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Biomedical subjects

M S Soloway

Publications and source records attributed to M S Soloway.

At least 127 records · Page 7Linked to original sources
PubMed1992

Surgical techniques for endoscopic resection of bladder cancer.

Accompanying the advances in surgical techniques and new intravesical and systemic therapeutic agents for the treatment of individuals with bladder cancer has been the development of greatly improved instrumentation for viewing the interior of the urinary tract and removing neoplasms. Fiberoptic lenses can now be combined with a video system, which enables the urologist to examine the lower urinary tract, not only more easily but with greater magnification. Training is obviously accelerated with the use of video endoscopy. The system also provides the opportunity for documentation and transmittal of the operative findings using either still or motion photography. The endoscopic procedure should be carried out in an orderly fashion. Sufficient lenses and cautery loops must be available to visualize the entire lower urinary tract and to biopsy or resect any abnormality and ensure hemostasis. The urologist should work closely with the pathologist to obtain sufficient cytologic and pathologic material to be confident of the presence or absence of tumor.

Anesthesia, Spinal↗
PubMed1991

Pathologic changes associated with androgen deprivation therapy for prostate cancer.

Prostate glands exposed to androgen deprivation with leuprolide +/- flutamide were evaluated for pathologic changes which might be related to therapy. Comparing pretreatment and posttreatment tissue by visual discrimination using light microscopic study revealed treatment-related alterations in the size and distribution of neoplastic glands in 60% of cases. Quantitative measurements documented glandular changes in an even greater percentage of cases. Although distinctive, the histologic pattern was not specific for leuprolide/flutamide. The absence of appreciable degeneration and necrosis in tumor cells suggests that this type of androgen deprivation may act through suppression rather than ablation of prostatic cancers. The relationship between treatment-related histologic effects and initial tumor grade and clinical stage as well as expression of prostate-specific antigen was studied. Accurate histologic assessment of leuprolide/flutamide-treated prostate glands should not be a problem so long as specimens are thoroughly examined and drug-related variations in tumor morphologic features are appreciated.

Aged↗
PubMed1991

Zoladex versus orchiectomy in treatment of advanced prostate cancer: a randomized trial. Zoladex Prostate Study Group.

We report preliminary results for the first 164 patients enrolled in a multicenter study comparing the endocrine effects, efficacy, and safety of 3.6 mg of goserelin acetate (Zoladex) and orchiectomy in patients with Stage D2 prostate cancer. Eighty-one patients were randomly allocated to receive Zoladex and 83 to orchiectomy. The median follow-up time for all patients was two hundred ten days. Median serum levels of testosterone were reduced to castrate levels (less than 50 ng/dL) within four weeks in both groups and remained suppressed for up to sixty weeks. An objective response according to modified criteria of the National Prostatic Cancer Project was observed in 81 percent and 78 percent of patients in the Zoladex and orchiectomy groups, respectively. There were no statistically significant differences between treatment groups in the distributions of time to treatment failure or time to disease progression. The most commonly reported adverse events in both treatment groups were hot flashes, cancer-related pain, unspecified pain, and urinary symptoms. These results suggest that Zoladex may offer an alternative to orchiectomy in the treatment of advanced prostate cancer.

Acid Phosphatase↗
PubMed1991

Morbidity of modified pelvic lymphadenectomy and radiotherapy for prostatic cancer.

The records of 63 patients treated by pelvic lymphadenectomy and radiotherapy at the University of Tennessee, Memphis, Baptist Memorial Hospital of Memphis, and the Memphis Veterans Affairs Hospital were reviewed. Of those patients, 45 received external beam radiation therapy to the prostate while 16 were treated by Iodine-125 implantation. Two patients had only staging lymphadenectomy. The incidence of postoperative and late complications were analyzed.

Aged↗
PubMed1990

The importance of prognostic factors in advanced prostate cancer.

