosier Oncology Group study. Invest New Drugs 1992; 10:225-30. [PMID: 1428732 DOI: 10.1007/bf00877251] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In vitro studies have documented the synergistic activity of interferon (IFN) and fluorouracil (5-FU) in human cancer cell lines, and recent clinical trials have demonstrated the efficacy of this combination in metastatic colon cancer. The current study was undertaken to evaluate the combination of IFN alpha-2a plus 5-FU in previously untreated patients with metastatic renal cell carcinoma. From May 1990 through August 1990, 14 patients with metastatic renal cell carcinoma were treated with 5-FU 750 mg/m2/day continuous infusion IV days 1-5, followed by weekly IV infusions of 5-FU 750 mg/m2 beginning on day 12. Patients concurrently received IFN alpha-2a 9 x 10(6) IU subcutaneously 3 times per week beginning on day 1. The median age of patients treated was 57 (range 38-80) with a median Karnofsky performance status of 90 (range 60-100). Sites of metastases included lung only in 6 patients, liver only in 1 patient, 1 patient had bilateral disease at presentation, and the remaining patients had multiple sites of metastases. The median duration of therapy was 2 months. The predominant toxicities seen were stomatitis, nausea, flu-like symptoms and neurotoxicity. The only grade IV toxicity observed was severe vomiting in 1 patient, though 5 patients discontinued therapy within 2 months because of poor subjective response. With a minimum follow-up of 13 months no objective responses were seen. Thirteen of the 14 patients have had progressive disease and 11 have died. The median time to progression was 2 months (range 0.5-6 months) and the median survival was 5 months (range 2-14.5 + months).(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- B R Murphy
- Department of Medicine, Indiana University School of Medicine, Indianapolis
| | | | | | | |
Collapse
|
39
|
Mrstik C, Salamon J, Weber R, Stögermayer F. Microscopic venous infiltration as predictor of relapse in renal cell carcinoma. J Urol 1992; 148:271-4. [PMID: 1635115 DOI: 10.1016/s0022-5347(17)36569-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In a retrospective analysis at a single institution we evaluated the significance of various pathological phenomena on the disease-free survival of patients with radically resected renal cell carcinoma. Parameters considered were tumor extension (pT stage) according to the International Union Against Cancer, tumor invasion into the renal vein or vena cava (V stage), standard histological grading (G stage), nuclear grading (F stage) and microscopic venous infiltration. The pT stage had a significant impact on disease-free survival (p = 0.0004) of patients with radically resected tumors, as did G stage (p = 0.0001) and F stage (p = 0.002). In contrast to some previously reported results tumor extension to the renal vein and vena cava showed no influence on disease-free survival (p = 0.077). On the other hand, microscopic venous infiltration, defined as local tumor infiltration through all vessel structures including the endothelial layer leading to a free tumor extension into the vessel, had a significant impact on disease-free survival (p less than 0.0001). When stratifying either tumor size or nuclear differentiation against microscopic venous infiltration, the latter retained a superior influence on disease-free survival (p = 0.01 and p = 0.0079, respectively). We conclude that microscopic venous infiltration is the most important predictor of relapse in renal cell carcinoma.
Collapse
Affiliation(s)
- C Mrstik
- Department of Urology, Ludwig Boltzmann Institute for Hematology and Leukemia Research, Vienna, Austria
| | | | | | | |
Collapse
|
40
|
Greenberg RE, Cooper J, Krigel RL, Richter RM, Kessler H, Petersen RO. Hoarseness; a unique clinical presentation for renal cell carcinoma. Urology 1992; 40:159-61. [PMID: 1502755 DOI: 10.1016/0090-4295(92)90518-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The first reported case of an isolated metastasis to the larynx from a regionally localized renal cell carcinoma presenting clinically as hoarseness is discussed. Aggressive management and outcome are presented.
Collapse
Affiliation(s)
- R E Greenberg
- Department of Surgery/Urology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | | | | | | | | | | |
Collapse
|
41
|
Abstract
We describe the surgical management and followup of 11 patients with local recurrence of renal cell carcinoma in the renal fossa, 10 of whom demonstrated no evidence of distant metastatic disease at the time of recurrence. Average interval to recurrence was 31 months from nephrectomy, with the majority of patients presenting with symptoms of weight loss, fatigue and lumbar discomfort. A total of 13 resections of recurrent carcinoma was performed with 3 immediate postoperative complications, including a retroperitoneal abscess, jejunal necrosis requiring resection and a duodenal obstruction requiring duodenojejunostomy. There were 2 postoperative deaths, 2 patients died of disseminated disease at 8 and 22 months, and 3 died of causes unrelated to cancer recurrence at 4 months, 6 months and 10 years. Four patients were without disease at a followup of 35, 46, 48 and 211 months. We include in this review a report on 1 patient who maintains a disease-free survival of 17 years after resection of a recurrent spindle cell carcinoma. We conclude that an aggressive surgical approach to recurrent renal cell carcinoma within the renal fossa can produce long-term disease-free survival and is justified when compared to the results reported for chemotherapy.
