[Chemotherapy of urothelial tumors of the bladder].
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Antineoplastic Combined Chemotherapy Protocols↗
Biomedical subjects
S Culine
Publications and source records attributed to S Culine.
[Prognostic factors for extratesticular involvement in stage I testicular cancer. Apropos of 58 cases].
To assess prognostic factors for extratesticular involvement in patients with testicular stage I non seminomatous germ cell tumors, we retrospectively studied the clinical and histological features of 58 patients treated at Institut Gustave-Roussy. Twenty-four patients were followed after orchiectomy alone, and 34 patients underwent an initial subsequent retroperitoneal lymphadenectomy. Nineteen patients (33%) experienced an extratesticular involvement after a mean follow-up period of 40 months. All relapses occurred during the first year of follow-up. Disease-free survival at one year was 64% and overall survival was 100%. The clinical and histological features studied were: age, AFP and HCG serum levels before orchiectomy, tumor size, TNM stage, histologic type with the corresponding percentage, venous and lymphatic involvement. The detection of metastasis at lymphadenectomy or during the follow-up after orchiectomy was the single criteria for prognostic factor research. Venous and/or lymphatic involvement as well as a high percentage of embryonal carcinoma component turned out to be the two independent significant prognostic factors which predict extratesticular involvement.
Adult↗
[Carcinoma in situ of the testis].
Carcinoma in situ of the testis is a pre-invasive lesion that precedes the development of all germ cell tumors except spermatocytic seminoma. The pathological, epidemiological, biological and therapeutic aspects of this entity are reviewed.
Adolescent↗
[Primary, highly malignant B-cell lymphoma of the prostate. Apropos of a case and review of the literature].
We report a case of prostatic non Hodgkin lymphoma arising in a 61-year-old man. The treatment consisted of a chemotherapy with cyclophosphamide, adriamycine, vincristine and prednisone (CHOP regimen). A complete remission histologically proved was obtained. The literature and the treatment approach of prostatic lymphomas are reviewed.
Antineoplastic Combined Chemotherapy Protocols↗
[Value of mono-antibiotic therapy using piperacillin associated with sulbactam and possibly followed by vancomycin in febrile neutropenia in solid tumors].
We evaluated the efficacy and safety of a monotherapy by piperacillin and sulbactam potentially associated to vancomycin as an empiric antimicrobial therapy in febrile neutropenic patients treated with nephrotoxic chemotherapy for solid tumors. Twenty-three patients were treated during 32 episodes with piperacillin 4 g i.v. every 8 hours and sulbactam 1 g IV every 8 hours. If the patient remained febrile after 48 hours, 1 g of vancomycin i.v. was added every 12 hours as indicated by our study design. The mean duration of neutropenia was 5.5 days (2-13 days). In ten episodes, the granulocyte nadir was < 100/mm3. Infection was microbiologically documented in seven episodes (22%) with six Gram negative bacilli and 3 Gram positive cocci. There were 19 apyrexia with piperacillin and sulbactam (59%) and further seven were resolved by the addition of vancomycin (total success: 81%). Failure was observed in six episodes consecutive to germ resistance (one episode), clinical deterioration (one episode), relapsing fever related to Pseudomonas infection (one episode), persistent fever despite withdrawal of neutropenia and no microbiological documentation (two episodes) and protocol violation (one episode). Neither septic death nor toxicity were observed. We conclude that this empirical treatment is active and safe in short period febrile neutropenic episodes in patients heavily treated with nephrotoxic chemotherapy for solid tumors.
Adolescent↗
[Liposarcoma of the spermatic cord: apropos of a case with review of the literature].
We report a case of spermatic cord liposarcoma in a 72-year-old man. Local disease progression was observed in spite of multinodal treatment, including repeated wide surgical excision, radiotherapy and chemotherapy. The literature and the treatment modalities of spermatic cord liposarcomas are reviewed.
Aged↗
[Efficacy of the combination of 5 fluorouracil, adriamycin and cisplatin (FAP protocol) in the treatment of metastatic cylindroma. Apropos of a case with review of the literature].
We report the case of a 43 year-old woman who was submitted to a complete surgical resection of an Adenoid Cystic Carcinoma (ACC) of the submandibular salivary gland which was associated with diffuse lung metastases. Combination chemotherapy with fluoro-5-uracil, adriamycin, and cisplatin (FAP) induced an almost complete disappearance of the chest lesions. The literature about ACC and its chemotherapy is reviewed.
Adult↗
[False multiple coin lesions in prostatic cancer under hormone therapy].
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Adenocarcinoma↗
High-dose continuous-infusion fosfestrol in hormone-resistant prostate cancer.
