Assuntos
Proteínas de Ligação a Calmodulina/genética , Carcinoma de Células Pequenas/patologia , Rearranjo Gênico , Neoplasias Renais/patologia , Proteínas de Ligação a RNA/genética , Adulto , Carcinoma de Células Pequenas/genética , Carcinoma de Células Pequenas/cirurgia , Feminino , Humanos , Neoplasias Renais/genética , Neoplasias Renais/cirurgia , Prognóstico , Proteína EWS de Ligação a RNA , Literatura de Revisão como Assunto , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: Men with penile squamous cell carcinoma and regional lymph node involvement have a low probability of survival with lymphadenectomy alone. A multimodal approach to treatment is desirable for such patients. We performed a phase II study of neoadjuvant chemotherapy with the objective of determining the response rate, time to progression (TTP), and overall survival (OS) among patients with bulky adenopathy. PATIENTS AND METHODS: Eligible patients had stage N2 or N3 (stage III or stage IV) penile cancer without distant metastases. Neoadjuvant treatment (four courses every 3-4 weeks) consisted of paclitaxel 175 mg/m(2) administered over 3 hours on day 1; ifosfamide 1,200 mg/m(2) on days 1 to 3; and cisplatin 25 mg/m(2) on days 1 to 3. Clinical and pathologic responses were assessed, and patient groups were compared for TTP and OS. RESULTS: Thirty men received chemotherapy of whom 15 (50.0%) had an objective response and 22 (73.3%) subsequently underwent surgery. Three patients had no remaining tumor on histopathology. Nine patients (30.0%) remained alive and free of recurrence (median follow-up, 34 months; range, 14-59 months), and two patients died of other causes without recurrence. Improved TTP and OS were significantly associated with a response to chemotherapy (P < .001 and P = .001, respectively), absence of bilateral residual tumor (P = .002 and P = .017, respectively), and absence of extranodal extension (P = .001 and P = .004, respectively) or skin involvement (P = .009 and P = .012, respectively). CONCLUSION: The neoadjuvant regimen of paclitaxel, ifosfamide, and cisplatin induced clinically meaningful responses in patients with bulky regional lymph node metastases from penile cancer.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/secundário , Excisão de Linfonodo , Terapia Neoadjuvante/métodos , Neoplasias Penianas/tratamento farmacológico , Neoplasias Penianas/patologia , Adulto , Idoso , Carcinoma de Células Escamosas/cirurgia , Quimioterapia Adjuvante , Cisplatino/administração & dosagem , Intervalo Livre de Doença , Esquema de Medicação , Humanos , Ifosfamida/administração & dosagem , Estimativa de Kaplan-Meier , Excisão de Linfonodo/métodos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Paclitaxel/administração & dosagem , Neoplasias Penianas/cirurgia , Valor Preditivo dos Testes , Estudos Prospectivos , Radioterapia Adjuvante , Fatores de Risco , Resultado do TratamentoRESUMO
We report the case of a 78-year-old man with metastatic transitional-cell carcinoma with squamous differentiation that responded dramatically to the monoclonal antibody agent, bevacizumab. The tumor originated in the bulbar urethra, with histology of poorly differentiated urothelial carcinoma. Metastasis to a right inguinal lymph node was biopsy-confirmed as transitional-cell carcinoma with areas of keratinization. At last follow-up, he had received 24 months of bevacizumab treatment with minimal toxicity and a positive response. Mediators of angiogenesis have been implicated in the clinical progression of bladder cancer, although the role of angiogenesis inhibitors as treatment has not yet been defined. The striking benefit achieved in this heavily treated patient suggests that bevacizumab could have clinically useful antitumor activity in advanced urothelial carcinoma.