Collapse
Affiliation(s)
- D Esrig
- Department of Urology, University of Southern California, School of Medicine, Los Angeles
| | | | | | | |
Collapse
|
42
|
Abstract
Metastatic cancer can cause severe pain and disability. Metastases can occur in any bone, but usually are located in the axial or proximal appendicular skeleton. The most frequently encountered primary tumors that spread to bone are those of the prostate, breast, kidney, lung, and thyroid. When the origin of the primary cancer is known, skeletal metastases are more often from breast or prostate. When the primary site is unknown, the lung and kidney should be suspected as sites of origin. The nonoperative management of skeletal metastases from multiple myeloma and from carcinomas of the prostate, breast, kidney, lung, and thyroid are discussed.
Collapse
Affiliation(s)
- M E Brage
- Section of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Ill 60637
| | | |
Collapse
|
43
|
Fischer P, Baum RP, Tauber M, Boeckmann W, Weier S, Scherberich JE. Immunoscintigraphic localization of renal tumours in an extracorporeal perfusion model with a monoclonal antibody against gamma-glutamyltransferase. Cancer Immunol Immunother 1992; 35:283-8. [PMID: 1355011 PMCID: PMC11038987 DOI: 10.1007/bf01789336] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/1992] [Accepted: 03/17/1992] [Indexed: 10/25/2022]
Abstract
Monoclonal antibody 138H11 against human gamma-glutamyltransferase has been shown to react immunohistochemically with 98% of all tested clear-cell type and chromophilic renal cell carcinomas, but not with renal chromophobic carcinomas, Duct-Bellini carcinomas or oncocytomas. In normal kidney the target epitopes of mAb 138H11 are located in the luminal brush-border membrane of proximal tubule cells, whereas in renal carcinomas the epitopes are found surrounding the whole tumour cells. These results form the basis of the present immunoscintigraphic study designed to evaluate mAb 138H11 in an extracorporeal perfusion model. Immediately after nephrectomy, human tumour-bearing kidneys were perfused with 99mTc-labelled mAb 138H11 in Euro-Collins solution. High specific uptake in 4/4 renal clear cell carcinomas could be demonstrated by planar immunoscintigraphy and single-photon-emission computed tomography, "regions of interest" investigation and immunohistochemistry. In contrast, a perfused oncocytoma showed up as an unlabelled lesion. The results indicate a possible use for mAb 138H11 in immunoscintigraphy or even therapy, provided high tumour uptake can be confirmed in patients.
Collapse
Affiliation(s)
- P Fischer
- Department of Nephrology, University Hospital, J. W. Goethe University, Frankfurt (Main), Federal Republic of Germany
| | | | | | | | | | | |
Collapse
|
44
|
Masuda F, Nakada J, Kondo I, Furuta N. Adjuvant chemotherapy with vinblastine, adriamycin, and UFT for renal-cell carcinoma. Cancer Chemother Pharmacol 1992; 30:477-9. [PMID: 1394804 DOI: 10.1007/bf00685600] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
VAU therapy (vinblastine, Adriamycin, and UFT) was given postoperatively to 31 patients with stage I, II, or III renal-cell carcinoma, and the incidence of relapse as well as the survival of patients were studied. Administration was started at 7-14 days post-surgery; 5 mg/m2 vinblastine and 30 mg/m2 Adriamycin were given i.v. once every 4 weeks for a total of five courses, and three capsules of UFT (containing 300 mg tegafur) were given p.o. every day for 2-3 years. The postoperative observation period ranged from 2 years and 6 months to 7 years and 1 month (mean, 4 years and 2 months). The 1-year survival of patients was 100%, and the 3- and 5-year survival values were 96%. These results were significantly better (P less than 0.01) than the respective values (81%, 72%, and 60%) obtained for the historical controls, i.e., the 60 patients with stage I, II, or III renal-cell carcinoma who received no chemotherapy. Side effects such as alopecia, gastrointestinal symptoms, and myelosuppression were encountered, but all symptoms were so mild and transient that discontinuation of the treatment was not necessary. As VAU therapy might be useful as adjuvant chemotherapy for renal-cell carcinoma, it seems to merit further study.
Collapse
Affiliation(s)
- F Masuda
- Department of Urology, Daisan Hospital, Jikei University School of Medicine, Tokyo, Japan
| | | | | | | |
Collapse
|
45
|
De Riese W, Goldenberg K, Allhoff E, Jonas U. Spontaneous regression of metastatic renal carcinoma with long-term survival. BRITISH JOURNAL OF UROLOGY 1991; 68:98-100. [PMID: 1873697 DOI: 10.1111/j.1464-410x.1991.tb15264.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- W De Riese
- Department of Urology, Hannover Medical School, Germany
| | | | | | | |
Collapse
|
46
|
Plawner J. Results of surgical treatment of kidney cancer with solitary metastasis to contralateral adrenal. Urology 1991; 37:233-6. [PMID: 2000680 DOI: 10.1016/0090-4295(91)80291-e] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A large series of patients were reviewed in two major teaching institutions, and patients with a carcinoma of the kidney with a solitary metastatic deposit in the contralateral adrenal were identified. Their survival was analyzed and compared with the survival of those patients having a solitary metastatic deposit in other organs.
