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Онкоурология

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Том 3, № 2 (2007)
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https://doi.org/10.17650/1726-9776-2007-0-2

ДИАГНОСТИКА И ЛЕЧЕНИЕ ОПУХОЛЕЙ МОЧЕПОЛОВОЙ СИСТЕМЫ. РАК ПОЧКИ

5-11 25
Аннотация

Objective: to assess the results of organ-preserving treatment of patients with renal cell carcinoma (RCC).

Materials and methods: 238 patients with renal tumors underwent partial nephrectomy at our institution between 1971 and 2006. 35(14.7%) of 238 patients were showed to have benign histology. RCC was revealed in 203(85.3%) cases on pathological examination. The latter group was retrospectively analyzed.

Results: The indications for partial nephrectomy included bilateral lesions in 28.6%, solitary kidney in 3.9%, solitary functioning kidney in 1.5%, horseshoe kidney in 4.9%. An elective partial nephrectomy was performed in 61.1% of the patients. Local stage T was considered as T1 in 68.7%, T2 Р in 24.2%, T3а Р in 6.6%, T3в Р in 0.5% cases. Among 58 patients with bilateral lesions T stage of the contralateral kidney was considered as T1 in 25.9%, T2 Р in 10.3%, T3а Р in 12.0%, T3b Р in 3.5%, Tх Р in 48.3% cases. Positive lymph nodes (N+) were found in 2 (1.5%), distant metastases (M1) in 5 (2,5%) patients. An open partial nephrectomy was performed in 92.1%, laparoscopic in 2.5%, bench surgery in 4.4% cases. In 82.2% cases of bilateral RCC the surgery was performed on both kidneys. Five (2.5%) patients with solitary metastasis were treated with liver resection (1), pulmonary resection (1), scapular resection (1), contralateral adrenalectomy(2). Early surgical complications which required surgery occurred in 6.9% cases. Acute renal failure that necessitates dialysis was registered in 3.9%, chronic renal insufficiency with programmed dialysis in 1.0% of the patients. Renal artery clamping for more than 30 minutes significantly increased the risk of renal failure. Local recurrences appeared in 8.9% (local in 2.5%, distant in 6.4%) patients at a median of 56.1(3—120) months following surgery. The width of the surgical margin has no impact on local recurrence rate. 5-year cancer-specific and relapse-free survival of the whole group of patients was 93.4% and 82.5%, respectively; in the subgroups of uniand bilateral lesion, these were 95.1% and 89.6%, and 91.5% and 75.2%, respectively (p>0,05). T stage and presence of positive lymph nodes and distant metastases significantly influenced the survival.

Conclusion: partial nephrectomy in patients with RCC has a low complication rate and provides an excellent long term survival in patients with localized disease.

12-17 18
Аннотация

Objectives. To compare the results of traditional open-, laparoscopic-, and laparoscopically assisted radical nephrectomies in the treatment of patients with renal cancer. One of the goals was to define the roll of laparoscopic operations and their advantages over open procedures.

Subjects and methods. Seventy-four patients with renal cancer age of 36 to 79 years (mean age 58/7 years) were divided into 3 groups: 1) open radical nephrectomy (n = 32); 2) radical nephrectomy via laparoscopic transabdominal access (n = 17); and 3) radical nephrectomy via laparoscopically assisted access (n = 25). All the patient groups were comparable with regard to the T stage and the size of a tumor.

Results. In the open nephrectomy group mean duration of surgery was 152 min; mean blood loss — 264 ml; mean hospital stay — 15.8 days; early postoperative complications were not observed. In the laparoscopic transabdominal surgery, these were 117 min, 138 ml, and 7.5, respectively; early postoperative complications were also absent. In laparoscopically assisted transabdominal access, the duration of an operation was 80 to 300 min (at the stage of procedure mastering) and averaged 123.1 min; blood loss was 50 to 700 ml (mean 228.5 ml). There were no intraoperative complications. The average postoperative hospital stay — 9.4 days.

Conclusion. The results of open- and laparoscopic-access nephrectomies are comparable in the duration of an operation, the volume of blood loss, and the presence of intraoperative complications. The parameters of the early and late postoperative periods are also identical. Recovery is shorter when endovideo-assisted interventions are applied.

18-25 20
Аннотация

Nephroblastoma (NB) is a tumor that frequently occurs in childhood. Progress in therapy of NB is associated with the development of modern radio and chemotherapy. Contemporary chemotherapy allows for an organ-preserving treatment of patients with NB. The author’s experience gained at the Research Institute of Pediatric Oncology and Hematology (RIPOH), N.N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences is presented. Data on 120 patients aged 6 months to 12 months, who were treated with organ-preserving operations of different types and extent, are analyzed. A clinical classification of NB in children and a working classification of bilateral NB, which has been developed at the RIPOH, are provided. The technique of different types of organ-preserving surgery in children with NB is described as well as the long-term results of treatment.

