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Palliative radiotherapy (pRT) is primarily employed for palliation of bone pain in patients with castrate-resistant prostate cancer (CRPC). However, evidence that pRT influences prostate-specific antigen response in patients with CRPC on systemic therapy is lacking. We describe three cases of CRPC progressing after treatment with docetaxel (n=2) and abiraterone (n=1), who responded unusually after pRT for bone pain with the development of a significant biochemical response and restoration of response to systemic therapy. The possibility of pRT influencing metastatic disease in CRPC has not been previously reported, and raises the possibility of radiation-induced modulation of anti-tumor immune response mechanisms that may play a role in the restoration of response to systemic treatment.
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The management of castrate-resistant prostate cancer progressing after maximum androgen blockade (MAB) has evolved in the last decade with the development of several novel therapeutic options. However, the initial therapeutic strategy in these patients usually involves withdrawal of anti-androgen that can be associated with biochemical response in approximately 20% of patients. Notably, we have observed evidence of sustained biochemical response in two patients following second- and third-line MAB using rechallenge schedule of previously administered anti-androgen after latent interval. The possibility of response following sequential MAB using the same anti-androgen agent has not yet been reported.
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Nephrobronchial fistulas are a rare complication of xanthogranulomatous pyelonephritis. We report the diagnosis of such a case together with its investigation, management and a review of current literature.
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OBJECTIVES: To analyse a group of patients with clinically and radiologically detected renal neoplasms who were conservatively treated for various reasons. The patients were followed-up radiologically and intervened only if symptomatic. The natural progression of these masses and also a brief review of the literature is done. METHODS: The series was collected retrospectively from the case-notes of patients coded for renal neoplasms. Of the 13 patients followed up conservatively, eight were deferred surgery in view of their age (mean age-83.25 years), one patient had a single kidney, two were unwilling for surgery and two had severe co-morbidities which made them unfit for surgery. RESULTS: The mean age at diagnosis was 80.4 years (median-82; range 66-88). Seven females and six males were followed up for a mean and median follow-up of 38.38 and 34 months respectively (range-19 to 105 months). Six patients died during follow-up (mean-41.57 months). The average longest dimension at diagnosis and when last reviewed were 5.01 cm and 5.57 cm. However, only one of these died due to metastasis which developed during follow-up and two had to be angio-embolised for hematuria. The average rate of growth along the longitudinal dimension was 0.17 cm/year while the average change in volume was 11.97 cc/year. CONCLUSIONS: Malignant renal neoplasms grow at a relatively slow rate. Without tumour growth the risk of metastasis appears limited. Thus expectant management can be considered as an alternative for a selected group of patients who are either unwilling or unfit or high risk for surgery.
Assuntos
Neoplasias Renais/terapia , Idoso , Idoso de 80 Anos ou mais , Demografia , HumanosRESUMO
We report a case of an elderly gentleman with renal cell carcinoma presenting with the rare entity of non-islet cell tumor hypoglycemia (NICTH). Non-islet cell tumor hypoglycemia syndrome is caused by the tumor producing insulin-like growth factor II, causing hypoglycemia. The syndrome is most commonly associated with very large fibromas or fibrosarcomas.
