ABSTRACT
We have reported two cases of adenocarcinoma in a horseshoe kidney and their successful surgical treatment. Review of the literature suggests that transitional cell carcinoma and Wilms' tumor are seen more often than adenocarcinoma in horseshoe kidneys.
Subject(s)
Adenocarcinoma/diagnostic imaging , Kidney Neoplasms/diagnostic imaging , Kidney/abnormalities , Adenocarcinoma/surgery , Female , Humans , Kidney/surgery , Kidney Neoplasms/surgery , Male , Middle Aged , Nephrectomy , Renal Artery/diagnostic imaging , Tomography, X-Ray Computed , UrographyABSTRACT
This clinical trial explores the possibility of inducing long-term unmaintained complete remissions in testicular cancer using sequential multimodality therapy. We designed a prospective study using a combination of vinblastine and bleomycin for three courses followed by cis-dichlorodiammineplatinum(II), actinomycin D, and vincristine until a surgically proven complete remission was achieved. One to three additional consolidation courses were given following surgery, and then all therapy was stopped. Eleven of 15 patients completing therapy have achieved complete remission, with seven patients remaining free of disease without maintenance therapy for 15-36 months (average, > 27 months). We conclude that patients with disseminated nonseminomatous testicular cancer should be treated for cure with intensive primary therapy. Prolonged disease-free status can be achieved without maintenance therapy, and the value of maintenance therapy needs further study.
Subject(s)
Antineoplastic Agents/administration & dosage , Adolescent , Adult , Bleomycin/administration & dosage , Choriocarcinoma/drug therapy , Cisplatin/administration & dosage , Clinical Trials as Topic , Dactinomycin/administration & dosage , Drug Therapy, Combination , Dysgerminoma/drug therapy , Humans , Male , Middle Aged , Neoplasm Metastasis , Prospective Studies , Teratoma/drug therapy , Testicular Neoplasms/drug therapy , Vinblastine/administration & dosage , Vincristine/administration & dosageABSTRACT
Although this series is too small for meaningful statistical conclusions it demonstrates the effectiveness and hazards of bleomycin and vinblastine combined with other treatment modalities in the handling of non-seminomatous germinal testicular cancer. Bleomycin and vinblastine therapy is indicated 1) as a last restor in patients who have failed with other forms of therapy, 2) to convert high stage lesions to a lower stage and 3) as adjuvant therapy in the lowest stage lesions. The indications, risks and alternatives to chemotherapy, especially in patients with low stage tumors, must be realized by the physician and patient prior to its administration. However, the results reported here and elsewhere are so encouraging that we strongly recommend more aggressive use of these agents in any treatment regimen involving non-seminomatous tumors.