Collapse
Affiliation(s)
- J Plawner
- Urology Department, New York University Medical Center, New York
| |
Collapse
|
47
|
Abstract
Of 52 patients who underwent partial nephrectomy for tumor 44 were found to have renal cell carcinoma. The indications for this parenchyma-sparing procedure were categorized according to the initial status of the contralateral kidney and included bilateral tumors or tumor in a solitary kidney in 16 patients (mandatory indications), unilateral carcinoma with compromise of the contralateral kidney by a benign disease process in 9 (relative indications) and small peripheral tumor with a normal contralateral kidney in 19 (elective indications). There were 4 recurrences that accounted for 3 deaths, all in patients with mandatory indications. All patients who underwent partial nephrectomy for relative or elective indications were without definite evidence of recurrent disease at last followup (over-all mean 36 months). Our results suggest that conservative surgery can often provide effective and advantageous therapy for renal cancer and we encourage further consideration of the role of partial nephrectomy as an alternative to radical nephrectomy in selected patients with small peripheral tumors and normal contralateral kidneys.
Collapse
|
48
|
Abstract
A case of bilateral synchronous renal cell carcinomas with metastases to the regional lymph nodes and later to the thyroid gland was treated with aggressive surgical extirpation and adjuvant gamma interferon. The patient continues to have an excellent performance status sixteen months after initial diagnosis despite a large tumor burden at presentation.
Collapse
|
49
|
Naito S, Kimiya K, Sakamoto N, Soejima T, Ueda T, Kumazawa J, Osada Y, Kurozumi T, Sagiyama K, Ariyoshi A. Prognostic factors and value of adjunctive nephrectomy in patients with stage IV renal cell carcinoma. Urology 1991; 37:95-9. [PMID: 1992596 DOI: 10.1016/0090-4295(91)80200-q] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We reviewed 57 cases of Stage IV renal cell carcinoma to clarify the factors influencing prognosis and to evaluate the value of nephrectomy. Cumulative survival from the initial diagnosis was analyzed with respect to the patients' age, sex, side of primary tumor, initial performance status (PS), site of metastasis, and nephrectomy. Overall survival for the patients was 51 percent at one year, 22 percent at three years, and 11 percent at five years. Age, sex, and side of primary tumor had no influence on survival. Improved survival was correlated with good PS, metastases limited to single organ, and removal of the primary tumor. With regard to histopathologic features in nephrectomized patients, low grade and stage were correlated with longer survival. These factors should be considered in the analysis of results of future clinical trials of metastatic renal cell carcinoma.
Collapse
Affiliation(s)
- S Naito
- Department of Urology, Kyushu University, Sanshinkai-Hara Hospital, Fukuoka, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
de Riese W, Goldenberg K, Allhoff E, Stief C, Schlick R, Liedke S, Jonas U. Metastatic renal cell carcinoma (RCC): spontaneous regression, long-term survival and late recurrence. Int Urol Nephrol 1991; 23:13-25. [PMID: 1938215 DOI: 10.1007/bf02549723] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We report 4 cases of metastatic renal cell carcinoma (RCC) with long-term survival either following radical nephrectomy alone or in combination with radio- or hormonal therapy. Two patients with lymph node metastases showed a long-term survival of 12 or more years following radical tumour nephrectomy (with lymphadenectomy) and radiotherapy. One of them exhibited a histologically proven tumour recurrence nearly 12 years after primary surgical treatment and died shortly later; the other one is still without any evidence of metastatic disease. Two other patients exhibited spontaneous regression of pulmonary metastases: one regression occurred after radical tumour nephrectomy alone, the other one after successful primary hormonal treatment and subsequent radical tumour nephrectomy. The following important aspects are emphasized: 1. Renal cell carcinoma is a very unpredictable tumour. Once the diagnosis of renal cell carcinoma is proved, a patient can never be considered cured. 2. Although adjuvant palliative nephrectomy has produced contradictory results in several reports, radical tumour nephrectomy either alone or in combination with other adjuvant therapies such as radiotherapy, hormonal or immunological treatment, can be worthwhile. Cases with long-term survival and spontaneous regression of distant metastases are proof of this. Besides, if carefully selected, the mortality rate of different adjuvant therapies is not significantly higher in patients with metastatic disease than in patients without metastases. The world literature on this subject is reviewed.
Collapse
Affiliation(s)
- W de Riese
- Department of Urology, Hannover Medical School (HMS), Germany
| | | | | | | | | | | | | |
Collapse
|