ДИАГНОСТИКА И ЛЕЧЕНИЕ ОПУХОЛЕЙ МОЧЕПОЛОВОЙ СИСТЕМЫ. РАК ВЕРХНИХ МОЧЕВЫВОДЯЩИХ ПУТЕЙ

26-29 19
Аннотация

The results of organ-preserving interventions are analyzed in 12 patients (7 males and 5 females) with neoplasms of the renal pelvis and ureter. Endoscopic operations were performed in 4 patients with the normally functioning contralateral kidney and in one patient with the single kidney. Early complications developed in 2 of the 12 patients and were infectious and inflammatory. The mean duration of endoscopic surgery was 32.8±4.9 min; intraoperative blood loss is 83.0±15.3 ml; the duration of open surgery averaged 157.2±29.7 min and intraoperative blood loss was 1930±69.3 ml. After 4 years of a follow-up, the frequency of tumor relapse was 40%; 5-year survival was 80%. Thus, in patients with upper urinary tract neoplasms, organ-preserving operations are a justifiable alternative to nephroureterectomy with urinary bladder resection and most reasonable in uni- and bilateral renal tumor. Urinary tract endoscopic examination assessing the possibilities of freely manipulating an endoscope in the ureteral lumen and renal cavitary system for biopsy of a tumor and its further removal is a major and determining factor in defining indications for this type of intervention.

ДИАГНОСТИКА И ЛЕЧЕНИЕ ОПУХОЛЕЙ МОЧЕПОЛОВОЙ СИСТЕМЫ. РАК МОЧЕВОГО ПУЗЫРЯ

30-34 30
Аннотация

Transurethral resection (TUR) of the urinary bladder is a gold standard of the treatment of superficial bladder cancer (BC); however, after the above surgical intervention the incidence of relapses is high and ranges from 40 to 90%, as shown by different authors. Adjuvant intravesicular immuno- or chemotherapy reduces the rate of relapses by 30—35%. Thus, the development of new methods for preventing recurrent superficial BC remains an urgent problem today. Photodynamic therapy (PDT) is a promising line in oncology. The study included 196 patients with superficial BC. Following TUR of the bladder 110 patients received adjuvant PDT; a control group comprised 86 patients treated with TUR only. In the PDT group, the incidence of relapses depended on energy density: with the latter of 10, 12, and 15 J/сm2, the incidence of relapses was 31.7, 19.4, and 15.5%, respectively. In the control group, it was 55.1%. Thus, treatment aimed at preventing recurrent superficial BC may be performed by three methods: 1) intravesical immunotherapy, 2) intravesical chemotherapy, and 3) PDT. On the basis of the findings, it is impossible today to define unambiguous indications for either method in the first-line prevention of relapses in the treatment of superficial BC. Adjuvant PDT is a competitive treatment in low and moderate BC risk patients. In the high-risk group, the advantage of BCG therapy is beyond question.

34-41 24
Аннотация

The results of a prospective randomized study of the efficacy of neoadjuvant chemoimmunotherapy with intravesical roncoleukin (interleukin- 2) versus the standard M-VAC chemotherapy regimen are analyzed. The study protocol included 60 patients. Additional intravesical administration of roncoleukin failed to affect the frequency and severity of the toxic effects of multidrug therapy. The immediate and long-term results of the proposed regimen were better than those of the standard one. Complete regressions were 53.3±9.1 and 26.7±8.1, respectively (p = 0.049; Mann—Whitney U-test). Organ-preserving surgery was made in 24 (80.0%) study-group patients and in 16 (53.3%) control ones; the difference being significant (p = 0.03, χ2). In the study group, cumulative survival was significantly higher than that in the control group (p = 0.02, log-rank-test). In the groups, overall 5-year survival was 81.4±7.6 and 46.5±12.5%, respectively.

ДИАГНОСТИКА И ЛЕЧЕНИЕ ОПУХОЛЕЙ МОЧЕПОЛОВОЙ СИСТЕМЫ. РАК ПРЕДСТАТЕЛЬНОЙ ЖЕЛЕЗЫ

42-51 24
Аннотация

Background. High intensity focused ultrasound (HIFU) is a method of delivering acoustic energy to a focal point, thus destroying it and causing coagulation necrosis. Repeating the fires, the whole needed volume of organ can be treated without damaging the adjacent tissue. Objective. To establish the clinical efficacy and safety of HIFU in the treatment of prostate cancer on the basis of the authors’ 3-year experience in applying this technique.

