Adjuvant chemotherapy after radical cystectomy: Do all patients who need chemotherapy after surgery actually receive it?

Background

Compliance with the guideline recommendations for neoadjuvant chemotherapy in patients with muscle-invasive bladder cancer is incomplete. The adjuvant chemotherapy approach has the advantage of pathology-based decision-making, allowing for patient selection. In addition, radical surgery is not delayed and treatment-related toxicity does not impair surgical fitness. The proportion of patients who completed chemotherapy after cystectomy among those who were fit and in need of treatment were evaluated. The reasons for not completing adjuvant chemotherapy were determined.

Materials and methods

We retrospectively evaluated all patients who had undergone radical cystectomy at our center over the last 7 years. Indications for adjuvant chemotherapy included pathological T > 2, any node+, or surgical margin involvement. Only patients who were fit for chemotherapy before surgery were included in the study.

Results

Of the 52 patients with muscle-invasive bladder cancer, 14 received neoadjuvant chemotherapy or unfit for chemotherapy were excluded. Of the remaining 38 patients, 14 (37%) had bladder-confined cancers and did not require additional chemotherapy. Of the 24 patients who needed chemotherapy and were fit to receive it, 8 patients completed treatment (33%), and 3 discontinued treatment due to toxicity. Twelve patients (50%) declined chemotherapy, whereas 1 patient became unfit for chemotherapy after surgery.

Conclusions

While the adjuvant chemotherapy approach could save unnecessary treatment in 37% of patients, two-thirds of those who needed chemotherapy did not complete it. Patient refusal was the primary reason for not receiving treatment.

Radical Cystectomy after Previous Radiation or Pelvic Surgery: Is It Associated with Increased Morbidity?

BACKGROUND

Radical cystectomy is a complicated surgery with significant risks. Complications of Clavien-Dindo grade 3-4 range from 25% to 40% while risk of mortality is 2%. Pelvic surgery or radiotherapy prior to radical cystectomy increases the challenges of this surgery.

OBJECTIVES

To assess whether radical cystectomy performed in patients with prior history of pelvic surgery or radiation was associated with increased frequency of Clavien-Dindo grade 3 or higher complications compared to patients without prior pelvic intervention.

METHODS

We retrospectively evaluated all patients who underwent radical cystectomy at our center over a 7-year period. All patients with pelvic radiation or surgery prior to radical cystectomy comprised group 1, while group 2 included the remaining patients.

RESULTS

In our study, 65 patients required radical cystectomy at our institution during the study period. Group 1 was comprised of 17 patients and group 2 included 48 patients. Four patients from group 2 received orthotopic neobladder, while an ileal conduit procedure was performed in the remaining patients. Estimated blood loss and the amount of blood transfusions given was the only variable found to be statistically different between the two groups. One patient from group 1 had four pelvic interventions prior to surgery, and her cystectomy was aborted.

CONCLUSIONS

Radical cystectomy may be safely performed in patients with a history of pelvic radiotherapy or surgery, with complication rates similar to those of non-irradiated or operated pelvises.

Single Instillation of Hypertonic Saline Immediately Following Transurethral Resection of Bladder Tumor for Recurrence Prevention –A Phase I Study

BACKGROUND: Urologic guidelines recommend perioperative instillation of chemotherapy after transurethral resection of bladder tumor (TURBT) to decrease tumor recurrence, yet implementation of this recommendation is partial due to associated morbidity. Hypertonic saline destroys cells by osmotic dehydration and might present a safer alternative. OBJECTIVE: To evaluate the safety of 3% hypertonic saline (Hypersal) intravesical instillation following TURBT in rats and in humans. METHODS: In 8 rats whose bladders were electrically injured, intravesical blue-dyed Hypersal was administered. We measured serum sodium levels before and after instillation and pathologically evaluated their pelvic cavity for signs of inflammation or blue discoloration. Twenty-four patients were recruited to the human trial (NIH-NCT04147182), 15 comprised the interventional and 10 the control group (one patient crossed over). Hypersal was given postoperatively. Serum sodium was measured before, 1 hour and 12–24 hours after instillation. Adverse effects were documented and compared between the groups. RESULTS: In rats, average sodium levels were 140.0 mEq/L and 140.3 mEq/L before and following instillation, respectively. Necropsy revealed no signs of inflammation or blue discoloration. In humans the average plasma sodium levels were 138.6 mEq∖L, 138.8 mEq∖L and 137.7 mEq∖L before, 1 hour and 12–24 hours after instillation, respectively. During the postoperative follow-up there was one case of fever. A month after the surgery, dysuria was reported by 5 patients while urgency and hematuria were reported by one patient each. The most severe adverse events were grade 2 on the Clavien-Dindo scale. Adverse events were similar in the control group. CONCLUSIONS: Hypersal instillation is safe and tolerable immediately after TURBT.

