K.-J. Klebingat

Gemcitabine and radiotherapy in the treatment of brain metastases from transitional cell carcinoma of the bladder: a case report.

Hematogenous metastases occur in over 50% of muscle-invasive transitional cell carcinomas (TCC) of the bladder. Despite treatment (mostly surgery and radiotherapy), patients with brain metastases have an especially poor prognosis (median survival 2–5 months), making palliative treatment an important consideration. We followed a 60-year-old man with multiple brain metastases who was ultimately treated with gemcitabine chemotherapy. He underwent a cystectomy in 1997 because of a T3a N0 M0 G3 TCC of the bladder. Two years later, he developed one brain metastasis and one lung metastasis. Both metastases were resected and adjuvant chemotherapy was planned. Before chemotherapy, the patient suffered from headaches and symptoms of hemiparesis. A magnetic resonance imaging (MRI) showed multiple brain metastases of up to 2 cm, particularly in the brain stem. The patient underwent whole-brain radiotherapy with 30 Gy, followed by four cycles of a 3-week gemcitabine (800 mg/m2 on days 1 and 8) schedule. Another MRI showed a nearly complete response after four cycles of chemotherapy, with only small residual tumors remaining in the brain stem. This impressive activity was accomplished without adverse side effects, suggesting that radiotherapy combined with gemcitabine monotherapy may be an excellent choice for palliative treatment of TCC of the bladder.

[The current state of the art of chemotherapy of penile cancer: results of a nationwide survey of German clinics].

INTRODUCTION The prognosis for advanced penile carcinomas is extremely poor. Due to the low response rates and relevant side effects of current chemotherapy regimens, several attempts have been made to improve chemotherapy in recent years. In a retrospective survey the current state of the art of chemotherapy for penile carcinoma in Germany was analysed. METHODS The study took the form of a retrospective survey among all urological departments in Germany. The questionnaire contained seven questions concerning indications and modalities for chemotherapy of penile carcinoma in addition to general questions. RESULTS Out of 280 departments 129 (46%) returned an answered questionnaire. Chemotherapy was reported to be carried out by 91 of the answering departments and overall 18 different chemotherapy regimens were used. The regimens cisplatin/methotrexate/bleomycin, vinblastin/methotrexate/bleomycin and cisplatin/5FU were the most frequently reported. Chemotherapy was carried out on average 2.3 times per year per department. The majority of the departments reported response rates under 30%. Finally 101 of the answering departments confirmed the necessity of new chemotherapy regimens. CONCLUSIONS The current state of the art for chemotherapy of penile carcinoma showed a very large variation in Germany. The response rates were disappointing. A nationwide study with new chemotherapy approaches is urgently needed (information under www.uni-rostock.de/peniskarzinom).ZusammenfassungEinleitungDie Prognose des fortgeschrittenen Peniskarzinoms ist