BACKGROUND: The initial treatment of advanced-stage prostate cancer is total androgen deprivation. Autonomous proliferation of primarily or secondarily hormonal unresponsive cells may explain the development of hormone-refractory status. The median survival of patients with hormone-resistant disease is short; there is no standard regimen of chemotherapy. METHODS: Fosfestrol or diethylstilbestrol diphosphate and its metabolites have cytotoxic activity in hormone-refractory prostatic cell lines. Pharmacokinetic studies have shown that fosfestrol metabolites have a short half-life that supports the use of long-term infusion in the clinic. RESULTS: A review of the literature shows that high-dose fosfestrol induces no objective response, a greater than 50% tumor marker decrease in 50% of patients, a subjective improvement in 75% of patients, and cardiovascular complications in 5% of patients. The median survival time of patients is 5 months after the onset of treatment. CONCLUSIONS: An exact evaluation of the role of high-dose estrogens requires additional investigation.
Aged↗
The growing teratoma syndrome: a woman with nonseminomatous germ cell tumor of the ovary.
A 38-year-old woman underwent an incomplete surgical excision of multiple peritoneal nodules from nonseminomatous germ cell tumor of the ovary. Tumor markers normalized with combination chemotherapy but contrasted with abdominal node enlargement. Surgical resection failed to remove abdominal masses completely and histologic examination revealed mature teratoma without malignant cells. Nodules continued to grow, infiltrating the liver parenchyma and causing small bowel necrosis and urinary tract obstruction. According to the literature, this female patient presents the typical features of the growing teratoma syndrome. This syndrome was described in treated nonseminomatous germ cell tumors of the testis. Moreover, this patient had an unexpected very high CA 19-9 level. Treatment by low-dose interferon-alpha-induced a subjective improvement and a slight decrease in the size of teratomatous cysts.
Adult↗
Penile cancer chemotherapy: twelve years' experience at Institut Gustave-Roussy.
Between 1980 and 1992, 14 patients (median age 50 years) with penile carcinoma were treated with multidrug combination chemotherapy in our institution. Twelve patients had Stage IV (Jackson classification) tumor, 1 patient each had Stage III and Stage II. All patients received cisplatin-based chemotherapy. Cisplatin was associated with either 5-fluorouracil (4 patients), methotrexate and bleomycin (4 patients), methotrexate (3 patients), Adriamycin (1 patient), bleomycin and vinblastine (1 patient), or bleomycin and epirubicin (1 patient). Thirteen patients were evaluable for response. Objective response was encountered in 2 patients (15%) with 1 complete response and 1 partial response. Response duration was difficult to determine because of additive radio-therapy or patient was lost to follow-up. There were 2 patients with long-term evidence of no disease among 12 patients with Stage IV disease. These 2 patients received complementary irradiation in association with the chemotherapy. The response rate was dismal in our series. Methotrexate-based regimens seem to be the most active. The bimodality treatment with multidrug chemotherapy and radiotherapy for advanced penile cancer could offer a survival advantage in the management of these patients.
Adult↗
High failure rate of carboplatin-etoposide combination in good risk non-seminomatous germ cell tumours.
24 patients with good risk non-seminomatous germ cell tumours (GR-NSGCT) were enrolled in a phase II trial combining carboplatin (C) and etoposide (E). Carboplatin was given at a fixed dose of 450 mg/m2 at d2, and E 120 mg/m2, dl-3, every 4 weeks x 4 cycles (cy). Myelosuppression was the major toxicity with neutropenia grade 4 in 18 cy (19%) and grade 3 in 26 cy (27%). Thrombocytopenia grade 3 and 4 occurred in 7 and 1 cy, respectively. Responses included: 20 complete responses (CR) (83%) with 16 clinical CR and 4 pathological CR; 3 additional patients had complete surgical removal of residual disease (SRRD) with viable tumour (surgical CR); 1 patient progressed during C+E therapy. 5 of the 16 clinical CR relapsed, and all the 3 surgical CR progressed despite post-operative salvage chemotherapy. Adverse events occurred in 9 patients (37.5%; 95% C.I., 19-59%). After a median follow-up of 24 m (range 14 to 38) 4 patients had died [3 progressive disease (PD), 1 suicide while in CR], 3 were alive with PD, and 17 had no evidence of disease. No significant correlation between area under the curve values of carboplatin, overall treatment failure and the platelet nadirs was observed. We conclude that the efficacy of the C+E regimen as given in our protocol is inferior to the standard cisplatin-containing regimens. The low dose-density (D/I) of carboplatin could be responsible for the high failure rate.
Adolescent↗
Paratesticular rhabdomyosarcoma in adult patients: 16-year experience at Institut Gustave-Roussy.
BACKGROUND: Children with paratesticular rhabdomyosarcoma (RMS) have both a good prognosis and a high survival rate. The clinical behaviour and outcome of the disease in adults is not well described. PATIENTS AND METHODS: We reviewed retrospectively our experience with paratesticular RMS in patients older than 16 years during a 16-year period (1975-1991). RESULTS: Thirteen adult patients with paratesticular RMS are reported. Median age was 21 years (range 16 to 31). Presentation characteristics were scrotal mass in 11 cases, lumbar pain and weight loss in 5 cases, hypercalcemia in 3 cases and thrombocytopenia in 3 cases. There were 5 patients with stage IV, 2 with stage IIB and 6 with stage IA (IRS classification). The 5 stage IV patients are reported in detail, with initial bone marrow infiltration encountered in 4 of them. Objective response to chemotherapy was achieved in all 6 patients with measurable disease (2 CR + 4 PR). Two of 7 patients who received adjuvant chemotherapy relapsed at 7 and 11 months. After a median follow-up of 90 months, 8 patients (5 stage IV, 3 stage IA) died from disease progression. CONCLUSION: Metastatic disease with bone marrow involvement at presentation and aggressive behaviour seem to be more relevant in adult paratesticular RMS patients compared with children.
