RESUMO
PURPOSE: We evaluated the efficacy of a combined chemoradiation therapy protocol for the primary treatment of primary invasive carcinoma of the male urethra. MATERIALS AND METHODS: From January 1991 to December 2006, 18 patients with invasive carcinoma of the male urethra referred to our institution were treated with a chemoradiation therapy protocol, consisting of 2 cycles of 5-fluorouracil (1,000 mg/m(2)) on days 1 to 4 and days 29 to 32, and mitomycin-C (10 mg/m(2)) on days 1 and 29 with concurrent external beam radiation therapy (45 to 55 Gy in 25 fractions during 5 weeks) to the genitalia, perineum, and inguinal and external iliac lymph nodes. Kaplan-Meier curves were constructed to assess overall, disease specific and disease-free survival. RESULTS: The stage and node distribution was T2N0 in 2 patients (11%), T3N0 in 8 (44%), T4N0 in 2 (11%), TXN1 in 1(6%) and TXN2 in 5 (28%). The most prevalent histology was moderately (7 of 18 patients or 39%) or poorly (10 of 18 or 56%) differentiated squamous cell carcinoma (17 of 18 or 95%). Overall 83% (15 of 18) of the patients had a complete response to the primary chemoradiation therapy protocol, and the 5-year overall and disease specific survival rates were 60% and 83%, respectively. Five-year disease-free survival rates after chemoradiation therapy and after chemoradiation therapy with salvage surgery were 54% and 72%, respectively. The 3 nonresponders died of disease after undergoing salvage surgery and 5 of the 15 complete responders (30%) had recurrence. Complex urethral reconstruction was required in 3 of 10 patients (30%) who had prolonged disease-free survival. CONCLUSIONS: The chemoradiation therapy protocol is an alternative primary treatment modality for invasive urethral carcinoma. It enables an unprecedented potential for organ preservation.
Assuntos
Antineoplásicos/administração & dosagem , Carcinoma/terapia , Fracionamento da Dose de Radiação , Fluoruracila/administração & dosagem , Mitomicina/administração & dosagem , Neoplasias Uretrais/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma/mortalidade , Carcinoma/patologia , Estudos de Coortes , Terapia Combinada , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento , Neoplasias Uretrais/mortalidade , Neoplasias Uretrais/patologiaAssuntos
Doença Cardíaca Carcinoide/patologia , Neoplasias Cardíacas/patologia , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Doença Cardíaca Carcinoide/tratamento farmacológico , Neoplasias Cardíacas/tratamento farmacológico , Septos Cardíacos/patologia , Ventrículos do Coração/patologia , Humanos , Neoplasias Intestinais/patologia , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-IdadeAssuntos
Tumor Carcinoide/patologia , Neoplasias do Mediastino/patologia , Neoplasias do Timo/patologia , Adrenalectomia , Hormônio Adrenocorticotrópico/sangue , Idoso , Tumor Carcinoide/sangue , Tumor Carcinoide/etiologia , Síndrome de Cushing/complicações , Síndrome de Cushing/cirurgia , Progressão da Doença , Humanos , Masculino , Neoplasias do Mediastino/sangue , Neoplasias do Mediastino/etiologia , Estadiamento de Neoplasias , Neoplasias do Timo/sangue , Neoplasias do Timo/etiologia , Tomografia Computadorizada por Raios XRESUMO
There has been a dramatic improvement in outcomes for patients who have colon cancer over recent years. These improvements have come about largely because of the availability of new chemotherapy agents (irinotecan, oxaliplatin and capecitabine) and new biologic agents (bevacizumab and cetuximab). Large, well-designed clinical trials have resulted in the routine use of all of these agents in the treatment of patients who have metastatic disease, and this has led to improved survival for these patients. In earlier stage disease, oxaliplatin/5-FU-based chemotherapy has become a new standard of adjuvant therapy for many patients. Clinical research efforts are investigating the use of biologic agents along with chemotherapy for adjuvant treatment; it is hoped that this will translate into a greater cure rate for these patients.