The fate of patients with locally advanced bladder cancer treated conservatively with neoadjuvant chemotherapy, extensive transurethral resection and radiotherapy: 10-year experience.

PURPOSE: We assess the results of bladder preservation for infiltrating bladder cancer. The potential for neoadjuvant chemotherapy followed by extensive transurethral resection and radiotherapy was evaluated in 40 patients with T2-T4a G2-G3 bladder carcinoma. MATERIALS AND METHODS: From 1983 to 1995, 40 patients with bladder cancer underwent bladder sparing treatment, consisting of neoadjuvant chemotherapy, extensive transurethral resection and radiotherapy. Most patients had T3G3 cancer. A deep transurethral resection biopsy was performed before and after chemotherapy, and an extensive transurethral resection was repeated at the end of radiotherapy. Of the patients 30 received cisplatin and methotrexate and 10 also received vinblastine. Total dose of radiotherapy was 60 to 65 Gy. Recurrent superficial tumors were treated transurethrally. Radical cystectomy was considered for persistent or recurrent invasive disease. RESULTS: Complete response occurred in 19 patients (47.5%) after chemotherapy, and in 8 patients after transurethral resection and radiotherapy (67.5%). Within 10 years 8 responding patients (30%) had local recurrences and 3 underwent cystectomy. Of the patients 14 (35%) are alive, including 13 with no evidence of disease (mean survival 65 months), 5 died of unrelated disease and 21 (52.5%) died of distant metastases (mean survival 28 months). Of the 21 patients 14 had residual tumor after radiotherapy, 3 presented with distant metastases after vesical infiltrating recurrence and 4 had distant metastases in the absence of locoregional recurrence. In 22 patients (55%) the bladder was salvaged. Patients with complete response to chemotherapy had a low risk for recurrent infiltrating tumors and metastases. CONCLUSIONS: Complete tumor control was maintained at 5 years in more than 50% of the patients treated conservatively. Bladder salvage is feasible in select patients.

[Functional evaluation of cystic thyroid nodules]. / Valutazione funzionale dei noduli tiroidei cistici.

7 patients (age between 22 and 52 years, mean 38.2 +/- 10.6 SD) with cystic nodules have been subjected to the same diagnostic screening (scintiscanning and echography, needle aspiration); in every subject hormonal pattern has been studied at the cyst and periphery level. The Authors found very high TG levels in the cyst's fluid, perhaps due to an increased sensitiviness to the thyrotropic hormone, and an rT3/T4 increased at periphery level, probably because an enhancement of mechanisms connected to the reuptake of iodine. These reports outline the great importance in the induction and development of cystic nodules of changes related to the enzymatic steps of iodination and coupling.

[Intraoperative functional study of unilateral cold thyroid nodules]. / Studio funzionale intraoperatorio dei noduli tiroidei freddi unilaterali.

The authors studied 7 patients (age between 22 and 52 years, mean 40.2 +/- 6.55 S.D.) with single or multiple solid nodules, localized in the same thyroid lobe. All subjects performed scintiscanning and echography for evaluating the nature of nodules. During the thyroidectomy the hormonal pattern has been studied in the venous blood of both lobes (inferior thyroid and jugular veins, homo and heterolateral). The authors found a significant decrease of T3 and T4 values with increased T3/T4 ratio at the nodular level. This report could be related to an hypothetical alteration of iodination mechanisms, maybe due to an intrinsic defect of oxidative mitochondrial systems.