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M S Soloway

Publications and source records attributed to M S Soloway.

At least 163 records · Page 9Linked to original sources
PubMed1988

Introduction and overview of intravesical therapy for superficial bladder cancer.

The initial and subsequent management of patients with transitional cell carcinoma of the urinary bladder requires the cooperative effort of the urologist, pathologist, and cytologist. The initial endoscopic session should provide sufficient material to assess accurately the extent of tumor. The tumor is termed superficial if it is confined to the mucosa (Stage Ta and CIS) or lamina propria (T1). Based on the prognostic factors, the clinician decides whether or not intravesical therapy should be incorporated into the treatment plan that is designed to eradicate any remaining postresection tumor(s) as well as retard the development of subsequent tumors. The clinician who chooses to utilize intravesical therapy should be knowledgeable regarding the frequently used drugs: thiotepa, mitomycin C, doxorubicin, and bacillus Calmette-Guérin (BCG). Each has established efficacy in the treatment and prophylaxis of transitional cell carcinoma. Each also has a different spectrum and incidence of local and systemic toxicity.

Administration, Intravesical↗
PubMed1988

Efficacy of buserelin in advanced prostate cancer and comparison with historical controls.

Buserelin (B) is a synthetic nonapeptide analogue of native LHRH. Upon continued administration it reliably lowers the serum testosterone level to less than 100 ng/dl. It has been used in a clinical trial for the treatment of patients with stage C, D1, and D2 prostate cancer. Analysis of efficacy of testosterone suppression and toxicity included all 207 buserelin-treated patients. A comparison with historical controls from two National Prostate Cancer Project (NPCP) studies considered only the 147 evaluable patients with distant metastases (stage D2). All patients received buserelin, 500 micrograms q 8 hours subcutaneously (s.c.) for the first 7 days and then elected to take 200 micrograms s.c. daily or 400 micrograms q 8 hours by the intranasal (i.n.) route. Seventy-three percent elected s.c. administration. Only 2% changed the route of administration. The serum testosterone (T) level increased during week 1 in both the s.c. (426 ng/dl) and the i.n. (521 ng/dl) group but reached castrate (less than 100 mg/dl) levels by 4 weeks in 90% of patients. Subsequently, the likelihood of having a T level greater than 100 was higher for those treated by the i.n. than the s.c. route. The mean T level 4 and 12 months after therapy for the s.c. treated patients was 29 and 28. These values were 61 and 53 for those taking i.n. buserelin. This difference may in part be due to poor compliance. Toxicity was minor. Twelve percent of 151 s.c. treated patients had at least one episode of reaction at the injection site. None required discontinuation of the agent. Seventy-two percent experienced hot flushes; this was the same for both the s.c. and i.n. groups. Only 2 of 207 patients had a severe exacerbation of symptoms (spinal cord compression) during the first week of therapy. The criteria for response to therapy were those of the NPCP. There was no significant difference in the percentage of patients achieving a response when comparing the B-treated D2 patients to the NPCP D2 patients treated with DES, 3 mg daily, or orchiectomy. More of the B-treated patients entered with pain, a poor performance status, and weight loss than the DES/orchiectomy group. Nonetheless, the progression-free survival did not differ among the treatments. In summary, buserelin reliably lowers the serum T level by week 4 in 95% of men. Treatment efficacy is equivalent to a historical group treated with either DES or orchiectomy.

Buserelin↗
PubMed1988

Intravesical therapy for bladder cancer.