The complete DNA sequence and genome organization of the avian adenovirus, hemorrhagic enteritis virus

Hemorrhagic enteritis virus (HEV) belongs to the Adenoviridae family, a subgroup of adenoviruses (Ads) that infect avian species. In this article, the complete DNA sequence and the genome organization of the virus are described. The full-length of the genome was found to be 26,263 bp, shorter than the DNA of any other Ad described so far. The G + C content of the genome is 34.93%. There are short terminal repeats (39 bp), as described for other Ads. Genes were identified by comparison of the DNA and predicted amino acid sequences with published sequences of other Ads. The organization of the genome in respect to late genes (52K, IIIa, penton base, core protein, hexon, endopeptidase, 100K, pVIII, and fiber), early region 2 genes (polymerase, terminal protein, and DNA binding protein), and intermediate gene IVa2 was found to be similar to that of other human and avian Ad genomes. No sequences similar to E1 and E4 regions were found. Very low similarity to ovine E3 region was found. Open reading frames were identified with no similarity to any published Ad sequence.

Reduced Dosage of Methyl Bromide for Controlling Verticillium Wilt of Potato in Experimental and Commercial Plots

The use of gas-impermeable films to reduce the dosage of methyl bromide (MB) required to control Verticillium wilt in potatoes was examined in field experiments, conducted in soils naturally infested with Verticillium dahliae. The incidence and severity of Verticillium wilt were significantly reduced (by 74 to 94%) by fumigation with MB at 50 g/m² under standard low density polyethylene (LDPE) or at 25 g/m² under gas-impermeable films. Fumigation at 25 g/m² under LDPE was less effective. Disease severity was inversely correlated (r² = 0.89 to 0.91) with chlorophyll content in the leaves. Fumigation also reduced (by 89 to 100%) stem colonization by the pathogen. Potato yield in the fumigated plots was significantly higher (26 to 69%), than in their nonfumigated counterparts, and was inversely correlated with disease index (r² = 0.69 to 0.9). The percentage of high-value tubers (above 45 g) was 52 to 56% of total yield in the fumigated plots as compared with 32 to 40% in the nonfumigated controls. Thus, fumigation also improved the commercial quality of tuber yield. Effective control of V. dahliae and yield increases following MB fumigation at the recommended dosage or at a reduced dosage with gas-impermeable films was also observed in a consecutive crop. These results were verified in a large-scale field experiment using commercial applications, further demonstrating the feasibility of reducing MB dosages under farm conditions, without reducing its effectiveness in terms of disease control and yield improvement.

Induced diploid gynogenesis and polyploidy in the ornamental (koi) carp Cyprinus carpio L. : 3. Optimization of heat-shock timing during the 2nd meiotic division and the 1st cleavage

The results of a series of experiments conducted in our laboratory on the ornamental common carp (koi), aimed at optimizing heat-shock chromosome-set manipulation procedures, are described. The timing of heat-shock initiation was expressed in the relative unit of embryological age (τ0) in order to standardize this parameter, the absolute time for heat-shock initiation being calculated from duration of one τ0 at two different pre-treatment water temperatures. Heat shocks were applied within the periods of 0.05-0.60 τ0 and 1.20-2.20 τ0 which, respectively, cover the successive phases of the 2nd meiotic division and the 1st cleavage. The highest production of diploid gynogenetic offspring was observed when heat shocks were initiated at 0.15-0.25 τ0 and at 1.5 τ0, after insemination, corresponding to anaphase of meiosis-II, and metaphase of the 1st cleavage, respectively. Similar results were obtained irrespective of the different pre-treatment water temperatures, thus confirming the possibility of standardizing heat-shock timing by τ0.

Induced diploid gynogenesis and polyploidy in the ornamental (koi) carp, Cyprinus carpio L. : 4. Comparative study on the effects of high- and low-temperature shocks

The effects of high- and low-temperature shock treatments, applied at different phases of the 2nd meiotic division within the limits of 0.05-0.60 τ0 (τ0 = relative unit of embryological age) in order to induce gynogenesis in the common carp, were studied. A remarkable difference in the effect of two temperature treatments applied at the same biological age after insemination (expressed in τ0) was revealed. The curves of embryo survival and diploid gynogenetic larva output showed a bimodal response in cold-shocked gynogenetic progenies, with the highest level of diploid larva output at the periods 0.05-0.10 τ0 and 0.30-0.40 τ0 (after insemination), separated by a period of high sensitivity to cold shock (0.15-0.25 τ0). In contrast to this, the curves of embryo survival and diploid gynogenetic larva output showed a single, narrow, peak corresponding to 0.15-0.25 τ0 in heat-shocked gynogenetic progenies. The results obtained are in general accord with those of previous experiments on induced gynogenesis and triploidy in common carp, in which either cold- or heat-shock was used.