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ABSTRACT: The significance of combination of docetaxel (DTX) with estramustine phosphate (EMP) in castration-resistant prostate cancer (CRPC) patients remains unclear. In this study, we aimed to retrospectively evaluate the efficacy and toxicity of DTX with or without EMP and to elucidate the significance of DTX and EMP combination therapy in Japanese EMP-refractory CRPC patients.
To compare the efficacy and toxicity of DTX and EMP, we divided CRPC patients, who were confirmed to be resistant to EMP, into the following two groups: group D (n = 28), which included patients treated with DTX (60 mg/m2, once in every four weeks) alone, and group DE (n = 33), which included patients treated with a combination of DTX (60 mg/m2, once in every four weeks) and EMP (twice daily oral administration at 280 mg).
Prostate specific antigen (PSA) response (> 50% decline in PSA) was observed in six patients (21%) in group D and eight patients (24%) in group DE. The median time to progression (TTP) was 12.0 months and 6.2 months and the median overall survival (OS) was 26.4 months and 24.3 months in group D and DE, respectively. There was no statistical difference between the two groups in terms of PSA response, TTP, and OS. The incidence of adverse events of grade 3/4 was low in both the groups, and there was no statistical difference between the two groups.
Although treatment with DTX at 60 mg/m2 was effective and highly tolerated in EMP-refractory Japanese CRPC patients, the DTX and EMP combination therapy might not exhibit any survival benefit for CRPC patients.
BMC Urology 02/2012; 12:3. · 1.45 Impact Factor
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ABSTRACT: Sunitinib, an oral multitargeted tyrosine kinase inhibitor, is widely used in the treatment of renal cell carcinoma and gastrointestinal stromal tumor and has had a variety of adverse events. However, sunitinib-related acute cholecystitis has been reported in only two patients with gastrointestinal stromal tumor and renal cell carcinoma (clear cell subtype).
A 75-year-old Japanese woman with a right sided abdominal swelling was referred to our hospital. Computed tomography (CT) showed a hypervascular bulky tumor in her right kidney, suggesting right renal cell carcinoma in clinical T4N0M0. Although sunitinib therapy was started as neoadjuvant chemotherapy, during the fourth week of the first cycle, she developed acute acalculous cholecystitis and disseminated intravascular coagulation associated with sunitinib. Sunitinib therapy was discontinued immediately and she recovered after subsequent treatment with antibiotics and gabexate mesilate followed by percutaneous cholecystostomy. Cholecystectomy and right radical nephrectomy were performed and pathological examination showed that her renal tumor was a chromophobe renal cell carcinoma (pT2) with necrosis. Inflammation and ischemia were observed in the gallbladder wall, which was compatible with acute acalculous cholecystitis. There has been no evidence of disease recurrence for more than six months.
We described the third case of sunitinib-related acute cholecystitis in a patient with chromophobe renal cell carcinoma. Attention is required to sunitinib-related acute cholecystitis which, while uncommon, could be life-threatening.
Journal of Medical Case Reports 02/2012; 6:69.
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ABSTRACT: To examine the outcome and risk factors of biochemical failure (BCF) in Japanese prostate cancer (PCa) patients treated with adjuvant radiotherapy (RT) after radical prostatectomy (RP).
In this study we enrolled 83 Japanese patients having clinically organ-confined PCa without neoadjuvant treatments who received conventional RT (60 Gy) after RP. All patients had extracapsular extension (ECE) and/or positive surgical margin (PSM) of the RP specimens, but no lymph node metastasis. The disease-specific, clinical failure-free, and BCF-free survivals were analyzed. Furthermore, the risk factors affecting the BCF-free survival were examined in detail.
The 5-year disease-specific, clinical failure-free, and BCF-free survival rates were 100, 99, and 87%, respectively. The clinicopathological factors associated with BCF were seminal vesicle invasion (SVI) (p = 0.024), perineural invasion (PNI) (p = 0.03), and pre-RT prostate-specific antigen (PSA) (p = 0.014). In the patients with PSM (n = 59), the entire surgical margin-positive patients had a significantly higher risk of BCF than the focal surgical margin-positive patients (p = 0.015). Multivariate analysis showed that SVI and pre-RT PSA were independent prognostic factors of BCF (p = 0.0142, p = 0.0225, respectively). 22% of our patients had only low-grade adverse effects.
The outcome of adjuvant RT after RP in the Japanese patients with ECE and/or PSM was excellent, and the adverse effects were mild and tolerable. However, the patients with SVI, PNI, entire surgical margin-positive specimens, or high pre-RT PSA had poor biochemical control by only adjuvant RT after RP.