Bladder tumors confined to the mucosa and lamina propria are heterogeneous. Papillary, low-grade (I-II) noninvasive tumors (Ta) may recur frequently, thus subjecting the patient to numerous endoscopic procedures, but these patients infrequently have progression in grade or stage. Treatment need not be overly aggressive. High-grade (III) tumors confined to the mucosa (carcinoma in situ or Ta) or with lamina propria invasion (T1) require not only thorough initial endoscopic resection if possible, but extremely careful monitoring. Intravesical therapy should be seriously considered, as a subsequent tumor might invade the muscle and thus be life threatening. At this writing, there are no conclusive data to indicate which intravesical agent is most appropriate for each circumstance. Randomized trials are in progress. A few statements are possible, however. Thiotepa delays the development of low-grade tumors when used for prophylaxis. Toxicity is low, and the drug is not expensive. Mitomycin C is effective for treatment of residual superficial tumor and when instilled regularly after complete transurethral resection (prophylaxis). Side effects are infrequent (cystitis, dermatitis, rash) and almost never severe. The drug is expensive. Adriamycin appears to be active in the treatment and prophylaxis of superficial tumors, but its precise role has not been defined. Cystitis is common. BCG may be the most effective intravesical agent in the treatment of carcinoma in situ. The frequency and severity of local and systemic side effects vary with the strain but are potentially worse than with the chemotherapeutic agents. Thus, the clinician must carefully consider which patients to treat with BCG.

Administration, Intravesical↗
PubMed1987

Treatment of invasive bladder cancer by cisplatin and radiation in patients unsuited for surgery.

Seventy patients with muscle-invading bladder carcinoma (clinical stages T2 to T4) who were not candidates for cystectomy were treated with combined cisplatin and full-dose external-beam radiation on a multi-institutional prospective protocol from 1980 through 1985. Thirty-six patients are alive, all but three without evidence of cancer. The complete response rate is 77% in the 62 patients completing planned irradiation and 70% for all patients. Among the complete responders, 73% are currently maintained, and this group has a significantly higher four-year survival than those not having a complete response and those with recurrence of disease--57% vs 11%. The observed high complete response rates in patients in all stages and the high survival rates suggest irradiation plus cisplatin therapy offers an important therapeutic gain over radiation therapy alone for invasive cancer of the bladder. These results encourage further evaluation of combining cisplatin-based, multidrug chemotherapy with irradiation in patients with locally very-advanced bladder tumors who are not suited for surgery.

Aged↗
PubMed1987

Selecting initial therapy for bladder cancer.

Progress has been made at both ends of the spectrum of bladder cancer. The introduction and increasing use of effective intravesical agents for both treatment and prophylaxis of tumors limited to the mucosa or lamina propria has reduced the incidence and frequency of subsequent tumors. At the other end of the spectrum--patients with locally extensive bladder cancer--neoadjuvant or initial chemotherapy is producing complete and partial responses. Hopefully this will translate into an improvement in the cure rate. In arriving at a decision regarding treatment for a patient with bladder cancer the urologist integrates information derived from a thorough endoscopic examination of the lower urinary tract (bladder and urethra), complete grading and staging of resected tumor including results of mucosal biopsies from suspicious and normal appearing urothelium, and cytology obtained by bladder irrigation. Treatment also may be influenced by such factors as prior history and treatment of bladder cancer and the patient's age and medical status. Assuming no prior bladder tumor history, endoscopic resection/fulguration followed by intravesical therapy will be used for tumors confined to the mucosa (Ta or Tcis) or lamina propria (TI). Optimally the urologist should resect all evident tumor and incorporate the intravesical agent as prophylaxis. Cytology and endoscopy will monitor the success of this approach. If the patient develops another superficial tumor while receiving prophylaxis another intravesical agent can be delivered, possibly using an intensive treatment schedule. Several agents have demonstrated effectiveness both for treatment and prophylaxis. They include mitomycin C, thiotepa, Adriamycin (doxorubicin), and bacillus Calmette-Guerin. The indications for radical cystectomy are invasion into the bladder muscle, tumor extension into the prostatic ducts or prostatic substance, or persistent tumor after an adequate trial of one or more intravesical agents used in conjunction with endoscopic resection. The escalating complete and partial response rates associated with combination chemotherapy of metastatic bladder cancer has led to the use of these regimens before considering cystectomy for patients with locally extensive bladder cancer, e.g., T3, T4, and N1-2. Downstaging with chemotherapy in this group of poor-risk patients may be preferable to the traditional approach of proceeding with exenterative surgery or full-dose radiation and considering chemotherapy later when metastases are evident.

