ABSTRACT
The resistance of neoplastic cells to chemotherapeutic agents may develops by a variety mechanisms. One of these mechanisms seems to be the amplification or overexpression of the multidrug resistance(MDR) gene. The MDR phenotype is conferred by a 170kD membrane protein, P-glycoprotein. This protein acts as a drug efflux pump for a variety of structurally unrelated antineoplastic agents, especially hydrophobic natural products such as adriamycin and vincristine. In the present study, immunohistochemical stain for P-glycoprotein was performed in paraffin section of 41 specimens of transitional cell carcinoma of the bladder obtained prior to chemotherapy to investigate the usefulness of P-glycoprotein as a predictor of response to M-VAC ( methotrexate, vinblastine, adriamycin and cisplatin) chemotherapy. The overall clinical response rate to chemotherapy was 65.9%. The overall 3- year survival rate was 63%, with 80% in responder group( clinical complete and partial remission) and 36.3% non-responder group(minor response, stabilization and progression ) (P<0.05). In the responder group, 7.4% expressed strongly positive P-glycoprotein, 63% weakly positive and 29.6% negative. In the non-responder group, 28.6% expressed strongly positive P-glycoprotein, 64.3% weakly positive and 7.1% negative. The negative expression rate was high in responder group than non-responder, but this difference was not statistically significant. There was no correlation of expression of P-glycoprotein with either tumor stages or grades. In conclusion, these results suggest that tumors with negative expression of P-glycoprotein seem to have a better clinical response to chemotherapy, and further investigation of other mechanisms of cellular drug resistance should be required.
Subject(s)
Antineoplastic Agents , Biological Products , Carcinoma, Transitional Cell , Doxorubicin , Drug Resistance , Drug Therapy , Membrane Proteins , Methotrexate , ATP Binding Cassette Transporter, Subfamily B, Member 1 , Paraffin , Phenotype , Survival Rate , Urinary Bladder , Urinary Bladder Neoplasms , Vinblastine , VincristineABSTRACT
Wilms' tumor is composed of a mixture of epithelial, stromal and blastematous elements in varing proportions. Adult Wilms' tumor, unlike that of childhood is a rare disease. Spontaneous rupture of the kidney with subcapsular or perirenal hematoma also is rarely seen in malignant renal tumor. A case of adult Wilms' tumor in 65-year old female is here reported, associated with spontaneous renal rupture, which was treated with radical nephrectomy and chemotherapy (vincristine, actinomycin D and doxorubicin).
Subject(s)
Adult , Aged , Female , Humans , Dactinomycin , Drug Therapy , Hematoma , Kidney , Nephrectomy , Rare Diseases , Rupture , Rupture, Spontaneous , Wilms TumorABSTRACT
The trend in chemotherapy of bladder carcinoma has evolved from the single agent to the combination chemotherapy. In 1985 Sternberg et al. reported 71 per cent of significant tumor regression and 50 per cent of complete clinical remission with M-VAC(methotrexate, vinblastine, adriamycin and cisplatin) combination chemotherapy of treatment for advanced urothelial transitional cell carcinomas. Therefore, the effects of neoadjuvant systemic M-VAC chemotherapy in 23 patients with bladder carcinoma at the Department of Urology, Chonnam University Hospital from January 1987 to June 1989 were evaluated. The following results were obtained. 1. The average number of cycle were 2.1 and the cycle length varied from 28 days to 52 days (average: 32.8 days). 2. Clinical complete and partial remission rate were obtained in 11 patients( 47.8 per cent), while 6 patients( 26.1 per cent) had a minor response, 4 patients( 17.4 per cent) stabilization and 2 patients (8.7 per cent) progression. 3. After chemotherapy, 13 patients underwent operation (radical cystectomy 8, partial cystectomy and lymph node dissection 4, transurethral resection of bladder tumor 1) and there were no lymphatic metastasis except only one advanced case. 4. Toxicity included leukopenia in 21 patients and all patients had experienced alopecia, nausea, vomiting and general weakness. It was suggested that neoadjuvant M-VAC chemotherapy may be effective as treatment for patients with invasive bladder carcinoma and we need to define further and extend the potential roles of neoadjuvant chemotherapy for carcinoma.
Subject(s)
Humans , Alopecia , Carcinoma, Transitional Cell , Cystectomy , Doxorubicin , Drug Therapy , Drug Therapy, Combination , Leukopenia , Lymph Node Excision , Lymphatic Metastasis , Nausea , Urinary Bladder Neoplasms , Urinary Bladder , Urology , Vinblastine , VomitingABSTRACT
Seminomatous testis tumors are treated highly effectively with irradiation and chemotherapy following orchiectomy according to stage. We report a relatively rare case of seminoma developed in abdominal cryptorchid testis of 35 years old man, which was treated with surgery including the segmental resection of sigmoid colon involved.