ABSTRACT
Metronomic chemotherapy has been tested only a few times in the treatment of metastatic kidney cancer. We have combined metronomically dosed cyclophosphamide (mCTX) with full dosed interferon alpha (IFN) in patients with disseminated clear cell cancer. Toxicity was mainly attributable to IFN treatment. We have noticed mainly hematological and general symptoms with only few grade 3 or 4 adverse events. No patient required mCTX withdrawal. In 30 patients evaluated for the response, clinical benefit (CB) (objective responses and stabilization of the disease ≥24 weeks) was observed in 40%. Median overall survival (OS) for the whole group was 13.2 months. Survival responders and nonresponders were 9.5 versus 28.9 months (P=0.001). Patients with a higher hemoglobin concentration and fibrinogen level <6 g/L had a higher probability of response. Responders also had different kinetics of fibrinogen than nonresponders. When assessed for clinical response, the combination of mCTX and IFN proved to be disappointing. In contrast, OS in patients with CBs proved to be long. It is crucial to properly select patients for whom some predictive markers can be used. The combination of metronomic chemotherapy with targeted therapies might be an interesting direction for further research.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Kidney Neoplasms/drug therapy , Kidney Neoplasms/pathology , Aged , Aged, 80 and over , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Cyclophosphamide/administration & dosage , Female , Humans , Interferon-alpha/administration & dosage , Kaplan-Meier Estimate , Kidney Neoplasms/mortality , Male , Middle Aged , Neoplasm Metastasis , Retreatment , Treatment OutcomeABSTRACT
In comparison to an open procedure, the laparoscopic radical nephrectomy has demonstrated advantages in regard to perioperative morbidity, postoperative pain, time of hospitalization, and convalescence. However, most series of laparoscopic radical nephrectomy are confined to T1 tumors. The authors present a case of a large-volume- T2 renal tumor treated laparoscopically. The aim of the study is to present the operative technique and to discuss several unique problems that arise during the laparoscopic procedure in patients with large renal masses.
ABSTRACT
INTRODUCTION: A retrospective study was performed to compare the results of dismembered and nondismembered Y-V laparoscopic pyeloplasties and the complications observed after the two types of surgery. MATERIALS AND METHODS: Eighty-eight patients with ureteropelvic junction obstruction (UPJO) underwent a laparoscopic operation. In 2 cases, an open conversion was made. A laparoscopic Hynes-Anderson pyeloplasty (LH-AP) was performed on 50 patients, whereas a laparoscopic Y-V pyeloplasty (LY-VP) was performed in 36 cases. The diagnosis of UPJO was based on a complete medical history, ultrasonography, diuretic urography (IVU), and/or diuretic renography. The mean follow-up was 29 (range, 6-66) months. Complete success was defined as the absence of any clinical symptoms, combined with a significant reduction of hydronephrosis on IVU and ultrasonography, as well as no sign of obstruction on IVU and/or diuretic renography. RESULTS: The mean operative time for LH-AP was 219 minutes and for LY-VP 185 minutes. The mean hospital stay after LH-AP was 5.9 days and after LY-VP 5.3 days. The overall success rate was 91.5% (91.8% for LH-AP patients and 91.2% for LY-VP patients). CONCLUSION: LY-VP appears to be a safe, attractive alternative to LH-AP.
