Archivio italiano di urologia, nefrologia, andrologia : organo ufficiale dell'Associazione per la ricerca in urologia = Urological, nephrological, and andrological sciences最新文献

Metastases in the central nervous system (C.N.S.) from urological tumors can be spinal or craniocerebral. The experience of 30 patients with spinal and craniocerebral metastases from urological tumors admitted to Neurosurgical Clinic of the University of Milan, is reported. They were 7.5% of the all number of metastases admitted at the Neurosurgical Department, during the same period. The brain metastases constitute 10% of brain metastases diagnosed in this period. Only patients with solitary (to CT scan and NMR) metastasis, and with a general prognosis that allow to an adequate and useful period of survival, are submitted to surgical treatment. 23 patients (76.6%) are surgical treated. The mean survival from the discovery of the C.N.S. metastases was 9 months (9.4 months among surgically treated patients and 7.8 months among those were not operated). Surgical mortality was 13%. Out of patients with survival until 5 months, patients submitted to surgical treatment showed a better quality of life. Our results allow us to affirm that in selected patients surgical removal of solitary metastases, could improve the quality of survival, but is not able to prolong substantially the period of survival.

The Authors report their experience about surgical treatment of metastases from renal cell carcinoma. From January 1983 to December 1989, twenty eight patients, 19 males and 9 females, with a median age of 58 years (range 42-79), have been submitted to contemporary or subsequent metastasectomy. Metastases were synchronous in 10 cases, while they appeared after a free disease mean-time of 28 months after nephrectomy in 18 patients. Recovery period has always been normal and all the patients were controlled, every six months, with routine blood and urine examinations, Chest X-ray, abdominal CAT and bone scan. Among the 10 patients with synchronous metastases 5 died, 3 are in progression and 2 are NED after a mean-time follow up of 36 months. Among 18 patients who underwent surgery for metachronous metastases, 2 died, 4 are in progression and 12 NED (mean follow up of 36 months). In conclusion, while the presence of synchronous metastases is an unfavourable prognostic factor even after their surgical removal (8 out of 10 patients died or are in progression shortly after metastasectomy), results after metachronous metastases surgery are encouraging, but the real efficiency of this treatment is still to be confirmed.

The present contribution considers the diagnostic possibilities of radiological imaging procedures in the evaluation of the lymphatic and bloodborne metastases in urological tumors. As regards the evaluation of the lymph node chains the presently available imaging modalities are discussed. For each of them, diagnostic accuracy and the percentage of false positive and false negative readings are presented. For the evaluation of the bloodborne metastases, the available imaging procedures for each organ and site are reported and a diagnostic flow chart is suggested.

Antiblastic chemotherapy of the urological tumors proves to be effective in germ-cell testicular tumor, in bladder cancer and in penis cancer, while a real effective anti-cancer therapy for prostatic and renal cell cancer has not found yet. There is not a significant difference between BVP and BEP regimens as first-line treatments of the good risk germ-cell testicular tumors. On the contrary BEP showed a lower toxicity and an higher efficacy in the treatment of the poor risk patients. Considering salvage therapies, PEI regimen proves to be as the most effective, also in the management of patients pretreated with BEP; high dose chemotherapy with autologous bone marrow transplant is currently examined as third-line therapy. In the treatment of bladder cancer the most effective drugs are Methotrexate, Adriamycin, Vinblastine and Cyclophosphamide, that, when combined, are sensitively more efficacious. The different chemotherapies achieved elevated percentage of Complete and Partial Responses (CR+PR): however these results are maintained in only 10% of the cases. So far the aim of the last studies is to improve the results both with a modification of posology and of the schedule of administration, and with the employ of growth-factors to reduce toxicity. An appreciable improvement in the treatment of locally advanced penis cancer has been achieved employing VBM regimen as adjuvant therapy, especially for patients with extrinsic lymph-nodal metastases, who underwent bilateral inguinal and iliac lymphadenectomy.(ABSTRACT TRUNCATED AT 250 WORDS)

The best knowledge of the biological and genetic mechanism involved in the process of metastasizing must determine the attempt of elaborating new therapeutical modalities. The authors show the sequential events of the metastasizing process based on the most recent theories, underlining the way the organotropism of the neoplastic cells can be the explanation of the otherwise inexplicable metastases.

Renal cancer has an high incidence of metastasizing and its metastases are just a little responsive to chemo and radiotherapy. Because of this, thoracic surgeons began to have experiences on surgical resections of lung metastases from renal cancer. Pulmonary metastases can be isolated or multiple and may appear at the same time of renal cancer discovery or after it, and they generally have a very slow evolution. Authors report their own 15 years old experience on lung metastases from renal cancer resections.

Until now, patients with a progressive prostatic cancer, in whom all therapies failed and the disease spread locally and distally, was considered "a lost patient"; because it did not exist an effective therapy easily to be used. The skeletal pain control is a serious problem and it is a great responsibility also for the Urologists especially if the patient has not a short survival time and the quality of life very poor. Physicians feel the need for a systemic, well tolerated and effective therapy also for a long time, uniform and repeatable, able to be efficient for these patients. Strontium 89 chloride seems to offer all those possibilities and to be the best procedure for Urologist, Radiotherapists and Nuclear Specialists in order to satisfy the patients requirements. International research has shown Sr-89 Chloride is a powerful new therapy. Sr-90 Chloride is a radiopharmaceutical product for the treatment of painful metastases from prostatic cancer. It is a new treatment but its effectiveness is well documented and results are reported in the most important international literature. In our Department a clinical research has started and our purpose is to produce more data for a clinical and biological evaluation of the results hoping that a similar research will extend as a multicenter study.

Advanced prostatic carcinoma shows a high incidence of bone metastases. This is the main cause of clinical problems such as invalidating bone fractions, collapses and consequently of sharp pain syndromes. In these cases the therapy needs to achieve quick relief of symptoms. Radiotherapy, with its large variety of technical options, allows a wide modulation to fit a lot of clinical situations among the most frequent for these patients. A large series of treatment modalities and related indications will be presented and discussed in this work.

Tumor markers are antigens which can be associated with certain malignancies. A variety of markers have been demonstrated in genitourinary tumors. The best known examples are human chorionic gonadotropin (bHCG) and alpha-fetoprotein (AFP) for testicular tumors, prostatic acid phosphatase (PAP) and prostatic specific antigen (PSA) for prostatic cancer. The plasma levels of these substances are influenced by the tumor mass and therefore by the tumor stage. Markedly elevated plasma levels can be demonstrated when metastases are present, although a few patients without metastases may elaborate abnormal amount of markers. The removal of the primary tumor leads to a fall to normal levels: a still increased level indicates residual primary tumor or the presence of metastases. Measurements of markers are also of value in estimating the effects of medical treatment and in detecting local or distant recurrences.

The treatment of the prostatic carcinoma is an open problem. Nowadays the medical and/or endoscopic therapy combines with the surgical therapy by means of the radical prostatectomy. This work presents the experience of the team of Desenzano (BS) and their position, which, in accordance with many authors, underlines the validity of the radical prostatectomy, in those cases of tumor at stage D 1, in order to reduce the progression of the disease and to prolong the survival.