Administration, Intravesical↗
PubMed1987

Buserelin treatment of advanced prostatic carcinoma. Long-term follow-up of antitumor responses and improved quality of life.

The safety and efficacy of buserelin, a luteinizing hormone-releasing hormone (LH-RH) agonist, was tested in 33 evaluable patients with Stages C or D adenocarcinoma of the prostate. With a minimum follow-up duration of 10 months, there was one complete response and 22 partial responses (69%) by National Prostatic Cancer Project criteria, with a median duration greater than 18 months. Six patients (18%) had stable disease, median duration greater than 25 months, and only 12 patients have progressed. Performance status improved in 67%, patient-scored pain improved in 75%, and quality of life improved in 58%. Symptoms occurring during treatment consisted of hot flashes, loss of libido, and impotence. Buserelin produces a high frequency of durable objective and subjective responses in patients with advanced prostatic carcinoma.

Adenocarcinoma↗
PubMed1987

Nephrogenic adenoma.

Nephrogenic adenoma is a peculiar reactive process of urothelium which may occur anywhere along the urinary collecting system but rarely if ever arises in the absence of a preexisting urogenital abnormality. Although its histogenesis and biological potential have not been entirely defined, the evidence strongly suggests a metaplastic lesion comprising immature cells which lack the capacity to invade or metastasize. Clinical signs and symptoms are nonspecific and may relate more to the coexisting abnormality than to the nephrogenic adenoma itself. Although nephrogenic adenomas may resemble certain types of urologic malignancies, their histology is distinctive and varies little from lesion to lesion so that once the entity is considered, an accurate pathologic diagnosis is rarely a problem.

Adenoma↗
PubMed1987

Comparison of single agent cisplatin and cisplatin containing combinations in treatment of murine bladder cancer.

Using the FANFT-induced tumors MBT-2 and MBT-683 we compared the response rate and survival using cisplatin alone and in various combinations with doxorubicin hydrochloride (Adriamycin), mitomycin C, methotrexate, and vinblastine. Sixty C3H/He female mice received 7.5 x 10(4) MBT-2 cells in the right hind limb. The animals were randomly divided into a control group and four treatment groups as follows: cisplatin, 6.0 mg/kg; cisplatin, 2.0 mg/kg, vinblastine, and methotrexate; cisplatin, 2.0 mg/kg, vinblastine, methotrexate, and doxorubicin hydrochloride; and cisplatin, 2.0 mg/kg, vinblastine, methotrexate, and mitomycin C. The drugs were given intraperitoneally on days 7, 14, and 21. The study was repeated using MBT-683. Drug effect on tumor diameter and survival were compared. Cisplatin alone was as effective in MBT-2 and more effective in MBT-683 in reducing tumor volume and increasing survival than the various combinations. The higher tolerable dose of cisplatin used as a single agent probably accounts for these results and suggests that cisplatin is the most effective agent in these combination therapy regimens.

Animals↗
PubMed1987

Bacillus Calmette-Guerin for treatment of superficial transitional cell carcinoma of the bladder in patients who have failed thiotepa and/or mitomycin C.

Thirty patients with stage Ta carcinoma in situ or T1 superficial bladder cancer received 6 weeks of intravesical bacillus Calmette-Guerin. All patients had persistent or recurrent tumor despite thiotepa and/or mitomycin C. Response was determined by the results of endoscopy, bladder wash cytology and biopsy performed 4 weeks after the last dose of bacillus Calmette-Guerin. Of the 30 patients 15 (50 per cent) had a complete response. The likelihood of a complete response was better for those with initial Ta lesions (62 per cent) and carcinoma in situ (56 per cent) than for patients with an initial T1 lesion (25 per cent). Although the longest followup is only 36 months (mean 16 months) patients with a complete response have a much better prognosis in terms of subsequent tumor, need for cystectomy and death of bladder cancer.

