CONGRESSES AND CONFERENCES
CLINICAL CASE
Urethral melanoma is a rare malignancy that has a poor prognosis. The paper presents the data available in the worldwide literature on urethral melanoma and analyzes the specific features of the disease occurring in males and females. It also describes clinical cases of malignant melanoma of the urethra in one woman and two men treated at the Russian Cancer Research Center.
TOPICAL PROBLEM
Laparoscopic access allows radical nephrectomy and renal resection to be performed in patients with small tumors, including in those with renal cancer of T1-2, by providing the immediate and early results comparable with those of open interventions. The advantages of the laparoscopic access are low traumatism, less length of stay, a good cosmetic effect, and shorter rehabilitation. At the same time simultaneous operations may be performed. The future role of laparoscopy shall be defined when the 5-year survival rates are assessed.
DIAGNOSIS AND TREATMENT OF URINARY SYSTEM TUMORS
The positron emission tomography (PET) is a valuable in a clinical oncology as a highly sensitive method of diagnostics. However, PET possibilities in diagnostics of genitourinary tract tumors are less investigated. 61 patients with genitourinary lesions aged 18 to 78 years were examined. Diagnosis was verified by data of histological analysis in all cases. 18F-FDG PET (« Ecat Exact 47 « and « Ecat Exact HR + «) was performed in whole body mode. Results of our studies show high diagnostic accuracy of 18F-FDG PET at abundance definition of neoplasms and coincident with literature data. Most perspective 18F-FDG PET application is a definition of tumors follow-up efficacy. However diagnostic possibilities show poor efficacy at a hypernephroid cancer determination due to low level of a glycolysis in kind tumors.
The incidence of renal cell carcinoma accounts for about 3% of all solid tumors. The incidence is increasing (1). The primary management of renal cell carcinoma is surgical. Most of the time metastases are already present at the time of diagnosis in more than half of the tumors. Once metastatic disease is present, the response rate of any treatment is low (15-20%) and the cure rate is only 6 to 8% (2-5). Factors which adversely influence prognosis are a high tumor stage, the histologic subtype, age, and co-morbidity factors. The histologic subtype of the tumor indeed plays an important role. It is well known that the conventional (clear cell) subtype is the only subtype that reacts to immunotherapy. The described spontaneous regression of metastases after nephrectomy or after an inflammatory syndrome, and the earlier successes with immunotherapy (and also due to the low success of chemotherapy) have resulted in an increased interest in the development of specific immunotherapy.
Nephroblastoma (NB), a childhood embryonic tumor, accounts for less than 1% of all neoplasms in adults. The algorithm of an examination of patients aged above 14 years who has suspected NB should include angiography in addition to ultrasound computed tomography and computed tomography. Verification of its diagnosis in adults before therapy requires fine-needle tumor biopsy. Treatment for NB in adults should be multimodality and include neoadjuvant chemotherapy, primary tumor removal, and subsequent chemoradiation therapy. The prognosis is fair in patients over 14 years of age who had a localized NB and poor in those with locally extended and disseminated tumors. It is necessary to perform multicenter studies in order to develop an optimal therapeutic algorithm and to improve the results of treatment for NB in adults.
The results of treatment of 170 patients with prostate cancer (T2—3N0—1M0—1) who received radiotherapy or radiotherapy plus antiandrogenic therapy from 1998 to 2003 were reviewed. The mean age was 69,5 year. The diagnosis was verified morphologically (Gl — 146 (85%), G2 — 10 (6%), G3 — 14 (8%) patients). The mean level of PSA was 24 ng/ml. Morphologic characteristics of tumors with defining of their differentiation grade according to Glisson scale were studied in 75 patients. Conformation radiotherapy with three dimensional planning was carried out by linear accelerator. Multipetal collimator was used for figured fields construction taking into account the spread of tumor.
The total dose of radiation was 70—74 Gy. Only radiation therapy was carried out to 45 patients, whereas in 125 patients the radiotherapy was supplemented by administration of antiandrogenic therapy with Flucin or Zoladex. For initial assessment of tumor extent and evaluation of the treatment effect, we used transrectal ultrasound investigation (TRUSI) with ultrasonographic angiography. According to TRUSI, capsule invasion was found in 25 (16%) patients, which determines the risk of disease progression. Five year disease free survival in the absence of capsule invasion was 92%, whereas the capsule invasion diminishes it to 60%. With increasing levels of PSA long term results deteriorates: 5-year disease free survival was 80% at PSA level below 10 ng/ml, 72% at PSA level 10,1 — 20 ng/ml and 50% at PSA level higher than 20 ng/ml (p=0,36). Capsule invasion found on TRUSI and US angiography, high PSA level and Glisson sum are indications for administration of radiotherapy with antiandrogenic therapy. Unfavorable prognostic factors are found in one third patients over 70 years old, which demands employment of adequate antitumor treatment. Radiation therapy is an effective treatment for prostate cancer: 5-year observed survival was 86%, corrected survival — 91% and disease free survival — 78%
Androgen blockade has been widely used in the treatment of. prostatic cancer (PC) for more than 60 years. However, most patients develop high-grade androgen-resistant PC a few years after the initiation of hormonal therapy. This study was undertaken to explore the mechanisms of this process. Fourteen patients with Stages 3-4 PC were followed up. They all underwent orchiectomy. Comparison of the data obtained before and 1 month has shown than the decreased level of testosterone enhances mitotic activity, impairs the regulation of a cell cycle, and induces apoptosis, while its significantly lowered level causes antitumor immunity decompensation.