extrem schlecht. Aufgrund der schlechten Ansprechraten und erheblichen Nebenwirkungsraten der aktuellen Standardtherapien wurden in den letzten Jahren verschiedene neue Schemata zum Einsatz gebracht, um die Prognose des fortgeschrittenen Peniskarzinoms zu verbessern. Mittels einer retrospektiven Umfrage analysierten wir den aktuellen Standard der Chemotherapie des Peniskarzinoms in Deutschland.Material und MethodenIn einer deutschlandweiten Umfrage wurden Fragebögen an alle urologischen Kliniken und Abteilungen versandt. Der Fragebogen beinhaltete neben allgemeinen Fragen zum Peniskarzinom 7 Fragen zu Indikation und Modalitäten der Chemotherapie.ErgebnisseWir erhielten Antwortbögen aus 129 von 280 angeschriebenen Kliniken (Rücklaufquote 46%). 91 Kliniken berichteten über die Durchführung von Chemotherapie beim Peniskarzinom. Insgesamt wurden dabei 18 verschiedene Therapieschemata zum Einsatz gebracht. Die Kombinationen Cisplatin/Methotrexat/Bleomycin, Vinblastin/Methotrexat/Bleomycin and Cisplatin/5FU kamen am häufigsten zum Einsatz. Die durchschnittliche Zahl der Chemotherapien lag bei 2,3/Jahr/Klinik. Die Mehrheit der antwortenden Kliniken berichtete über Ansprechraten von <30%. Den dringenden Bedarf zur Einführung neuer und wirkungsvollerer Therapieschemata sahen 101 antwortende Kliniken.SchlussfolgerungDie aktuellen Standards in der Chemotherapie des Peniskarzinoms variieren in Deutschland sehr stark. Hauptgrund hierfür scheint die Suche nach neuen wirkungsvolleren und nebenwirkungsärmeren Therapieschemata. Ziel sollte es sein, diese Bemühungen in einer neuen deutschlandweiten Registerstudie zu bündeln (Informationen dazu unter http://www.uni-rostock.de/peniskarzinom)AbstractIntroductionThe prognosis for advanced penile carcinomas is extremely poor. Due to the low response rates and relevant side effects of current chemotherapy regimens, several attempts have been made to improve chemotherapy in recent years. In a retrospective survey the current state of the art of chemotherapy for penile carcinoma in Germany was analysed.MethodsThe study took the form of a retrospective survey among all urological departments in Germany. The questionnaire contained seven questions concerning indications and modalities for chemotherapy of penile carcinoma in addition to general questions.ResultsOut of 280 departments 129 (46%) returned an answered questionnaire. Chemotherapy was reported to be carried out by 91 of the answering departments and overall 18 different chemotherapy regimens were used. The regimens cisplatin/methotrexate/bleomycin, vinblastin/methotrexate/bleomycin and cisplatin/5FU were the most frequently reported. Chemotherapy was carried out on average 2.3 times per year per department. The majority of the departments reported response rates under 30%. Finally 101 of the answering departments confirmed the necessity of new chemotherapy regimens.ConclusionsThe current state of the art for chemotherapy of penile carcinoma showed a very large variation in Germany. The response rates were disappointing. A nationwide study with new chemotherapy approaches is urgently needed (information under www.uni-rostock.de/peniskarzinom).

