RESUMEN
BACKGROUND: The aim of this study was to evaluate the efficacy and safety of a combined chemotherapy regimen, gemcitabine and cisplatin (GC), in the treatment of advanced urothelial carcinomas. METHODS: Fifty-five patients with advanced urothelial cancer were treated with GC (gemcitabine 1000 mg/m(2) on days 1, 8, and 15; cisplatin 70 mg/m(2) on day 2) every 28 days. The median follow-up was 30 months (range, 3 to 57 months). RESULTS: With the GC therapy, 35 of the 55 patients (63.6%) showed an objective response, with 7 (12.7%) achieving a clinical complete response (CR) and 28 (50.9%), a partial response (PR). GC therapy had a better impact on metastases in the lung and lymph nodes than on metastases in the liver and bone. Lung and lymph nodes showed objective responses of 64.7% and 65.8%, respectively. Eight of the 20 patients (40.0%) who had previously been treated with other regimens showed an objective response, with 1 achieving a CR and 7 achieving a PR. In the 47 patients with metastasis, the median time to progression was 7.0 months (range, 2 to 49 months), and the median overall survival was 12.0 months (range, 3 to 49 months). The 2-year survival rate was 80.0% in the CR group, while it was 55.1% in the PR group and 10.0% in the progressive disease (PD) group. The toxicities associated with GC, particularly mucositis, anorexia, and alopecia, were quite mild. Grade 3-4 toxicity was primarily hematological, including anemia (27.3%), neutropenia (32.7%), and thrombocytopenia (43.6%). CONCLUSION: GC is considered to be a highly effective and well-tolerated regimen for the treatment of advanced urothelial carcinomas, with moderate toxicity.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Cisplatino/uso terapéutico , Desoxicitidina/análogos & derivados , Neoplasias Urológicas/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma/tratamiento farmacológico , Carcinoma/patología , Cisplatino/administración & dosificación , Cisplatino/efectos adversos , Desoxicitidina/administración & dosificación , Desoxicitidina/efectos adversos , Desoxicitidina/uso terapéutico , Femenino , Hospitales Universitarios , Humanos , Japón , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Análisis de Supervivencia , Neoplasias Urológicas/patología , GemcitabinaRESUMEN
OBJECTIVE: Cisplatin-based combination chemotherapy has been considered as standard therapy for advanced or metastatic urothelial carcinoma. A recent study has, however, revealed that gemcitabine may have the potential to act synergistically with cisplatin. Therefore, the side effects of gemcitabine plus cisplatin (GC) therapy were compared with those of methotrexate, vinblastine, doxorubicin and cisplatin (MVAC) therapy in patients with advanced or metastatic urothelial carcinoma. PATIENTS AND METHODS: Twenty-two patients received GC therapy. Gemcitabine (1000 mg/m2) was administered on days 1, 8 and 15 of each 28-day cycle. Cisplatin (70 mg/m2) was administered on day 2 of each cycle. As a control group, 24 patients received MVAC therapy (methotrexate at 30 mg/m2 on days 1, 15, 22, vinblastine at 3 mg/m2 on days 2, 15, 22, doxorubicin at 30 mg/m2 on day 2, and cisplatin at 70 mg/m2 on day 2 of each 28-day cycle. RESULTS: In the group of patients which received GC therapy, the overall response rates based on independent radiologic reviews of the 20 patients with measurable disease were 55%, with 20% CR and 35% PR. Fewer GC patients as compared with MVAC patients had grade 3/4 anorexia (4.5% vs. 75%, respectively), stomatitis (9.0% vs. 66.7%, respectively), and alopecia (27.3% vs. 100%, respectively). On the other hand, there were no significant differences in the incidence or pattern of hematologic toxicities between the group receiving GC therapy and that receiving MVAC therapy. Fatal neutropenic sepsis occurred in one patient receiving MVAC therapy. CONCLUSION: GC therapy is effective for the treatment of advanced or metastatic urothelial carcinoma, with an acceptable clinical safety profile. This study also indicates that GC therapy may be better tolerated and safer than MVAC therapy.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Neoplasias Urológicas/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Alopecia/inducido químicamente , Anorexia/inducido químicamente , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Cisplatino/administración & dosificación , Cisplatino/efectos adversos , Desoxicitidina/administración & dosificación , Desoxicitidina/efectos adversos , Desoxicitidina/análogos & derivados , Doxorrubicina/administración & dosificación , Doxorrubicina/efectos adversos , Esquema de Medicación , Femenino , Humanos , Masculino , Metotrexato/administración & dosificación , Metotrexato/efectos adversos , Persona de Mediana Edad , Estadificación de Neoplasias , Calidad de Vida , Neoplasias Urológicas/patología , Vinblastina/administración & dosificación , Vinblastina/efectos adversos , GemcitabinaRESUMEN
AIM: The application of cardiopulmonary bypass to atrial involvement represents an important advance that has improved the safety and technical efficacy of a difficult surgical undertaking. Our experiences of the management of extended thrombi into the right atrium in patients with retroperitoneal malignancy using a cardiopulmonary bypass were discussed. METHODS: Data were reviewed for five patients (two men and three women; mean age, 60.4 years; range, 49-79 years) with retroperitoneal tumors displaying intracardiac tumor extension. Tumors originated in the right kidney in four patients, and in left adrenal gland in one patient. Cardiopulmonary bypass was used in all cases. RESULTS: Mean total blood loss was 6059 mL. Mean operative time was 14.7 h. No intra- or postoperative complications due to surgical technique were encountered, and no significant bleeding occurred during incision of the inferior vena cava or after removal of tumor thrombus. The follow-up period ranged from 3 to 20 months with a mean of 12.6 months. Of the five patients, three died of metastatic diseases, one died of liver dysfunction and one remains disease free as of 18 months postoperatively. CONCLUSIONS: Our experience indicates that this procedure can be safely used for atrial involvement. Although superior long-term survival cannot be shown yet, favorable early results and a lack of perioperative complications were identified.