Administration, Intravesical↗
PubMed1987

Evaluation and management of patients with superficial bladder cancer.

The outlook for patients with bladder tumors confined to the mucosa or lamina propria has improved. The reasons are several: (1) diagnostic and therapeutic endoscopic instruments continue to improve; (2) pathologists and cytologists are providing more accurate and uniform readings of submitted material; (3) prognostic factors have been identified by cooperative groups; and (4) new effective intravesical agents have been introduced and used. I do not foresee any dramatic advances in the next few years, but I believe that the information gained over the last decade is being widely disseminated. We can hope that this will minimize diagnostic and treatment excesses for patients with little likelihood of progression, reduce the number and frequency of endoscopic resections for those with frequent recurrences, and limit the number of exenterative procedures.

Carcinoma in Situ↗
PubMed1986

Prognostic significance of urine cytology on initial follow-up after intravesical mitomycin C for superficial bladder cancer.

Seventy patients were given courses of intravesical mitomycin C for residual transitional cell carcinoma of the bladder following partial resection or biopsy. The patients were reassessed 3 months after the initiation of treatment by cystoscopy and cytology from cystoscopic urines and bladder washings. Twelve had no visible cancer at cystoscopic study but had positive urine cytologic findings. The incidence of tumor recurrence, cystectomy, radiotherapy, and deaths due to bladder cancer for this group of cytologically positive partial responders was analyzed. Thirty-three percent (4/12) required cystectomy, none underwent radiation therapy and none died of bladder cancer. These outcomes were compared with that of complete responders (negative cystoscopic and cytologic results) and partial responders with visible tumor (reduction by greater than 50%). We conclude that in high-grade carcinomas, particularly carcinoma in situ, positive urine cytologic findings at the initial 3-month follow-up visit following treatment with intravesical mitomycin C is as ominous a prognostic indicator as endoscopic or biopsy evidence of cancer.

Aged↗
PubMed1986

Flow cytometry versus urinary cytology in the evaluation of patients with bladder cancer.

We compared the roles of urinary cytology and flow cytometry in the evaluation of patients with bladder cancer in clinical practice situations at a large general hospital. Specimens included 105 bladder washings from patients being followed for urothelial carcinomas and 28 control washings from individuals undergoing cytoscopy for other reasons. Flow cytometry and cytology were performed on aliquots of the same specimen in all bladder cancer samples. When carcinoma was present at the time of specimen collection it was detected by positive cytology in 75 per cent and deoxyribonucleic acid aneuploidy in 78 per cent of the cases. Combination of flow cytometry and urinary cytology increased the diagnostic yield to 95 per cent. Flow cytometry was slightly more sensitive than urinary cytology for detection of abnormalities in specimens from noninvasive and untreated tumors but the only statistically significant difference between the 2 procedures occurred among specimens from treated invasive cancers in which flow cytometry was a less sensitive method than cytology. Abnormal deoxyribonucleic acid ploidy was documented in a few specimens from noncancer-bearing patients having diseases associated with high urothelial cell turnover rates but the concomitant urinary cytology was negative for neoplasia. When used in conjunction with urinary cytology, flow cytometry was a valuable procedure in the followup of patients with bladder cancer. The diagnostic yield with this combination was such that flow cytometry and cytology may be used to reduce the frequency of cystoscopy and biopsy during clinical management in selected situations.

Aneuploidy↗
PubMed1986

Selective urethrectomy following cystoprostatectomy for bladder cancer.

