Richard M. Wolf

Monitoring intravesical bacillus Calmette-Guerin treatment of bladder carcinoma with flow cytometry.

Flow cytometry of bladder irrigation specimens was studied in 22 patients with low stage bladder carcinoma who were treated by transurethral resection of visible tumor followed in 3 to 5 weeks by a course of intravesical bacillus Calmette-Guerin. The most informative examinations were just before the first bacillus Calmette-Guerin treatment, 6 weeks after completing a 6-week course of treatment (3 months) and at 9 months. Of the patients 10 had recurrent tumors after therapy; recurrence was anticipated correctly by flow cytometry at the 12-week followup examination in 6 of the 10 patients and suspected in another. Of 12 patients who remained clinically free of disease for a minimum of 15 months after bacillus Calmette-Guerin therapy flow cytometry identified correctly 7 at 12 weeks, while 1 had a partial response and the remaining 4 reverted to a negative status at 9 months. Of interest, only 4 of the 22 patients were free of disease by flow cytometry at the start of bacillus Calmette-Guerin treatment despite attempted ablation of the tumor by transurethral resection, suggesting that intravesical administration of bacillus Calmette-Guerin destroys existing carcinoma in situ in some cases.

Presumptive downstaging from preoperative irradiation for bladder cancer as determined by flow cytometry: Preliminary report

Presumptive tumor downstaging was evaluated in 28 patients with grade II or III, solid, muscle-infiltrating bladder cancer (clinical category T3) treated by integrated irradiation (2000 rad to the whole pelvis in 5 days) and cystectomy (1-14 days later) by comparing the results of flow cytometry (FCM) on barbotage specimens obtained before and after irradiation (at the time of cystectomy) and the results of pretreatment clinical stage (T category) and post cystectomy pathological stage (P category). The patients were divided into three groups: (1) P greater than T, (2) P = T, and (3) P less than T. All of the patients in this study had positive FCM specimens with an aneuploid stemline in the pre-irradiation specimen. A complete radiation response (CRR) was defined by FCM as disappearance of the aneuploid stem cell line. Of the 5 patients in the P less than T group, 4 showed a CRR; of 20 patients in the P = T group, 8 showed a CRR; of the 3 patients in the P greater than T group, none showed a CRR. The proportion of patients in the various T/P groups is consistent with that previously observed in patients receiving integrated irradiation (2000 rad in 5 days) and cystectomy (1-14 days later). The overall downstaging response of 43%, as determined by FCM, correlates well with the pathological downstaging rates of 40%-68% reported by others following high dose (4000-5000 rad) integrated irradiation cystectomy regimens; however, it is more than the 27% rate reported with the low dose short course (2000 rad in 5 days) regimen. The correlation of the FCM findings with clinico-pathological downstaging is consistent with the possibility that FCM may be useful in identifying a favorable radiation response.

Vaginal Recurrence after Cystectomy for Bladder Cancer

The records of 14 patients with vaginal recurrence following cystectomy were reviewed in an attempt to find factors responsible for the local failure. Comparison was made with female patients who underwent cystectomy for bladder cancer during the same period but who did not have vaginal recurrence. Patients with previous surgery and radiation to the pelvic organs appear to be at risk for local recurrence, probably because of the difficulties associated with surgical removal of the bladder. Patients with tumors other than transitional cell carcinoma, especially those located at the bladder neck and urethra, also appear to be at high risk. Proper surgical technique with en bloc cystourethrectomy, including excision of the anterior vaginal wall, is of paramount importance to avoid local recurrence.

Prostate angiosarcoma: a case report and literature review

Angiosarcomas are a relatively rare histological subtype of sarcomas and represent <1% of all sarcomas. Prostate angiosarcoma is extremely rare and displays remarkable clinical and pathological heterogeneity. Despite the rarity, it usually presents with dysuria, hematuria, or pelvic pain and represents a treatment challenge. Only nine cases have been reported in the literature, and we report the 10th case of prostate angiosarcoma and the first case of prostate angiosarcoma with recurrent adenocarcinoma.

Prostate angiosarcoma: is there any association with previous radiation therapy?

Whats known on the subject? and What does the study add?

Pelvic rhabdomyosarcoma: a review of the RPMI experience

Between 1959 and 1983, 16 patients with pelvic rhabdomyosarcoma were treated at Roswell Park Memorial Institute (RPMI). A multidisciplinary approach was utilized consisting of surgery, radiotherapy (XRT), and combined chemotherapy which resulted in prolonged survivals of thirteen to one hundred forty-four months in 10 patients. This improved survival was observed despite the fact that 63 per cent of the patients (10/16) presented with advanced stages of the disease. Herein we present a retrospective study of these 16 patients.