Die aktuelle Situation der Chemotherapie des Peniskarzinoms

INTRODUCTION The prognosis for advanced penile carcinomas is extremely poor. Due to the low response rates and relevant side effects of current chemotherapy regimens, several attempts have been made to improve chemotherapy in recent years. In a retrospective survey the current state of the art of chemotherapy for penile carcinoma in Germany was analysed. METHODS The study took the form of a retrospective survey among all urological departments in Germany. The questionnaire contained seven questions concerning indications and modalities for chemotherapy of penile carcinoma in addition to general questions. RESULTS Out of 280 departments 129 (46%) returned an answered questionnaire. Chemotherapy was reported to be carried out by 91 of the answering departments and overall 18 different chemotherapy regimens were used. The regimens cisplatin/methotrexate/bleomycin, vinblastin/methotrexate/bleomycin and cisplatin/5FU were the most frequently reported. Chemotherapy was carried out on average 2.3 times per year per department. The majority of the departments reported response rates under 30%. Finally 101 of the answering departments confirmed the necessity of new chemotherapy regimens. CONCLUSIONS The current state of the art for chemotherapy of penile carcinoma showed a very large variation in Germany. The response rates were disappointing. A nationwide study with new chemotherapy approaches is urgently needed (information under www.uni-rostock.de/peniskarzinom).ZusammenfassungEinleitungDie Prognose des fortgeschrittenen Peniskarzinoms ist extrem schlecht. Aufgrund der schlechten Ansprechraten und erheblichen Nebenwirkungsraten der aktuellen Standardtherapien wurden in den letzten Jahren verschiedene neue Schemata zum Einsatz gebracht, um die Prognose des fortgeschrittenen Peniskarzinoms zu verbessern. Mittels einer retrospektiven Umfrage analysierten wir den aktuellen Standard der Chemotherapie des Peniskarzinoms in Deutschland.Material und MethodenIn einer deutschlandweiten Umfrage wurden Fragebögen an alle urologischen Kliniken und Abteilungen versandt. Der Fragebogen beinhaltete neben allgemeinen Fragen zum Peniskarzinom 7 Fragen zu Indikation und Modalitäten der Chemotherapie.ErgebnisseWir erhielten Antwortbögen aus 129 von 280 angeschriebenen Kliniken (Rücklaufquote 46%). 91 Kliniken berichteten über die Durchführung von Chemotherapie beim Peniskarzinom. Insgesamt wurden dabei 18 verschiedene Therapieschemata zum Einsatz gebracht. Die Kombinationen Cisplatin/Methotrexat/Bleomycin, Vinblastin/Methotrexat/Bleomycin and Cisplatin/5FU kamen am häufigsten zum Einsatz. Die durchschnittliche Zahl der Chemotherapien lag bei 2,3/Jahr/Klinik. Die Mehrheit der antwortenden Kliniken berichtete über Ansprechraten von <30%. Den dringenden Bedarf zur Einführung neuer und wirkungsvollerer Therapieschemata sahen 101 antwortende Kliniken.SchlussfolgerungDie aktuellen Standards in der Chemotherapie des Peniskarzinoms variieren in Deutschland sehr stark. Hauptgrund hierfür scheint die Suche nach neuen wirkungsvolleren und nebenwirkungsärmeren Therapieschemata. Ziel sollte es sein, diese Bemühungen in einer neuen deutschlandweiten Registerstudie zu bündeln (Informationen dazu unter http://www.uni-rostock.de/peniskarzinom)AbstractIntroductionThe prognosis for advanced penile carcinomas is extremely poor. Due to the low response rates and relevant side effects of current chemotherapy regimens, several attempts have been made to improve chemotherapy in recent years. In a retrospective survey the current state of the art of chemotherapy for penile carcinoma in Germany was analysed.MethodsThe study took the form of a retrospective survey among all urological departments in Germany. The questionnaire contained seven questions concerning indications and modalities for chemotherapy of penile carcinoma in addition to general questions.ResultsOut of 280 departments 129 (46%) returned an answered questionnaire. Chemotherapy was reported to be carried out by 91 of the answering departments and overall 18 different chemotherapy regimens were used. The regimens cisplatin/methotrexate/bleomycin, vinblastin/methotrexate/bleomycin and cisplatin/5FU were the most frequently reported. Chemotherapy was carried out on average 2.3 times per year per department. The majority of the departments reported response rates under 30%. Finally 101 of the answering departments confirmed the necessity of new chemotherapy regimens.ConclusionsThe current state of the art for chemotherapy of penile carcinoma showed a very large variation in Germany. The response rates were disappointing. A nationwide study with new chemotherapy approaches is urgently needed (information under www.uni-rostock.de/peniskarzinom).

HIGH FREQUENCY ROTABLATION AS A NEW THERAPEUTIC PROCEDURE FOR OBSTRUCTED METALLIC URETER STENTS

Treatment of ureteral strictures caused by invasive growth of malignant processes or fibrotic changes after irradiation is challenging. Surgical urinary diversion is often complicated in patients with progressive malignancies or after irradiation of the abdomen. At the same time recurrent infection, dislocation and encrustation are common problems after application of percutaneous nephrostomy or Double J (Medical Engineering Corp., New York, New York) stents, which results in the need for frequent exchange. Implantation of metallic wall stents is an attractive therapeutic option. However, until now only limited data have been available on obstruction rates and on adequate treatment of obstruction in conjunction with such stents. We report on a patient with bilateral obstruction due to encrustation of bilaterally implanted titanium wall stents. The obstructions were successfully treated with a high frequency rotational atherectomy device designed and exclusively used in cardiology for treating atheromatous coronary stenosis. CASE REPORT

Die aktuelle Situation der Chemotherapie des Peniskarzinoms@@@The current state of the art of chemotherapy of penile cancer: Ergebnisse einer deutschlandweiten Klinikumfrage@@@Results of a nationwide survey of German clinics