Three factors were identified in a multivariate analysis of prognostic factors in men with metastatic prostate cancer as significantly associated with their progression-free survival: 1) extent of disease on the bone scan, 2) pretreatment serum testosterone, and 3) performance status. Men with less than six bone metastases, a pretreatment testosterone greater than 300 ng/100 ml, and an excellent performance status will have a progression-free survival much longer than a man with more extensive bone metastases, a low testosterone prior to androgen deprivation, and a poor performance status. This information should be used to ensure proper stratification in randomized trials. It may also be helpful in identifying the patient unlikely to be helped by our current treatment. Such patients should be considered for alternative approaches with the aim of improving survival.

Aged↗
PubMed1990

Dose response relationship of methotrexate in combination with cisplatin in murine bladder cancer.

Methotrexate (MTX) has activity in transitional cell carcinoma (TCC) in man and some have suggested an advantage of high-dose methotrexate versus the standard dose in controlling tumor growth and prolonging survival. MBT-2, a poorly differentiated TCC induced by the carcinogen FANFT, is both grossly and histologically similar to human TCC and has been used as an animal model. One hundred twenty C3H/HE female mice were injected in the hind limb with 7.5 X 10(4) MBT-2 tumor cells. When palpable tumors developed in all animals, therapy was initiated. Animals were randomized into a control group and nine treatment groups as follows: cisplatin (DDP), MTX32 mg, MTX50 mg, MTX80 mg, DDP + MTX32, MTX50 + Leucovorin, MTX80 + Leucovorin, DDP + MTX50 + Leucovorin, DDP + MTX80 + Leucovorin. The combination of MTX50 mg with Leucovorin + DDP and DDP alone were the two most effective regimens in controlling tumor growth and prolonging survival. No statistically significant difference was observed between the group treated by high-dose MTX alone and those treated by low-dose MTX. No toxicity was observed even when high doses of MTX were used.

Animals↗
PubMed1990

Urethral recurrence following radical cystectomy.

We reviewed the clinical courses of 86 men after radical cystoprostatectomy for transitional cell carcinoma of the bladder to determine who were at highest risk for urethral recurrence. We assessed patients for prostatic involvement as well as tumor extent in the bladder and distal ureters. Of the 30 patients with tumor in the prostate 11 (37%) suffered urethral recurrences. Of the 56 patients with all other types of tumor involvement patterns exclusive of disease in the prostate only 2 (4%) had recurrence. We recommend rigorous screening for transitional cell carcinoma of the prostate before cystectomy. Prophylactic urethrectomy is indicated for patients with prostatic involvement, while those without such involvement may be considered at low risk for urethral recurrence.

Carcinoma, Transitional Cell↗
PubMed1990

Instillation of bacillus Calmette-Guerin into the renal pelvis of a solitary kidney for the treatment of transitional cell carcinoma.

Intravesical bacillus Calmette-Guerin is effective in the treatment and prophylaxis of superficial urothelial cancer of the bladder. There have been few reports of its efficacy and toxicity when instilled into the upper urinary tract. We elected to use intracavitary bacillus Calmette-Guerin in a patient with recurrent high grade transitional cell carcinoma in the renal pelvis of a solitary autotransplanted kidney. The patient required hospitalization and triple-drug therapy after 5 instillations. She was free of tumor 1 year after bacillus Calmette-Guerin instillations.

Antitubercular Agents↗
PubMed1990

Follow up of patients receiving treatment for superficial bladder cancer with mitomycin C and BCG.

The approach that I have followed for patients with recurrent superficial transitional cell carcinoma of the urinary bladder has generally been to perform a thorough endoscopic evaluation of the bladder with appropriate evaluation of the prostatic urethra as well as the upper urinary tract, and if it is felt that the neoplasm is confined to the bladder (and possibly the mucosa of the prostatic urethra), then all obvious tumor should be resected and a three-month trial of intravesical therapy instituted. Based upon the results presented, the response at the first three-month evaluation has major prognostic importance. Those patients who had no evidence of tumor at this first three-month evaluation were less likely to have a subsequent cystectomy or die of bladder cancer than those who had evidence of persistent tumor. Among the 80 patients who received a treatment course of MMC, 13% of the complete responders compared to 34% of those who failed had a subsequent cystectomy, and among the 55 patients who received BCG, 6% of the complete responders compared to 25% of the failures had a subsequent cystectomy during the follow up interval. Indeed, part of this difference can be explained by the gradual adherence to the philosophy that if there is persistent high grade tumor or a high grade tumor develops following an adequate treatment course of MMC or BCG, cystectomy is indicated in order to avoid the development of a tumor which invades into the muscle.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Intravesical↗
PubMed1989

M-VAC or MVC for the treatment of advanced transitional cell carcinoma: metastatic, induction, and adjuvant.