Materials and methods. A total of 101 patients with biopsy-proven prostate cancer (and 2 more patients had only high-grade PIN) have been treated in our clinic using an Ablatherm® device. Seventy-one of them were enrolled in this study. They were followed from sixth months to three years at a regular interval, the follow-up included PSA measurement and control sextant biopsies.

Results. The median PSA nadir 1.5Р3.0 months after treatment ranged from 0.10 (in the low-risk localized prostate cancer group) to 2.50 ng/mL (in patients with a disseminated process). Negative control biopsies were in 75—80% of patients with localized prostate cancer and in 64—75% of the patients with disseminated process. Of all the patients, 91% underwent transurethral resection of the prostate before HIFU treatment. Such combination improved the efficacy of HIFU and reduced the treatment-related morbidity significantly. Grades 2 and 3 stress incontinence was observed in 1.9 and 0.9% of the patients, respectively. No other severe complications were recorded. Erectile function was preserved in 69.94% of the patients.

Conclusion. Our results demonstrated the efficacy and low-associated morbidity of HIFU. HIFU does not exclude other treatment options and is repeatable if needed. HIFU seems to be a valid alternative treatment for patients who are not suitable for radical surgery.

51-55 29
Аннотация

Postoperative progression of prostatic cancer (PC) after radical prostatectomy (RPE) may be caused by a residual tumor that is suggested by the presence of tumor cells in the resection positive surgical edge (PSE), regional and distant metastases.

Objective. To reveal the preoperative prognostic factors of PSE occurrence during retropubic RPE in patients with clinically localized PC. Subjects and methods. The incidence of PSE was analyzed in 288 PC patients treated with retropubic RPE between November 1997 and May 2006. The correlation between the results of transrectal multifocal prostatic biopsy and the incidence of PSE was assessed.

Results. PSE was detected in 87 (30.2%) of the 288 patients. Single and multiple PSEs were found in 70 (80.5%) and 17 (19.5%) patients, respectively. The commonest site of PSE was the posterolateral prostate surface [n = 26 (37.1%)]. In males who had less than 30.0% positive biopsies, PSE was diagnosed in 10.4% of cases. With the positive columns exceeding 30.0%, it was revealed in 52.5% of cases. In patients with PSE, the mean maximum tumor amount in the biopsy specimen was 84.8% (84.8±5.2%). PSE was detected in 71.1% of the patients with a Gleason grade of 7 or more, whereas in patients with lower grades, it was found in 19.9%. In the groups of patients with positive and negative surgical edges, perineural invasion was identified in 63 (73.3%) and 12 (5.9%) cases, respectively. In patients with PSE, the signs of capsular tumor invasion were detected in 58 (67.4%) cases and in those without PSE it was present in 20 (9.95%) cases only.

Conclusion. The incidence of PSE during retropubic RPE was associated with a number of positive columns of over 30.0%, the tumor amount in the biopsy specimen of more than 80.0%, a Gleason grade of 7 or more, capsular and perineural invasion.

56-60 19
Аннотация

Introduction: Hormonal therapy is the method of choice in treating disseminated prostate cancer. Chronic androgenic suppression causes a reduction in bone mineral density. The most common complications of bone metastases are pathological fractures, spinal cord compression, pain, etc.

Methods: A multicenter study (11 clinics of Russia) assessing the efficacy of Zometa in preventing skeletal complications of bone metastases was conducted in 2004—2005. Zometa was administered intravenously at a dose of 4 mg every 3Р4 weeks with androgenic deprivation. Its objective effect was evaluated in 70 patients. Changes in bone mineral density were evaluated by densitometry.

Results: Complete pain relief was achieved in 73% of the patients; after therapy 86% of the patients had 0—1 WHO activity status score, 97% of the patients had no bone complications. The level of bone resorption marker β-Cross-Laps decreased to the normal values in 51% of the patients.

Conclusion: The study has provided an evidence of the efficacy of Zometa and the necessity of using this drug in complex therapy for bone metastases of prostate cancer.

64-68 19
Аннотация

The paper presents the results of treatment of 57 patients with locally advanced and metastatic prostatic carcinoma (PC) (T3Р4N0M0, T1Р4N1M0, T1Р4N0M1, and T1Р4N1M1) (mean age 64.2±7.1 years) with Russian nonsteroidal antiandrogen Bilumide® at a dose of 50 mg/day for the maximum androgenic block after bilateral orchiectomy. The efficacy and safety of the drug were evaluated by the IPSS and QoL scales, laboratory and ultrasound studies, as well as osteoscintigraphy and uroflowmetry. The open-labeled non-comparative studies indicated the clinical effectiveness and safety of Bilumide that can be recommended for the treatment of locally advanced and metastatic PC. Further studies to compare Bilumide® with other antiandrogens commonly used in practice are required.

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ISSN 1726-9776 (Print)
ISSN 1996-1812 (Online)
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