RESUMEN
Polychemotherapy appears to increase survival moderately but at a cost of severe toxicity, mainly due to cisplatin. New platinum salts (chiefly carboplatin) have therefore been developed. This review on the use of carboplatin in advanced-stage urothelial tumours was undertaken to find the actual place of carboplatin in the treatment of these tumours, and to describe its best use in polychemotherapy. In 322 patients, carboplatin alone gave 12.9% objective responses (OR), 2.5% complete responses (CR) and 10.4% partial response (PR). Many polychemotherapy protocols were used, most frequently carboplatin/methotrexate/vinblastin. The results were OR: 63%, CR: 19%, PR: 44% among 146 patients. These results confirm the relative efficiency of carboplatin on urothelial tumours, particularly when used in combination. Because of the lack of prospective studies and the wide disparity in the doses and in the dose adjustment, no comparison can be made with cisplatin. Carboplatin has virtually no renal toxicity at the usual doses, and does not require hyperhydratation. The pharmacokinetic behaviour of the two platinum salts is highly different, as carboplatin does not undergo tubular metabolism. The efficiency and tolerance of carboplatin used to be optimised by adapting the dose to the glomerular filtration rate, as was shown for germ cell tumours. In conclusion, these considerations fully warrant further clinical trials of carboplatin.
Asunto(s)
Carboplatino/uso terapéutico , Neoplasias de la Vejiga Urinaria/tratamiento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carboplatino/farmacología , Cisplatino/uso terapéutico , Ensayos Clínicos como Asunto , Evaluación de Medicamentos , Femenino , Tasa de Filtración Glomerular/efectos de los fármacos , Humanos , Masculino , Metotrexato/administración & dosificación , Inducción de Remisión , Vinblastina/administración & dosificaciónRESUMEN
Prostatic cancer is the second most frequent cancer in men in France. It is a serious disease with a relative 5-year survival of 42%. Although the incidence of latent forms appears to be constant throughout the world, the incidence of clinical forms varies from country to country and according to race. These aspects are in favour of a dual mechanism of prostatic carcinogenesis: initiation of a cellular modification, which may be transmitted genetically according to an autosomal dominant mode, but whose expression may be influenced by the environment, and successive steps of transformation (epigenetic factors) which are essentially environment-dependent. The main identified risk factors essentially consist of a direct family history, age and a diet rich in animal fats. In contrast, neither the presence of benign prostatic hypertrophy, nor the characteristics of the sex life or a history of vasectomy appear to influence the incidence of prostatic cancer. The main epidemiological data currently available are presented.
Asunto(s)
Neoplasias de la Próstata/epidemiología , Anciano , Anciano de 80 o más Años , Andrógenos/sangre , Francia/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Hiperplasia Prostática/epidemiología , Neoplasias de la Próstata/genética , Factores de Riesgo , Conducta Sexual , Vasectomía/estadística & datos numéricosRESUMEN
We present a case of a large postoperative pseudosarcomatous bladder tumour and review the literature for this exceptional benign tumour. Several lesions, especially leiomyosarcoma, must be discussed. Immunohistochemical studies are helpful. The evolution is always benign, even with an incomplete tumour ablation.
Asunto(s)
Fibroma/epidemiología , Neoplasias de la Vejiga Urinaria/epidemiología , Anciano , Anciano de 80 o más Años , Carcinoma de Células Transicionales/cirugía , Diagnóstico Diferencial , Fibroma/diagnóstico , Humanos , Leiomiosarcoma/diagnóstico , Masculino , Complicaciones Posoperatorias/diagnóstico , Vejiga Urinaria/cirugía , Neoplasias de la Vejiga Urinaria/diagnóstico , Neoplasias de la Vejiga Urinaria/cirugíaRESUMEN
The prognosis of advanced-stage bladder cancer is poor. Chemotherapy, particularly regimens including platinum salts, appears to increase survival moderately but at the cost of severe, mainly renal toxicity. Platinum is a major factor in this toxicity, and new platinum salts (chiefly carboplatin) have therefore been developed. Carboplatin has no renal toxicity at usual doses, and its use does not require concomitant hyperhydration. Its gastrointestinal, otologic, and general tolerability is excellent. In contrast, most patients develop thrombocytopenia, which can be important, but which is always transitory. The platelet count reaches its nadir (grade 2 or 3) at around day 20, and the leukocyte nadir (grade 2 or 3) occurs about day 19. Anemia is rare. The literature on the use of carboplatin for the treatment of advanced-stage urothelial tumors is reviewed. Carboplatin is used at doses varying between 200 and 400 mg/m2, administered in 28-day courses. Dose adjustment is based on serum creatinine level, creatinine clearance, nadir blood cell levels, or previous treatment, reflecting the wide disparity between different studies. Used alone, carboplatin achieved objective responses (ORs) in 14% of patients (3% complete responses, CRs, and 11% partial responses, PRs) in a total group of 327 patients included in 13 trials. In polychemotherapy various combinations of carboplatin with other agents have been reported, most frequently carboplatin/methotrexate/vinblastine; the OR rate was 63% (CR rate 19% and PR rate 44%) among 88 patients in four studies. These results confirm the relative efficacy of carboplatin in the treatment of advanced-stage urothelial tumors, particularly when it is combined with other agents. Its efficacy is similar to that of cisplatin, but it is far less toxic. A prospective, comparative trial will be necessary to confirm these data. The pharmacokinetic behaviors of the two platinum salts are markedly different, as carboplatin does not undergo tubular metabolism. The efficacy of carboplatin could be optimized by adapting the dosage to the glomerular filtration rate, which is a more accurate method than extrapolation from the serum creatinine or creatinine clearance values. This has been shown in the case of nonseminomatous germ cell tumors. Calculation of the optimum carboplatin dose should now be applied to urothelial tumors. The general and renal tolerability of a platinum salt is an important element of choice when the efficacies are equivalent. These considerations fully warrant further clinical trials of carboplatin.