R. Bruce Bracken

Role of intravesical mitomycin c in management of superficial bladder tumors

Forty-three patients with biopsy-proved Stage O or A transitional cell carcinomas of the bladder, whose tumors were not amenable to transurethral resection, received mitomycin C intravesically at weekly intervals for eight treatments. Five different drug doses were used (20, 25, 30, 40, and 60 mg). Best response rates occurred at doses of 30 mg. or higher. Complete responses occurred in 49% of patients, partial responses in 30%, and improvement in 5%, for an over-all effective rate of 84%. Responses were achieved regardless of tumor extent as long as individual tumors were 1 cm. or less in diameter. Toxicity was minimal. The necessary for maintenance therapy in complete responders remains to be proved.

Cystectomy for superficial bladder cancer

One hundred nine patients with Stage O or A bladder cancer unmanageable transurethrally underwent radical cystectomy and ileal conduit urinary diversion without lymphadenectomy. Fifty-six were also given planned preoperative radiation therapy. Five-year survival rate was 76 per cent for the entire group. Irradiation eradicated all of the tumor (Po) in 36 per cent of patients, no patient Po after irradiation had recurrent disease, and local recurrence was noted in only 3.5 per cent of the irradiated patients compared with 9.4 per cent of those not irradiated. Urethral cancer was present in 9 per cent of our patients, a finding that does not support our previous impression that patients with multifocal bladder cancer or tumors involving the prostatic urethra had a higher than average incidence of urethral carcinoma.

Salvage cystectomy for bladder carcinoma

Sixty‐two patients with carcinoma of the bladder who had received external radiation as definitive therapy underwent radical cystectomy for persistent or recurrent tumor. A preoperative clinical assessment correctly predicted whether the tumor was superficial or advanced in 74% of patients, which correlated with prognosis. Overall five‐year survival rate after cystectomy was 43%, while five‐year survival rates for patients with clinically staged superficial and advanced tumors were 64% and 25%, respectively. There have been no postoperative deaths, and morbidity was not greater than that of patients undergoing cystectomy after planned preoperative radiation therapy. We conclude that salvage cystectomy can be recommended without fear of increased mortality or morbidity for selected patients who have failed definitive radiation therapy.

Preoperative chemotherapy for wilms tumor

Preoperative chemotherapy was administered to 19 children with Wilms tumor judged clinically to be unresectable at M. D. Anderson Hospital between January 1, 1962, and September 1, 1980. After 2 to 4 doses of vincristine, marked reduction in tumor size occurred in 16 patients. After chemotherapy 16 tumors could be resected completely, another required irradiation to reduce the tumor, and only 2 tumors could not be excised. Pathologically the most dramatic changes occurred in the undifferentiated interstitial stroma, followed next by changes in the nodular blastema. Differentiated elements were apparently not affected. No serious complications were attributed to the preoperative drug treatment. This experience suggests that in selected instances preoperative chemotherapy can affectively facilitate the therapy of Wilms tumor.

Complications of transabdominal retroperitoneal lymphadenectomy

Twelve complications occurred in 175 patients (7%) undergoing transabdominal retroperitoneal lymphadenectomy for management of nonseminomatous testicular carcinoma. There was no operative mortality. The low morbidity and rare mortality associated with the operation justifies its continued use both as a staging procedure and as a therapeutic modality.

Single Dose Whole Pelvis Megavoltage Irradiation for Palliative Control of Hematuria or Ureteral Obstruction

Of 7 patients with bladder carcinoma whose medical condition or disease status prevented an operation 5 had intractable vesical hemorrhage and 2 had progressive azotemia caused by ureteral obstruction. These patients were treated with pelvic irradiation of 1,000 rad single doses. Four patients received 3 doses 3 to 4 weeks apart and 1 patient received 2 doses at a 4-week interval. Prompt cessation of bleeding occurred in all patients and renal function improved in the 2 patients with ureteral obstruction.

Appendiceal carcinoma mimicking primary bladder cancer

We report the first case of adenocarcinoma of the appendix invading the bladder. Because invasive bladder cancer was diagnosed intially the pelvis was irradiated preoperatively. At operation a primary appendiceal neoplasm invading the bladder was discovered and a right hemicolectomy and en block partial cystectomy were done. This treatment is recommended for appendiceal adenocarcinoma that invades the bladder.

Exenterative surgery for posterior urethral cancer

Abstract Three men with locally extensive squamous carcinoma of the bulbous urethra underwent staged surgical therapy consisting of laparotomy and ileal conduit urinary diversion followed by a second operation, anterior exenteration and total emasculation with en bloc pubectomy. All have no evidence of disease eighteen to sixty months postoperatively. The operative technique is described.

Complications of single-stage radical cystectomy and ileal conduit

Single-stage radical cystectomy without pelvic lymphadenectomy and ileal conduit urinary diversion was performed on 241 consecutive patients over a three and one-half-year period. Operative mortality rate was 2.5%; early and late complications occurred in 32 and 34% of patients, respectively. In general, complications were less severe than in the past. Wound complications remain a major source of morbidity, but wound disruption and anastomotic leaks have been virtually eliminated.

Vesical adenocarcinoma occurring in patient with pelvic lipomatosis

This is the first case reported of adenocarcinoma of the urinary bladder in a patient with pelvic lipomatosis and cystitis glandularis. The abnormal pelvic fat hampered endoscopic evaluation and transurethral biopsy, confused clinical staging, and complicated preoperative irradiation and cystectomy. The development of adenocarcinoma in this patient indicates the potential for malignant transformation of cystitis glandularis and underscores the necessity for endoscopic follow-up of persons with pelvic lipomatosis.