The poor prognosis in patients who have symptomatic urethral carcinoma after cystoprostatectomy has prompted some investigators to recommend prophylactic urethrectomy. However, this approach subjects the majority of these patients (up to 90 per cent) to an operation for a disease that they might never have and precludes some innovative urinary diversion techniques. From June 1976 to July 1985 we performed 75 cystoprostatectomies for bladder cancer in men. Three patients underwent simultaneous urethrectomy because of tumor in the urethra. Of the remaining 72 patients who were followed by urethral wash cytology studies every 6 months 7 (10 per cent) had positive cytology studies during followup and underwent urethrectomy. Subsequent histological examination showed carcinoma in situ in all 7 specimens. To date 6 of the 7 patients are free of disease. One patient died 18 months after urethrectomy without evidence of transitional cell carcinoma. We have had no false positive urethral wash cytology studies and no patient has had local recurrence in the absence of a positive cytology study.

Adult↗
PubMed1986

Pre-treatment testosterone levels: significance in androgen deprivation therapy.

From June 1982 to February 1985, 53 patients with stage D2 carcinoma of the prostate confirmed by tissue biopsy, elevated prostatic acid phosphatase and a positive bone scan were initiated on androgen deprivation therapy. Before commencement of treatment all patients underwent determination of serum testosterone levels at 8 a.m. Of the patients 23 received 200 mcg. buserelin per day, 17 received 1 mg. diethylstilbestrol 3 times daily, 6 received 40 mg. megestrol acetate 4 times daily, 2 received 1 mg. leuprolide per day and 5 underwent bilateral orchiectomy. Evaluation of the best response in each patient revealed 3 (6 per cent) complete and 17 (32 per cent) partial responses, while 22 patients (41 per cent) remained stable and 11 (21 per cent) had progression. Pre-treatment serum testosterone levels ranged from 150 to 879 ng. per dl. The mean serum testosterone level in patients having a complete response was 524 +/- 18.04 ng. per dl. The mean in the progression group was 279.4 +/- 110.1 ng. per dl. This difference was not statistically significant owing to the large standard deviation in the progression group. However, of the 15 patients who had a pre-treatment serum testosterone level of more than 500 ng. per dl. only 1 (7 per cent) had progression. None of the patients whose pre-treatment testosterone level was less than 200 ng. per dl. had objective tumor regression. Our study suggests that pre-treatment serum testosterone levels may predict the probability of a satisfactory response to androgen deprivation therapy.

Aged↗
PubMed1986

Carcinogenesis in mammalian urothelium: changes induced by non-carcinogenic substances and chronic indwelling catheters.

Carcinogenesis in urinary bladders may not be represented by a continuum of pathological lesions beginning with papillary tumors or flat dysplasias/atypias. In a previous experiment, sterile water and saline continuously infused via catheters connected to ALZA mini-pumps were shown to induce papillary urothelial lesions indistinguishable from tumors considered to be carcinomas in most histological classification schemes. The animals in the initial experiment were followed for relatively brief periods which did not allow for determination of potential reversibility of the process and did not distinguish the effects of the catheters versus those of the infused substances. The present study was designed to control for these variables. Rats were divided into seven groups to examine the urothelial changes after: surgery alone, continuous infusion of the sterile water and mitomycin C, and chronic indwelling catheters with and without infusion. The results indicated that chronic irritation with indwelling catheters was a strong stimulus for the induction of urothelial neoplasms and that continuous infusion of certain substances, even sterile water, might play a small role in the process of carcinogenesis. Comparing the frequencies of papillary urothelial tumors appearing after brief exposure to sterile water and catheters in the initial experiment (75 per cent) and papillary lesions appearing long after removal of the sterile water and catheters in the current study (0 per cent) indicates that these lesions are reversible and probably not neoplastic.

Animals↗
PubMed1986

Treatment of prostatic cancer. Newer forms of androgen deprivation.

The hope of providing a safe alternative to bilateral orchiectomy for patients with prostatic cancer has spurred the development in recent years of various agents capable of reducing androgen level. Another reason for intensifying these efforts relates to the hope held by many clinicians that earlier initiation of androgen deprivation for patients with regional or distant metastases will improve the patient's course. Finally, attempts to provide a more complete androgen blockade hold the hope of delaying or preventing relapse, which usually occurs with continued androgen deprivation.

Androgen Antagonists↗