Harry W. Herr

Cis-Diamminedichloride Platinum II in the Treatment of Abvanced Bladder Cancer

There were 21 patients with advanced, measurable bladder cancer who were treated with cis-diamminedichloride platinum II. Of the 21 patients 3 (14 per cent) achieved a complete response that persisted for more than 1 year, while 6 (29 per cent) achieved a partial remission for an average duration of 5.7 months. Responses to cis-diamminedichloride platinum II were noted shortly after administration of the drug. After the initial response no additional benefit of cis-diamminedichloride platinum II was observed after 9 weeks (third dose). Despite the fact that cis-diamminedichloride platinum II was tolerated reasonably well by the majority of patients and that there were 3 cases of long-term remission cis-diamminedichloride platinum II appears limited to induction of a response in patients with advanced bladder cancer rather than for long-term maintenance therapy.

Peripheral neuropathy associated with cis‐dichlorodiammineplatinum (II) treatment

Peripheral neuropathy developed in two cases of recurrent bladder carcinoma treated with Cis‐dichlorodiammineplatinum (II) (DDP) at a dose of 75 mg/m2 IV every 3 weeks. The neuropathy appeared in both patients while they were achieving a subjective and objective response to DDP. The neuropathy was reversible in one patient. In the other patient, a disabling sensory neuropathy progressed despite cessation of therapy. The temporal relationship between the neurological symptoms and the administration of DDP implicate this drug as the possible causative agent in the peripheral neuropathy.

Malignancy in uremia: dialysis versus transplantation.

The incidence of cancer was compared in 499 dialysis patients and 121 renal transplant recipients. De novo malignancy developed in 15 patients on chronic dialysis (3 per cent) and in 6 transplant recipients (4.9 per cent), a significant increase over the expected number in the age-matched general population. There was no difference in the incidence of cancer in uremic patients on dialysis or after transplantation. A total of 10 dialysis patients (67 per cent) and 1 transplant patient (16 per cent) died of cancer. Neoplasms in the dialysis patients were the common types of mesenchymal tumors, while superficial skin cancers were seen more frequently in the transplant recipients. The differences in tumor types accounted for the higher mortality rate from cancer in the dialysis patients and may reflect different patterns of immunosuppression in these 2 patient populations.

Intermittent catheterization in neurogenic bladder dysfunction.

Experience with intermittent catheterization in 449 patients with traumatic cord bladder during a 9-year period is presented. There were 317 patients who were discharged from the hospital free of the catheter and maintain balanced bladder function on long-term followup. Of these catheter-free patients 45 per cent have sterile urine at any one time. Intermittent catheterization is the method of choice to establish a catheter-free state and reduce infection among spinal cord injury patients. It is a useful conservative method in long-term therapy of patients with non-traumatic neurogenic bladder dysfunction.

Radiation-induced sarcoma following radiotherapy for testicular tumor

We report 4 cases of soft tissue sarcoma following radiation therapy for testicular tumor. The tumors included leiomyosarcoma, fibroxanthosarcoma, reticulum cell sarcoma and spindle cell sarcoma. Each malignancy arose within the irradiated area after a long latent period (mean 12 years) and each was histologically proved. Total radiation doses ranged from 3,500 to 9,000 rad. Three patients died as a result of the second neoplasm. Radiation-induced sarcomas are rare but must be considered in the differential diagnosis of new tumor growth in patients treated previously with radiotherapy. Full evaluation of such new tumor growth, including tissue diagnosis, is necessary before additional therapy is prescribed.

Complications of pelvic lymphadenectomy and retropubic prostatic 125I implantation

Pelvic lymphadenectomy was accomplished in 75 patients with localized prostatic cancer at the time of retropubic prostatic implantation with iodine-125. Twelve (16 per cent) surgical complications were encountered in 11 patients and included 1 death. Late complications which persisted six months or longer occurred in 5 (8 per cent) of 61 patients. The most serious and as yet unquantitated complication appears to be pelvic vein thrombosis and pulmonary emboli. PELVIC LYMPHADenectomy may be accomplished safely and with minimal morbidity in the vast majority of prostatic cancer patients.

Preservation of sexual potency in prostatic cancer patients after pelvic lymphadenectomy and retropubic 125I implantation.

Sexual histories were obtained from 51 patients (average age 67.7 years) with prostatic cancer and their spouses before and after pelvic lymphadenectomy and retropubic 125iodine implantation. Sexual potency was retained in 40 of the 41 patients who were sexually active preoperatively. Ten patients were sexually inactive preoperatively: 4 with diminished potency and 6 with complete erectile impotence. Sexual dysfunction was most often psychogenic in origin. At 6 months 5 of these patients had resumed satisfactory sexual intercourse as a result of reassurance, encouragement and education of remaining sexual potential. No patient suffered complete erectile impotence as a result of the procedure.

Idiopathic Retroperitoneal Fibrosis Misinterpreted as Lymphoma by Computed Tomography

Two cases of idiopathic retroperitoneal fibrosis that were mistaken for lymphomas on a computed tomography scan are presented. The similar densities and anatomical appearances on cross section scans of these diseases probably account for this misinterpretation.

Cyclophosphamide, Methotrexate and 5-Fluorouracil Combination Chemotherapy Versus Chloroethyl-Cyclohexy-Nitrosourea in the Treatment of Metastatic Prostatic Cancer

In a prospective, randomized study the effect of cyclophosphamide, methotrexate and 5-fluorouracil combination chemotherapy was compared to the single agent, chloroethyl-cyclohexy-nitrosourea, in the treatment of hormonally refractive metastatic prostatic carcinoma. All patients could be evaluated and were followed for at least 2 years or until death. Responses were defined by the National Prostatic Cancer Project criteria. Of 20 patients who received cyclophosphamide, methotrexate and 5-fluorouracil 3 (15 per cent) had partial (median duration of 2.5 months), 4 (20 per cent) had stable (median duration of 5 months) and 13 had progression of the disease. Of 20 patients who received chloroethyl-cyclohexy-nitrosourea none had a partial response, 6 (30 per cent) had stability (median duration of 6.2 months) and 13 had progression of the disease. The over-all response rate for patients receiving cyclophosphamide, methotrexate and 5-fluorouracil was 35 per cent (stable plus partial regressions) and it was 30 per cent for those receiving chloroethyl-cyclohexy-nitrosourea (stable only). Subjective improvement was noted in all 7 patients who responded to combination chemotherapy and in 3 of the 6 patients who responded to the single agent. After 2 courses resistant patients were crossed over to the opposite regimen and none had an objective, stable or subjective response. Although the duration of response was short (2 to 6 months) patients with partial regressions or stabilized disease survived longer (p less than 0.05) than patients whose disease progressed (52 versus 24 weeks, respectively). The mean interval from diagnosis to chemotherapy (lead time) was 40 months for patients who responded to chemotherapy compared to 19 months for those with progression, which suggested a slower growing pattern of disease in those who did respond. There was no improvement in cohort survival with either treatment regimen. Over-all response rates to cyclophosphamide, methotrexate and 5-fluorouracil were not superior to reported responses to cyclophosphamide alone, and both treatment regimens appeared to be only marginally effective in the treatment of endocrine-resistant, advanced prostatic cancer.

Orbital metastases from prostatic carcinoma

Abstract Orbital metastases from prostatic cancer is rare. Herein we present 4 patients with metastatic carcinoma involving the orbit. Metastatic carcinoma of the prostate should be considered in the elderly male with proptosis.