The purpose of the study was to reveal the most optimal treatment of hormone-resistant prostatic cancer (HRPC), by comparatively analyzing the efficiency and toxicity of 4 chemotherapy regimens: 1) mitoxantrone, 12 mg/m2, i.v. once 21 days; prednisolone, 10 mg/day (MP); 2) mitoxantrone, 12 mg/m2, i.v. on day 2; cisplatin, 60 mg/m2, i.v. on day 1; prednisolone, 10 mg/day (MCP); 3) docetaxel, 75 mg/m2; estramustine, 300 mg/m2 daily; prednisolone, 10 mg/day (DEP); 4) doxorubicin, 20 mg/m2, on day 1 of weeks 1, 3, and 5; ketoconasole, 1200 mg/day on days 1—7 of weeks 1, 3, and 5; docetaxel, 20 mg/m2 on day 1 of weeks 2, 4, and 6; estramustine, 420 mg/day, on days 1—7 of weeks 2, 4, and 6; prednisolone, 10 mg/day (DKDEP). The study covering 39 patients indicated the low efficiency of MR (8,6%) as first-line chemotherapy for HRPC and the high efficiency of the docetaxel-induced regimens used mainly as second-line chemotherapy: DEP (40%) and DKDEP (30%). Treatment of HRPC was most effective when the docetaxel-containing combinations were administered. The latter may be used as first-line chemotherapy and second-line one after application of mitoxantrone-containing regimens.
The paper provides guidelines for the treatment of late radiation injuries. Prolonged and frequently recurring radiation-induced cystitis requires that new lines should be sought in the treatment of this pathology. The results of treatment in patients with late radiation injury to the bladder are analyzed. The findings show it necessary to apply a comprehensive and differential approach to treating this pathology.
The study was undertaken to evaluate the specificity and sensitivity of a rapid method for qualitative determination of the content of NMP 22 in the diagnosis of cancer of the bladder, as well as the efficiency of the method in detecting recurrences of this disease.
The method is based on enzyme immunoassay of the nuclear matrix proteins that are incorporated into the cell nuclear membrane, whose levels are approximately 20—80 times higher in the cancer cells of the bladder. The study included 83 patients. Group 1 comprised 18 patients with new-onset bladder cancer. Group 2 comprised 26 patients with histologically verified recurrent bladder cancer. Group 3 consisted of 19 patients who had a history of bladder cancer, received surgical treatment, and had no recurrences for at least 6 months. The control group included 20 healthy donors.
The test urine was put into a test well and the results were assessed 30 minutes later.
The resultant sensitivity of the test was 50% (p < 0.05) in the patients with new-onset cancer of the bladder and 54% (p < 0.05) in those with its recurrent cancer. With staging and grading of the disease and with higher tumor anaplasia, the sensitivity of the test increases: 37, 75, and 80% in T1, T2, T3, respectively (p < 0.05); 30, 50, and 87% in G1 (p > 0.05), G2 (p < 0.05), G3 (p < 0.05). Its specificity was 100% in Group 3 and 90% in the control group (p < 0.05). Thus, its total specificity was 95% (p < 0.05). The study has led to the conclusion that detection of NMP 22 is a promising marker of bladder carcinoma, which show a rather high specificity and specificity not only in identifying primary tumors, but a recurrence of the disease.
Carcinoma of the penis is a rare tumor. With adequate treatment of patients having no late metastases, 5-year survival is as high as 91.6%; 1-year relapse-free survival is 45.9%. Multivariance analysis shows that regional lymph nodal involvement is the only significant poor predictor in penile carcinoma, which reduces 5-year survival rates from 94.4 to 73.9%. Univariance analysis indicates that the partial effect of therapy, the endophytic form of primary tumor growth, a recurrence occurring after achievement of a complete therapeutic effect exert a significant negative action on survival. An insignificant survival reduction is observed in groups of patients less than 30 and more than 60 years with a neoplasm > 4 cm of high T stage being located on the glans et corpus penis.
The experience of CRC in the treatment of advanced germ cell tumors is reported. The analysis of factors influencing prognosis and treatment tactics is carried out. Contemporary conception of advanced germ cell tumors treatment implies the initial use of platinum based chemotherapy. After completion of chemotherapy, surgical removal of residual tumor (retroperitoneal and mediastinal lymph nodes, lung and liver metastases) carries diagnostic and curative means. Such approach allows curing 50-90% of patients depending on prognostic factors. Results of induction chemotherapy for relapses of germ cell tumors are presented separately. Treatment of this condition comprises chemotherapy with inclusion of ifosfamid or taxanes with following cytoreductive surgery. This modality allows long term remission in the fourth of patients with relapse of germ cell tumors.
ISSN 1996-1812 (Online)