ABSTRACT
OBJECTIVE: The activation of angiogenesis has been proven to suppress the anti-cancer immunity. The evidence of abnormally high pretreatment blood levels of vascular endothelial growth factor (VEGF), which is the main angiogenic factor, has appeared to predict resistance to IL-2 immunotherapy of metastatic renal cell carcinoma (RCC). Therefore, the control of VEGF secretion could influence the efficacy of IL-2. Recent data suggest that erythropoietin (EPO) may modulate VEGF secretion and IL-2 biological activity. On this basis, a study was planned with subcutaneous (s.c.) low-dose IL-2 plus EPO in metastatic RCC, which had progressed on IL-2 alone (6 million IU/day for 6 days/week for 4 weeks). METHODS: Patients received IL-2 at the same dose as the previous cycle, plus EPO (10,000 3 times/week until the end of IL-2 therapy. Serum levels of VEGF were measured by enzyme immunoassay on venous blood samples collected at weekly intervals. The study included 12 evaluable metastatic RCC patients. RESULTS: The treatment was well-tolerated and most patients referred a relief of IL-2-induced asthenia. A partial response (PR) and 4 stable diseases (SD) were achieved on IL-2 plus EPO, whereas the other 7 patients had a progressive disease (PD). Hemoglobin mean levels were significantly higher on IL-2 plus EPO than during the previous therapy with IL-2 alone in the same patients. In the same way, mean lymphocyte increase was higher on IL-2 plus EPO than on IL-2 alone, even though this difference was not significant. Finally, VEGF increase was significantly lower on IL-2 plus EPO than during IL-2 alone. CONCLUSION: This preliminary study shows that the concomitant administration of EPO may allow a control of the neoplastic growth in advanced cancer patients progressing on IL-2 alone, reduce the subjective toxicity, prevent hemoglobin decrease and counteract IL-2-related VEGF increase.
Subject(s)
Anemia/drug therapy , Carcinoma, Renal Cell/drug therapy , Endothelial Growth Factors/metabolism , Erythropoietin/administration & dosage , Immunologic Factors/administration & dosage , Interleukin-2/administration & dosage , Kidney Neoplasms/drug therapy , Lymphokines/metabolism , Neovascularization, Pathologic/prevention & control , Aged , Anemia/etiology , Carcinoma, Renal Cell/blood supply , Depression, Chemical , Disease Progression , Drug Synergism , Erythropoietin/therapeutic use , Female , Humans , Immunologic Factors/therapeutic use , Injections, Subcutaneous , Interleukin-2/therapeutic use , Kidney Neoplasms/blood supply , Male , Middle Aged , Salvage Therapy , Secretory Rate/drug effects , Treatment Outcome , Vascular Endothelial Growth Factor A , Vascular Endothelial Growth FactorsABSTRACT
Liposarcoma is the most common adult soft tissue sarcoma. The hallmark is the immature fat cell or lipoblast. It occurs in late adult life, frequently in the lower extremities, in the retroperitoneal, perineal and mesenteric region. Retroperitoneal liposarcoma doesn't produce symptoms until it is very large. A review of the literature is made and the case of a 65-years old man, submitted to surgical treatment for a bulky retroperitoneal mixoid liposarcoma is reported.
Subject(s)
Liposarcoma/diagnosis , Peritoneal Neoplasms/diagnosis , Aged , Humans , Liposarcoma/pathology , Male , Peritoneal Neoplasms/pathologyABSTRACT
Neoplasms of male urethra are particularly interesting for the diagnostic and therapeutical problems involved, urologist surgeons may be charged to resolve. The authors effected an anatomo-pathologic, diagnostical and especially therapeutical framing, by reviewing the data reported by the literature. The indications the Authors may draw therefrom are favourable to a radical surgery, even in consideration of the extensive nature of such tumours and the poor successes, in terms of survival, got by the conservative therapy.
Subject(s)
Urethral Neoplasms/surgery , Combined Modality Therapy , Endoscopy , Humans , Male , Neoplasm Staging , Urethral Neoplasms/classification , Urethral Neoplasms/diagnosis , Urethral Neoplasms/radiotherapyABSTRACT
Thirty-two cases of advanced bladder cancer (pT3b-pT4) undergoing radical cystectomy are compared with other similar series of patients of the same stages submitted to different treatments (radiotherapy, chemotherapy and combined treatments) reported in the literature. Survival rates at 3 and 5 years are analyzed in relation to the anatomopathological stage, cellular grading, lymph node infiltration, surgical risk and relative mortality. The results confirm that radical cystectomy is presently the most effective treatment.
Subject(s)
Urinary Bladder Neoplasms/surgery , Urinary Bladder/surgery , Adult , Aged , Female , Humans , Male , Methods , Middle Aged , Time Factors , Urinary Bladder Neoplasms/mortalityABSTRACT
The Authors show an operation of urological surgery, unusual in relation to the rather limited indications. The operation of hemitrigonectomy, although it is framed in the chapter of the partial resections of bladder, does not get an exact identity in literature; yet, it is peculiar for both technical problems and some basic expedients sheltering surgeons from various complications. Hemitrigonectomy, performed by the Authors in six cases in the last 3 years, supplied excellent anatomic and functional results, and was burdened by no relevant complications.
Subject(s)
Urinary Bladder/surgery , Humans , Methods , Suture Techniques , Ureter/surgery , Urinary Bladder Diseases/surgery , Urinary Bladder Neoplasms/surgeryABSTRACT
A personal surgical technique in the treatment of the tuberculous stenosis of the juxtavesical and intramural ureter, is described. 62 patients suffering from tuberculosis of the urinary tract underwent surgical treatment. 42 of these cases presented with ureteral stenosis: 14 were submitted to ureterocystoneostomy (UCNS) according to a personal technique. The results confirmed the initial hypotheses.