INTRODUCTION The prognosis for advanced penile carcinomas is extremely poor. Due to the low response rates and relevant side effects of current chemotherapy regimens, several attempts have been made to improve chemotherapy in recent years. In a retrospective survey the current state of the art of chemotherapy for penile carcinoma in Germany was analysed. METHODS The study took the form of a retrospective survey among all urological departments in Germany. The questionnaire contained seven questions concerning indications and modalities for chemotherapy of penile carcinoma in addition to general questions. RESULTS Out of 280 departments 129 (46%) returned an answered questionnaire. Chemotherapy was reported to be carried out by 91 of the answering departments and overall 18 different chemotherapy regimens were used. The regimens cisplatin/methotrexate/bleomycin, vinblastin/methotrexate/bleomycin and cisplatin/5FU were the most frequently reported. Chemotherapy was carried out on average 2.3 times per year per department. The majority of the departments reported response rates under 30%. Finally 101 of the answering departments confirmed the necessity of new chemotherapy regimens. CONCLUSIONS The current state of the art for chemotherapy of penile carcinoma showed a very large variation in Germany. The response rates were disappointing. A nationwide study with new chemotherapy approaches is urgently needed (information under www.uni-rostock.de/peniskarzinom).ZusammenfassungEinleitungDie Prognose des fortgeschrittenen Peniskarzinoms ist extrem schlecht. Aufgrund der schlechten Ansprechraten und erheblichen Nebenwirkungsraten der aktuellen Standardtherapien wurden in den letzten Jahren verschiedene neue Schemata zum Einsatz gebracht, um die Prognose des fortgeschrittenen Peniskarzinoms zu verbessern. Mittels einer retrospektiven Umfrage analysierten wir den aktuellen Standard der Chemotherapie des Peniskarzinoms in Deutschland.Material und MethodenIn einer deutschlandweiten Umfrage wurden Fragebögen an alle urologischen Kliniken und Abteilungen versandt. Der Fragebogen beinhaltete neben allgemeinen Fragen zum Peniskarzinom 7 Fragen zu Indikation und Modalitäten der Chemotherapie.ErgebnisseWir erhielten Antwortbögen aus 129 von 280 angeschriebenen Kliniken (Rücklaufquote 46%). 91 Kliniken berichteten über die Durchführung von Chemotherapie beim Peniskarzinom. Insgesamt wurden dabei 18 verschiedene Therapieschemata zum Einsatz gebracht. Die Kombinationen Cisplatin/Methotrexat/Bleomycin, Vinblastin/Methotrexat/Bleomycin and Cisplatin/5FU kamen am häufigsten zum Einsatz. Die durchschnittliche Zahl der Chemotherapien lag bei 2,3/Jahr/Klinik. Die Mehrheit der antwortenden Kliniken berichtete über Ansprechraten von <30%. Den dringenden Bedarf zur Einführung neuer und wirkungsvollerer Therapieschemata sahen 101 antwortende Kliniken.SchlussfolgerungDie aktuellen Standards in der Chemotherapie des Peniskarzinoms variieren in Deutschland sehr stark. Hauptgrund hierfür scheint die Suche nach neuen wirkungsvolleren und nebenwirkungsärmeren Therapieschemata. Ziel sollte es sein, diese Bemühungen in einer neuen deutschlandweiten Registerstudie zu bündeln (Informationen dazu unter http://www.uni-rostock.de/peniskarzinom)AbstractIntroductionThe prognosis for advanced penile carcinomas is extremely poor. Due to the low response rates and relevant side effects of current chemotherapy regimens, several attempts have been made to improve chemotherapy in recent years. In a retrospective survey the current state of the art of chemotherapy for penile carcinoma in Germany was analysed.MethodsThe study took the form of a retrospective survey among all urological departments in Germany. The questionnaire contained seven questions concerning indications and modalities for chemotherapy of penile carcinoma in addition to general questions.ResultsOut of 280 departments 129 (46%) returned an answered questionnaire. Chemotherapy was reported to be carried out by 91 of the answering departments and overall 18 different chemotherapy regimens were used. The regimens cisplatin/methotrexate/bleomycin, vinblastin/methotrexate/bleomycin and cisplatin/5FU were the most frequently reported. Chemotherapy was carried out on average 2.3 times per year per department. The majority of the departments reported response rates under 30%. Finally 101 of the answering departments confirmed the necessity of new chemotherapy regimens.ConclusionsThe current state of the art for chemotherapy of penile carcinoma showed a very large variation in Germany. The response rates were disappointing. A nationwide study with new chemotherapy approaches is urgently needed (information under www.uni-rostock.de/peniskarzinom).