Becht E

Conservative surgery of renal cell carcinoma.

From 1967 to 1985 conservative surgery (enucleation, n = 49; partial resection, n = 7) was performed for renal tumors in 57 patients (age 31-77, mean 54.8 years). Imperative indications for conservative surgery (n = 29) were chronic renal failure, benign pathology of contralateral kidney, functional or anatomical solitary kidney, and bilateral tumors. Elective conservative surgery (n = 28) was done for small, peripherally located lesions, in cases of uncertain malignancy and in one tumor detected by chance during stone surgery. Tumors removed for imperative indications were 2-11 cm (mean 5.8 cm) in size. In the elective group, tumor size ranged from 1 to 7 cm (mean 3.3 cm). Follow-up was 6-103 months (mean 35.8 months). In the group with imperative indications, there was 1 postoperative mortality; 18 of 29 patients are alive without evidence of disease, 2 with metastases, and 2 were reoperated conservatively for local recurrences; 1 was lost to follow-up, 2 died of metastases, and 3 died due to unrelated reasons. In the elective group all 28 patients are living free of cancer.

Tumor-specific monoclonal antibodies for renal cell carcinoma.

Monoclonal antibodies, tumor-specific for renal cell carcinoma (RCC), were produced in Balb/C mice, hyperimmunized with tumor cell suspensions from a histological grade II tumor. Boosting with lectin-immobilized tumor-antigen rendered high yields of specific antibody-producing hybrids. Hybridoma supernatants were screened for specificity using a solid-phase enzyme-linked immunoassay. Testing in parallel for reactivity with tumor tissue and corresponding autologous normal kidney material, only those hybrids producing antibodies exclusively reactive with RCC were propagated, resulting in 4 stable, highly productive subclones. Using the immunoperoxidase staining technique, tissue sections from 97 different RCC specimens and corresponding normal kidneys were evaluated for reactivity with the monoclonal antibodies. Over 90% of RCC were strongly positive, whereas normal kidney tissue did not react. Other normal human organ sections, including pancreas, liver, lung, stomach, small intestine, spleen, lymph node, arteries, veins, skeletal muscle, heart, skin and fetal tissues were negative for tumor-associated antigens. Mucous substances and Panets granular cells in colon mucosa showed nonspecific binding suppressible by addition of normal human serum. Adenocarcinoma of the stomach, colon, pancreas or breast did not demonstrate cross-reactivity with the antibodies to RCC. These monoclonal antibodies apparently recognize a tumor-associated antigen possibly specific for RCC. They could prove to be potent tools in the search for specific tumor markers applicable in the early diagnosis of the disease and immunotargeting cancer therapy.

Active immunotherapy of stage IV renal cell cancer using autologous tumor cells

SummaryA total of 53 patients with stage IV renal cell carcinoma were treated by vaccination with autologous tumor cells in Candida-antigen after palliative tumor nephrectomy. Follow-up has been up to 9 years. Complete remission within 48 months after nephrectomy was observed in 3 patients, while 6 showed partial remission and 18 are stable with disease. Of 26 patients with rapid progression, 17 died within 1 year after operation. The best response was seen in metastases to the liver and lung. CNS-lesions or bone metastases do not appear to respond to this treatment. We conclude that this mode of therapy is beneficiary to a certain group of patients and should be offered, as no severe side effects have been observed so far. Whether new perspectives of adoptive immunotherapy using tumor-specific monoclonal antibodies or recombinant interferons will prove effective remains to be seen.

Local excision of urothelial cancer of the upper urinary tract

In 9 of 93 patients (9.7%) with urothelial cancer of the upper tract (7 renal pelvis tumors, 3 ureteral tumors), conservative surgery was employed using a free peritoneal autotransplant for replacement of the renal pelvis in 5 kidneys. Absolute indications for conservative surgery were solitary kidneys/nonfunctioning contralateral kidneys in 4 patients and bilateral tumors in 1 patient. Local recurrences developed 1-3 years after operation in 4 of 6 kidneys (3 patients), 3 of which had grade-2 and grade-3 primary lesions. All patients were treated successfully by repeated local excision. In the presence of a normal contralateral kidney, local tumor excision was done electively in 4 patients (3 low-grade/low-stage lesions, 1 high-risk patient), none of these patients developed recurrences. Two patients died without evidence of tumor recurrence, 7 patients are free of tumor at an average follow-up of 23 months (range 5-65 months). Local excision of urothelial cancer should be considered not only for solitary kidneys, bilateral tumors and cases with renal failure, but also for low-stage/low-grade localized tumors, leaving the patient better prepared for later treatment of a possible recurrence due to the well recognized chance of a multiplicity of tumors in time and space.

Effect of lectins on KK-47 bladder cancer cell line.

The effect of three lectins, Ricinus communis agglutinin (RCA II), concanavalin agglutinin (ConA), and wheat germ agglutinin (WGA), on KK-47 bladder cancer cell line was studied, RCA II showed effective inhibition of H3-uridine and H3-thymidine uptake by KK-47. ConA showed a stimulatory effect in all three concentrations used. WGA also showed stimulatory effect, but it was less pronounced than ConA.

In vitro chemosensitivity testing of renal cell cancer Short-term culture technique

In an attempt to solve the problem of chemosensitivity testing of renal cell carcinoma in vitro, a modified short-term culture technique was developed. The kinetic study of hypernephroma cells and normal renal cells showed that the uptake of H3-uridine and H3-thymidine is at its maximum after eighty hours. The effect of doxorubicin, cisplatinum, vinblastine, and mitomycin C in different concentrations was tested. Tumors generally showed more resistance than sensitivity. Some tumors showed sensitivity to one or more drugs, but no one drug was persistently effective in all tumors. Our short-term culture technique solved the discrepancy between cell kinetics and test duration found in the Volm test and the problem of nongrowth in the clonogenic assay.

Effect of lectins on 3H-uridine and 3H-thymidine uptake by cultured renal cell carcinoma and normal renal cells.

The effect of lectins on cultured renal cell carcinoma and normal renal cells was studied. Ricin II showed effective inhibition of 3H-uridine and 3H-thymidine uptake by renal cell carcinoma and normal renal cells in all cases. Normal renal cells were more resistant to the inhibitory effect of ricin II as compared to renal cell carcinoma. Concanavalin agglutinin and wheat germ agglutinin led to stimulation of 3H-uridine and 3H-thymidine uptake by renal cell carcinoma and normal renal cells at low concentrations (0.2 micrograms/ml), and to suppression at high concentrations (2 and 20 micrograms/ml).

In vitro chemosensitivity testing of KK-47 bladder cancer cell line: a short-term culture technique.

We present our modified technique of short-term culture assay. As an experimental set-up we used the KK-47 bladder cancer cell line for chemosensitivity testing. The technique is very easy and requires only 3 days. The results were found to be reproducible.