Urologia Internationalis 03/2010; 84(4):382-7. · 0.99 Impact Factor
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ABSTRACT: A 66-year-old Japanese man with pulmonary metastases of renal cell carcinoma found 8 months after radical nephrectomy was treated with interferon-alpha and tegafur-uracil. Since it failed to achieve tumor responses resulting in progression, he was given interferon-alpha and capecitabine. After 2 courses of combination therapy with IFN-alpha and capecitabine, significant tumor responses were obtained; two out of four pulmonary metastatic sites disappeared completely, one site showed over 50% decrease in size, and the remaining one site did no change in size. The regimen was well tolerated and toxicity observed was World Health Organization grade 1 anorexia. His disease status was maintained as stable disease by the repeated treatment with interferon-alpha and capecitabine for 17 months after tumor responses were obtained. However, tumor progression was observed thereafter. He is at present under treatment with sorafenib. This is the first case report of metastatic renal cell carcinoma, which showed different responses to two types of 5-fluorouracil prodrugs in combination with interferon-alpha, suggesting the biochemical modulation of capecitabine by interferon-alpha as a possible mechanism underlying the antitumor effect of the combination of interferon-alpha and capecitabine at the clinical setting. Present case also suggests that a combination of tumor-selective capecitabine with interferon-alpha is a potentially useful therapeutic option in metastatic renal cell carcinoma.
Cases Journal 01/2009; 2:6567.
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ABSTRACT: It gives important information in selecting the appropriate treatment for urolithiasis to confirm the component of urinary calculus. Presently component analysis of the urinary calculus is generally performed by infrared spectroscopy which is employed by companies providing laboratory testing services in Japan. The infrared spectroscopy determines the molecular components from the absorption spectra in consequence of atomic vibrations. It has the drawback that an accurate crystal structure cannot be analyzed compared with the X-ray diffraction method which analyzes the crystal constituent based on the diffraction of X-rays on crystal lattice. The components of the urinary calculus including carbonate are carbonate apatite and calcium carbonate such as calcite. Although the latter is reported to be very rare component in human urinary calculus, the results by infrared spectroscopy often show that calcium carbonate is included in calculus. The infrared spectroscopy can confirm the existence of carbonate but cannot determine whether carbonate is originated from carbonate apatite or calcium carbonate. Thus, it is not clear whether calcium carbonate is included in human urinary calculus component in Japan. In this study, we examined human urinary calculus including carbonate by use of X-ray structural analysis in order to elucidate the origin of carbonate in human urinary calculus.
We examined 17 human calculi which were reported to contain calcium carbonate by infrared spectroscopy performed in the clinical laboratory. Fifteen calculi were obtained from urinary tract, and two were from gall bladder. The stones were analyzed by X-ray powder method after crushed finely.
The reports from the clinical laboratory showed that all urinary culculi consisted of calcium carbonate and calcium phosphate, while the gallstones consisted of calcium carbonate. But the components of all urinary calculi were revealed to be carbonate apatite by X-ray diffraction. The components of gallstones were shown to be calcium carbonate (one calcite and the other aragonite) not only by infrared spectroscopy but by X-ray diffraction.
It was shown that component analysis of the calculus could be more accurately performed by adding X-ray diffraction method to infrared spectroscopy. It was shown that calcium carbonate existed in a gallstone. As for the carbonate in human urinary calculi, present study showed that it was not calcium carbonate origin but carbonate apatite origin.
Nippon Hinyōkika Gakkai zasshi. The japanese journal of urology 10/2008; 99(6):681-7.
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ABSTRACT: We describe a patient with tuberous sclerosis complex and massive bilateral renal angiomyolipomas (AMLs) in association with pulmonary lymphangioleiomatosis, who experienced hemorrhagic shock because of rupture of the left renal AML. She was treated with transarterial embolization, followed by bilateral nephrectomy. The total tumor burden weighed 5800 g, making it the largest AML by weight in published reports. The histopathologic examination revealed concurrent oncocytomas with AMLs in the right kidney, indicating a possible shared mechanism in the pathogenesis of these two disorders. This case also represents a rare, but significant, overlap between renal AML, pulmonary lymphangioleiomatosis, and tuberous sclerosis complex.
Urology 06/2008; 72(4):948.e7-9. · 2.43 Impact Factor
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ABSTRACT: We describe a unique case of chronic glomerulonephritis that simulated a renal neoplasm observed on abnormal imaging. Histologic examination of the resected specimen supported the assumption that the observed mass lesion resulted from regional sparing in the development of chronic glomerulonephritis. We believe this case is the first to show the etiology of pseudotumor as an extremely uncommon manifestation of chronic glomerulonephritis by histologic examination.
Urology 04/2008; 72(2):461.e15-7. · 2.43 Impact Factor
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ABSTRACT: We have treated 8 patients with metastatic renal cell carcinoma for whom prior immunotherapy proved uneffective. The patients consisted of 6 males and 2 females, with a median age of 68 years. One patient had a primary site in place and 5 patients had multiple organs involvement. The chemotherapy consisted of gemcitabine 1,000 mg/m(2) div at day 1, 8 and capecitabine 1,657 mg/m(2)/day p.o. at day 1-14, followed by a week rest period. Then, the regimen was repeated every 3 weeks. No treatment response was observed. There were two SD, three SD to PD, and two PD after a median of 3 cycles of treatment. The median time to disease progression was 9.1 months, and the one-year progression- free survival rate was 83%. Adverse effects were observed in 3 cases (37.5%), however, treatment was well tolerated. Despite the limited anti-tumor efficacy, it would be meaningful that the treatment brought disease stabilization to the majority of this group of patients.
Gan to kagaku ryoho. Cancer & chemotherapy 03/2008; 35(2):277-9.
