ISSN:8756-0437    

DOI:10.1002/ssu.2980050402

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractThe management of testis cancer is continually changing. Since the introduction of curative chemotherapy for metastatic disease, the entire approach to early disease (stage I and stage II) is undergoing reevaluation. Individuals with favorable prognostic features can be offered, under detailed clinical protocols, orchiectomy followed by meticulous surveillance. Likewise, individuals with retroperitoneal disease may be offered retroperitoneal lymph node dissection initially or, alternatively, chemotherapy initially. The prognosis for individuals with metastatic disease is extremely favorable, with the majority of patients being cured with 9–12 weeks of combination chemotherapy. Major efforts are still underway to identify appropriate second‐line or “salvage” regimens for individuals who are not cured with first‐line chemotherapy. Likewise, the use of new modalities, such as bone marrow transplantation, and new drugs must be evaluated in appropriately designed, prospective studies. Such studies will continue to increase the cure rate of individuals with metastatic disease and enhance the prognosis for such high‐risk populations of patients. This paper reviews basic aspects relating to histology, clinical staging, and approach to management for all stages of germ cell cancer of

ISSN:8756-0437    

DOI:10.1002/ssu.2980050403

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractThe treatment of Wilms' tumor is based on initial surgical removal followed by clinical and histologic staging. Chemotherapy provides the major adjunctive therapy in virtually all Wilms' tumors, radiotherapy being used in some situations. Exceptions to this are the treatment of bilateral Wilms' tumors and large intracaval extension. Bilateral Wilms' tumor is treated with initial biopsy and staging, adjunctive chemotherapy, and/or radiation therapy and bilateral partial nephrectomy after there is maximum resolution of tumor. Similarly, extensive caval extension of tumor may be treated preoperatively with chemotherapy and radiotherapy followed by resection. Nephroblastomatosis, a precursor of Wilms' tumor, is a common associated finding at exploration. It requires alteration in management and may change the prognosis. Sarcomas of the kidney and congenital mesoblastic nephroma represent the spectrum of severity of solid renal masses in children. Neuroblastoma is the most common solid tumor in children, and its prognosis is largely dependent on the age of the patient and the stage of disease. Chemotherapy and radiotherapy as adjunctive treatments have been disappointing. Immunotherapy holds some promise for the future. Testicular tumors are unusual in children. Those that occur in infancy are most often benign teratomas that require orchiectomy alone. Malignant germ cell tumors in children are most often yolk sac tumors and respond to surgery and chemotherapy. Lymph node dissection is indicated only in paratesticular rhabdomyasarcoma. Other genitourinary rhabdo‐myasarcomas occur in the bladder, prostate, vagina, and uterus. After maximum decrease in tumor volume with chemotherapy and radiotherapy, surgical exploration and resection of remaining tumor probably represent the best form of treatment. Organ‐sparing procedures should be carefully selected in that they may worsen the progno

ISSN:8756-0437    

DOI:10.1002/ssu.2980050404

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractRegional lymph node dissection in the management of genitourinary (GU) neoplasms is controversial but is based on a 17 year clinical experience and the achievement of survival figures as good or better than those achieved by any other modality of therapy. Lymphadenectomy has proved to be effective in curing patients with metastatic testicular cancer, renal cell carcinoma and transitional cell carcinoma. Its efficacy in prostate cancer is much less certain and remains largely a staging procedure.

ISSN:8756-0437    

DOI:10.1002/ssu.2980050405

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractDiscovery of a localized prostatic cancer frequently creates a therapeutic dilemma. A significant number of patients do well for an extended period of time without treatment, while others suffer rapid tumor progression and death from prostatic cancer. Without treatment nearly one third of patients with stage B prostatic cancer can be expected to develop distant metastatic disease or death from prostatic cancer within 10 years. In patients who otherwise have a reasonable life expectancy of 10 years or more, aggressive therapy is justified. Long‐term disease‐free survival has been reported after both radical prostatectomy and external irradiation. The fact that nearly 50% of patients treated with external irradiation for stage B prostatic cancer have positive postirradiation biopsies is of concern, but the impact of this finding on overall survival is yet to be determined. The only randomized prospective study comparing radical prostatectomy with external irradiation showed a statistically significant decrease in the time to evidence of disease progression in the radical prostatectomy group. Nevertheless, as evidenced by the National Institutes of Health Consensus Development Panel, further randomized prospective trials are needed to determine the relative value of radical prostatectomy versus external irradiation for localized prostatic cancer. For the forseeable future, definitive scientific data on which to base treatment recommendations will not be available. Therefore, patients should be well informed of the various treatment options available, and the wishes of the patient are paramount. The clinician's roles are to interpret the data, present it in a meaningful manner to patients, be guided in discussions by patient preferences, and make recommendations. In this manner, the most appropriate form of therapy can be selected that provides the greatest chance of prolonged disease‐free survival with morbidity that is acceptable for an individual pa