Adolescent↗
Second-line M-VAC therapy in patients previously treated with the M-VAC regimen for metastatic urothelial cancer.
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Aged↗
Prognostic factors in non-seminomatous germ cell tumours of the testis. Experience at the Institut Gustave-Roussy.
The original prognostic model in non-seminomatous germ cell tumours of the testis at the Institut Gustave-Roussy was updated in a larger patient population. As in the former model human chorionic gonadotrophin (hCG) and alpha-feto-protein (AFP) serum concentrations attained prognostic significance in the multivariate analysis. We studied two important issues in this patient population: the impact of expressing hCG values in mass units and of the introduction of etoposide-containing chemotherapy. Etoposide has a major impact on the determination of the prognostic group limits which are considerably increased. It is, thus, suggested to reevaluate prognostic models in patient populations treated by modern chemotherapy regimens.
Antineoplastic Combined Chemotherapy Protocols↗
[Promising results of bimonthly chemotherapy with high dose cyclophosphamide and epirubicin in induction treatment of inflammatory cancer of the breast].
Forty-eight patients with inflammatory breast cancer were treated by an induction regimen with cyclophosphamide (1200 mg/m2), and epirubicin (75 mg/m2). Four to six courses were given every two weeks, whatever the absolute leukocyte counts, before mastectomy, loco-regional radiation, and conventional, or reinforced, for selected patients, chemotherapy. Main toxicity was leukopenia, with grade IV in 25% of cases. However, febrile neutropenia was rare, and relative dose intensity was 102% after four courses, and 97% after six courses. Complete disappearance of inflammatory signs was observed in 90% of patients. Three patients had a pathological complete response, and ten patients had negative axillary lymph nodes. Furthermore, 13 patients had a major pathological response. With a median follow-up of 42 months, progression-free survival and overall survival are 48% and 66%, respectively.
Adolescent↗
A CD2+ subset of non-malignant peripheral blood lymphocytes from patients with Sézary syndromes overexpress the low-molecular-weight GTP-binding protein Rab2.
The Rab branch of the Ras-related GTP/GDP-binding proteins currently includes at least 25 related members which are involved in the intracellular vesicular transport along the secretory and endocytic pathways in eukaryotic cells. The overexpression of the Rab2 protein in peripheral mononuclear cells is demonstrated from 13 out of 17 patients exhibiting a Sézary syndrome. Moreover, this phenomenon is detectable in other lymphoid and myeloid malignancies. Several lines of evidence are shown suggesting that the Rab2 overexpression can be related not to leukemic cells but to a subset of peripheral lymphocytes with a CD2+ phenotype. Our results provides strong evidence for the implication of a small GDP/GTP-binding protein in immunological events associated with neoplastic states. The precise cellular population involved in this process remains to be determined.
Antigens, Differentiation, T-Lymphocyte↗
[High dose fosfestrol in phase I-II trial for the treatment of hormone-resistant prostatic adenocarcinoma].
Androgen deprivation displays the mean therapy of advanced stage prostatic cancer, independently of palliative radiotherapy. The evolution to hormone-resistance status leads to a fatal tumor progression. High-dose fosfestrol (diethylstilbestrol diphosphate) has been suggested to circumvent hormone-resistance and to induce a direct cytotoxic effect. Sixteen patients with hormone-resistant prostate cancer were treated by continuous infusion of high-dose fosfestrol according to two schedules: 10 patients were included in a phase I trial of a daily escalating dose from 1.5 g/d to 4.5 g/d for 7 to 10 days. Six other patients were uniformly treated by 4 g/d for 3.5 h for 5 days. Between each course, patients received orally 300 mg/d fosfestrol and 200 mg/d salicylic acid. The mean age was 65 years (range 51-75). Mean number of courses was two (extremes 1-7). Toxicities: reversible weight gain was observed in five patients. One patient presented a pulmonary edema which was resolved immediately after diuretics. One patient and 9 patients respectively experienced grade III and II (OMS) nausea and vomiting. Transient perineal pruritus occurred in 5 patients. Responses: 15 patients were evaluable (one early death occurred on day 3 from tumor progression complicated by an intravascular coagulation disease). There were four objective stabilizations (NPCP criteria) lasting 2 m, 2 m, 5 m and 10 m respectively. Subjective improvement of pain was observed in five other patients. There was more than 50% reduction of PSA in eight patients. High-dose fosfestrol seems to have some objective activity with moderate toxicity and warrants further investigation.
Adenocarcinoma↗