The cisplatin-based combination chemotherapy regimens of M-VAC (methotrexate, vinblastine, doxorubicin, cisplatin) or MVC (methotrexate, vincristine, cisplatin) were given to 25 patients with metastatic urothelial carcinoma, 13 with locally advanced bladder cancer, and 10 as adjuvant therapy after radical surgery. Toxicity was significant with two deaths. Forty-eight percent of the patients with metastatic disease had a complete (20%) or partial (28%) response. Survival was only improved if a CR was achieved. Nine of 13 patients given M-VAC/MVC as neoadjuvant therapy underwent cystectomy and six are free of disease (mean 31 months). Three of the four patients who did not have radical surgery are also free of disease. These regimens appear to be superior to cisplatin alone. In the overall response evaluation, however, toxicity is greater.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

Diagnosis and management of superficial bladder cancer.

Superficial transitional cell carcinoma is defined as a transitional cell urothelial tumor that is confined to the mucosa, stages Ta or CIS, or with invasion of the lamina propria, T1. The initial treatment is transurethral resection with an attempt to remove all tumor. This should provide an accurate histologic grade and stage, and from this information a prognosis can be determined. The important predictive factors that correlate with a new occurrence or true recurrence and the development of a subsequent tumor with muscle invasion are a high tumor grade, lamina propria invasion, a positive cytology following resection, multifocal tumors, dysplasia or carcinoma in situ from mucosal biopsies of normal appearing urothelium, and a prior history of bladder cancer. Based on these factors, the recurrence rate varies from 30 to 80% and progression with a muscle invasive tumor up to 30%. Intravesical chemotherapy or "immunotherapy" following tumor resection has been shown to diminish the likelihood of a recurrence. Thiotepa has been used for the longest period of time. It is relatively inexpensive, safe if myelosuppression is closely monitored, and effective. Mitomycin C was more effective than Thiotepa in randomized trials, but is significantly more expensive. This has retarded its use as a first-line agent. It has been shown to eradicate persistent tumor in 30 to 40% of patients who have failed Thiotepa. Mitomycin C is also highly effective when used for prophylaxis. Intravesical bacillus Calmette-Guerin (BCG) has recently been demonstrated to be an effective intravesical therapeutic agent. It is effective both for treatment and prophylaxis. BCG is relatively safe and inexpensive.(ABSTRACT TRUNCATED AT 250 WORDS)

Aftercare↗
PubMed1989

Prognostic factors in patients with advanced prostate cancer.

One hundred ten patients with metastatic prostate cancer (Stage D2) were analyzed to determine the associations among time until progression and the pretreatment testosterone level, extent of bone metastases as indicated by a semiquantitative grading scale for extent of disease, performance status, race, age, and the pretreatment level of prostatic acid phosphatase (PAP). The median follow-up period was twenty-one months, with a range of four to eighty-nine months. All patients received androgen deprivation at the time metastases were identified. A multivariate analysis demonstrated that pretreatment serum testosterone was the most significant variable associated with time until progression (P less than 0.01) and that the extent of bone metastases observed on the bone scan was the second most important variable (P less than 0.05). The following factors did not significantly correlate with progression-free intervals: age, race, and PAP. The performance status was significantly correlated, but was nonsignificant in the multivariate analysis when the model already included the testosterone level and the extent of bone metastases. Patients with a pretreatment testosterone level of less than 300 ng/dL and with more than six areas of increased uptake on the bone scan progressed more rapidly.

Acid Phosphatase↗