RESUMEN
PURPOSE: Development of new renal tumors or recurrence after radio frequency ablation not amendable for repeat ablation presents a difficult therapeutic dilemma. We report on the outcomes of partial nephrectomy on kidneys previously treated with radio frequency ablation. MATERIALS AND METHODS: We performed a chart review of 13 patients who underwent 16 attempted partial nephrectomies following radio frequency ablation. Hospital records and operative reports were reviewed for demographic data, perioperative data and outcomes. The outcomes of the present series were compared to historical controls of published studies in similar patient populations. RESULTS: No cases were converted to radical nephrectomy. Median time from radio frequency ablation to surgery was 2.75 years (range 1 to 7.1). A median of 7 tumors (range 2 to 40) were removed with a median estimated blood loss of 1,500 ml (range 500 to 3,500) and a median operative time of 7.8 hours (range 5 to 10.7). Operative notes commented on the presence of severe fibrosis in the operative field in 12 of 16 cases (75%). There was a modest but statistically significant decrease in renal function. Partial nephrectomy after radio frequency ablation had a higher reoperation rate compared to other series of primary or repeat partial nephrectomies but had the lowest rate of vascular or visceral injuries. CONCLUSIONS: Partial nephrectomy on kidneys previously treated with radio frequency ablation is a technically challenging but feasible procedure. Residual or metachronous disease after radio frequency ablation may be salvaged with partial nephrectomy with a modest decrease in renal function. A trend toward a higher chance of reoperation and urine leak after partial nephrectomy after radio frequency ablation may be useful information for the planning and discussion of treatment decisions.
Asunto(s)
Ablación por Catéter , Neoplasias Renales/cirugía , Recurrencia Local de Neoplasia/cirugía , Nefrectomía/métodos , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , National Cancer Institute (U.S.) , Estados Unidos , Adulto JovenRESUMEN
Intravesical BCG has been used successfully to treat superficial bladder cancer for three decades. However, 20% to 30% of patients will fail initial BCG therapy and 30% to 50% of patients will develop recurrent tumors within 5 years. Alternative or complementary strategies for the management of superficial bladder cancer are needed. Interleukin-12 (IL-12) is a potent T(H)1 cytokine with robust antitumor activity and the ability to potentiate immunologic memory. Unfortunately, intravesical IL-12 did not show antitumor efficacy in a recent clinical study of patients with recurrent superficial bladder cancer. We hypothesized that coformulation of IL-12 with chitosan, a biocompatible, mucoadhesive polysaccharide, could improve intravesical IL-12 delivery and provide an effective and durable alternative for the treatment of superficial bladder cancer. In antitumor studies, 88% to 100% of mice bearing orthotopic bladder tumors were cured after four intravesical treatments with chitosan/IL-12. In contrast, only 38% to 60% of mice treated with IL-12 alone and 0% treated with BCG were cured. Antitumor responses following chitosan/IL-12 treatments were durable and provided complete protection from intravesical tumor rechallenge. Urinary cytokine analysis showed that chitosan/IL-12 induced multiple T(H)1 cytokines at levels significantly higher than either IL-12 alone or BCG. Immunohistochemistry revealed moderate to intense tumor infiltration by T cells and macrophages following chitosan/IL-12 treatments. Bladder submucosa from cured mice contained residual populations of immune cells that returned to baseline levels after several months. Intravesical chitosan/IL-12 is a well-tolerated, effective immunotherapy that deserves further consideration for testing in humans for the management of superficial bladder cancer.
Asunto(s)
Carcinoma de Células Transicionales/terapia , Quitosano/administración & dosificación , Interleucina-12/administración & dosificación , Neoplasias de la Vejiga Urinaria/terapia , Administración Intravesical , Animales , Vacuna BCG/administración & dosificación , Carcinoma de Células Transicionales/genética , Carcinoma de Células Transicionales/inmunología , Línea Celular Tumoral , Femenino , Inmunohistoquímica , Interferón gamma/sangre , Interferón gamma/orina , Interleucina-12/sangre , Interleucina-12/orina , Luciferasas/biosíntesis , Luciferasas/genética , Macrófagos/inmunología , Ratones , Ratones Endogámicos C57BL , Transfección , Neoplasias de la Vejiga Urinaria/genética , Neoplasias de la Vejiga Urinaria/inmunologíaRESUMEN
Laparoscopic port site metastases remain exceedingly rare for urologic tumors, despite the increasingly widespread use of laparoscopic techniques in the management of urologic malignancy. We report a case of port site metastases after transperitoneal laparoscopic radical prostatectomy.