ISSN:8756-0437    

DOI:10.1002/ssu.2980050406

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractSuperficial transitional cell carcinoma is defined as a transitional cell urothelial tumor that is confined to the mucosa, stages Ta or CIS, or with invasion of the lamina propria, T1. The initial treatment is transurethral resection with an attempt to remove all tumor. This should provide an accurate histologie grade and stage, and from this information a prognosis can be determined. The important predictive factors that correlate with a new occurrence or true recurrence and the development of a subsequent tumor with muscle invasion are a high tumor grade, lamina propria invasion, a positive cytology following resection, multifocal tumors, dysplasia or carcinoma in situ from mucosal biopsies of normal appearing urothelium, and a prior history of bladder cancer. Based on these factors, the recurrence rate varies from 30 to 80% and progression with a muscle invasive tumor up to 30%. Intravesical chemotherapy or “immunotherapy” following tumor resection has been shown to diminish the likelihood of a recurrence. Thiotepa has been used for the longest period of time. It is relatively inexpensive, safe if myelosuppression is closely monitored, and effective. Mitomycin C was more effective than Thiotepa in randomized trials, but is significantly more expensive. This has retarded its use as a first‐line agent. It has been shown to eradicate persistent tumor in 30 to 40% of patients who have failed Thiotepa. Mitomycin C is also highly effective when used for prophylaxis. Intravesical bacillus Calmette‐Guerin (BCG) has recetly been demonstrated to be an effective intravesical therapeutic agent. It is effective both for treatment and prophylaxis. BCG is relatively safe and inexpensive. The most important factor in the treatment and monitoring of patients with superficial bladder cancer is rigorous follow‐up after the initial transurethral resection. This consists of regular endoscopy and cytology. The urologist must be ready to intervene with cystectomy once it is apparent that the tumor is no longer remaining superficial or has become resistant to intravesical therapeutic agents, particularly with a high‐

ISSN:8756-0437    

DOI:10.1002/ssu.2980050407

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractIn recent years the role of planned preoperative irradiation in the management of clinical stage B2‐C (T3) bladder cancer has been questioned by a number of investigators. Much of the confusion regarding the efficacy of combined therapy results from studies that compare the results of treatment of pathological stage B2‐C patients treated by cystectomy alone versus clinical stage B2‐C patients treated by preoperative irradiation plus cystectomy. Such comparisons are biased because of 1) the exclusion of a large number of pathological stage D patients from cystectomy‐alone series and their inclusion in preoperative irradiation plus cystectomy series and 2) the inclusion in the cystectomy‐alone series of patients whose clinical stages were ≦T2. The purpose of this paper is to compare the results of treatment in patients withclinicalstage B2‐C bladder carcinoma following radical cystectomy alone versus preoperative irradiation plus cystectomy. This article reviews the rationale for administering preoperative irradiation, the effect of preoperative irradiation on the pathological specimen (including down‐staging, the effect on regional lymph nodes, and radioresponsiveness according to tumor configuration, i.e., papillary vs. solid), the impact of preoperative irradiation on pelvic recurrence and 5‐year survival, and the effect of preoperative irradiation on operative and postoperative complications.This paper cites all known literature on the subject in the English language. Data comparing 5‐year survival results of radical cystectomy alone versus preoperative irradiation plus cystectomy are analyzed in three different ways: a) retrospective comparisons of historical results, b) comparison of contemporaneous “modern‐day” (1960–1980) series comprising 1185 patients who received either radical cystectomy alone or preoperative irradiation plus cystectomy, and c) review of the results of six randomized trials. Preoperative results are also analyzed according to dose level (2,000 cGy versus 4,000 cGy vs. 4,500–5,000 cGy).The data presented indicate that the addition of preoperative irradiation to cystectomy for clinical stage B2‐C (T3) bladder cancer adds approximately 15–20 percentage points to the 5‐year survival, leading to a survival figure that is approximately half agai

ISSN:8756-0437    

DOI:10.1002/ssu.2980050408

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractNeoadjuvant chemotherapy is being integrated increasingly into the primary therapy for locally advanced bladder cancer. The rationale is due to the favorable responses observed in patients with metastatic bladder cancer, the high systemic relapse rate after apparent local control with either surgery or radiotherapy, the potential for using the bladder lesion as a indicator for selecting patients responsive to chemotherapy, and the ultimate possibility of bladder preservation. While neoadjuvant chemotherapy can induce significant clinical and pathologic tumor regression, such experiences have exposed multiple variables involving bladder tumor heterogeneity, patient selection, and investigator evaluation that raise serious questions regarding the overall efficacy of neoadjuvant therapy.

ISSN:8756-0437    

DOI:10.1002/ssu.2980050409

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractRadical cystectomy remains the gold standard in the treatment of patients with muscle invasive bladder cancer. However, the specter of high failure rates coupled with morbid treatment methods has caused urologists, oncologists, and radiotherapists to explore modifications in, and alternatives to, the traditional treatments for invasive bladder cancer.The identification of the active methotrexate‐platinum‐based combination chemotherapy regimens heralds a new era in our ability to treat advanced disease effectively. Patients with less extensive muscle invasive tumors may be efficiaciously treated using conservative surgical excision, either alone or in combination with adjunctive treatments. In addition, definitive radiation therapy, given via the interstitial route or in combination with radiosensitizers, may result in long‐term survival and preservation of bladder function.Progress has been made on multiple fronts in our ability to improve overall survival rates while allowing for the preservation of bladder function. The ability of these new mixed multimodality treatment initiatives to produce viable statistics equal to that of radical exenteration is an important landmark on the route towards an ideal treatment for invasive bladder c

ISSN:8756-0437    

DOI:10.1002/ssu.2980050410

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractComplete surgical excision of solitary metastatic lesions in renal cell carcinoma has been reported to be associated with improved survival.An analysis of 65 outpatients undergoing excision of metastatic renal cell carcinoma is reviewed. In our series there was no significant difference among patients with solitary versus those with multiple metastasis. The overall 5‐year survival was considerably lower than previously reported. We recommend that only patients with good performance status, who are participating in protocols with biological response modifiers, could potentially benefit from surgical removal of metastatic lesion

ISSN:8756-0437    

DOI:10.1002/ssu.2980050411

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY