Shuji Fukushima

Treatment of bladder cancer with a combination of hyperthermia, radiation and bleomycin.

The treatment of urinary bladder cancer with hyperthermia in combination with radiation and bleomycin was investigated. Immediately following a daily course of external bladder irradiation (150–200 rad; total 4 week exposure of 3500–4000 rad), patients diagnosed with transitional cell carcinoma of the bladder were irrigated with a solution of warmed saline (intravesical temperature, 42°C−43°C), containing 30 μg/ml bleomycin. Of a total of 33 patients, complete responses were observed in 14 patients, and partial responses were observed in 10. The side effects of the combined treatment were limited to local symptoms of bladder and urethral irritation. These preliminary results suggest that the combined use of hyperthermia, radiation, and bleomycin may represent an effective conservative therapy for the management of bladder cancer in humans.

Postoperative prophylactic use of progesterone in renal cell carcinoma.

Medroxyprogesterone acetate has been used prophylactically in 35 patients with stages I and IIIA renal cell carcinoma who had undergone radical nephrectomy. Metastasis was noted in 26 per cent (9 of 35) of the patients who had received the drug and in 44 per cent (20 of 45) of those who had not (controls). The incidence of metastasis in patients who had undergone nephrectomy more than 3 years previously was 10 per cent (3 of 31) for patients who received medroxyprogesterone acetate and 35 per cent (15 of 43) for the control group, the difference being statistically significant. Prognosis tended to be better in patients who had received medroxyprogesterone acetate than in the controls, and relative 3 and 5-year survival rates being 99.3 and 87.2 per cent, respectively, in the former group, and 86.8 and 75.0 per cent, respectively, in the latter group. There was no significant difference between these 2 groups. However, it may be concluded that prophylactic medroxyprogesterone acetate seems to be beneficial in the prevention of postoperative metastasis of renal cell carcinoma.

A phase II study of prophylactic intravesical chemotherapy with 4′-epirubicin in recurrent superficial bladder cancer: comparison of 4′-epirubicin and Adriamycin

Since intravesical recurrence of superficial bladder cancer (Ta, T1) after transurethral resection (TUR) is frequent, adjuvant therapy to reduce the recurrence rate has been extensively investigated. Although intravesical chemotherapy has been employed for 30 years or more, neither the exact effect on the bladder epithelium nor the optimal dose and administration schedule has yet been clarified. In recent years, several derivatives of Adriamycin (ADR) have been developed, and 4′-epirubicin (FARM) is one of them. This drug has been shown to have antitumor effects almost equal to those of ADR and to produce less toxicity when given systemically as chemotherapy. In an attempt to clarify the effect of intravesical FARM in the prevention of recurrence of superficial bladder cancer, we conducted a prospective randomized trial to compare the effects of equal doses of FARM and ADR given by intravesical instillation after TUR in cases of highly recurrent superficial bladder cancer. A total of 73 patients with recurrent superficial bladder cancer were randomized to receive TUR and either 30 mg FARM or 30 mg ADR by intravesical instillation every 2–4 weeks for 1 year. The prophylactic effect on recurrence and the toxic effects of these drugs were investigated. The current results show that FARM provides efficacy almost equal to that of ADR in the prevention of recurrence in these patients. However, FARM also caused almost the same local toxic effects (bladder irritation, among others) as ADR. On the basis of these preliminary results, FARM is surmised to be one of the agents as beneficial as ADR in the prevention of recurrence of superficial bladder cancer.

Clinical Significance of Interruption of Therapy with Allylestrenol in Patients with Benign Prostatic Hypertrophy

Background: A multicenter, clinical trial investigated the effects of an interruption of antiandrogen therapy on subjective and objective clinical parameters in patients with benign prostatic hypertrophy (BPH).

Preoperative doxorubicin instillation in recurrent superficial bladder cancer

SummaryFurther recurrence of superficial bladder cancer after transurethral resection is frequent in patients who have already experienced recurrence. In an attempt to prevent or delay further recurrences in such patients, the effect of preoperative doxorubicin instillation was investigated. A total of 51 patients with recurrent superficial bladder cancer were randomized to receive either TUR alone or TUR with preoperative doxorubicin instillation. Doxorubicin was administered twice a week for 3 weeks before TUR surgery. An objective response (CR+PR) of the tumors was observed at operation in 12 of 25 (48%) evaluable doxorubicin-treated patients. Chemical cystitis was seen in 32% of the patients. Further recurrence after TUR was observed in 13 of 25 (52%) patients in the doxorubicin group, as against 15 of 23 (65%) evaluable patients in the control group. The mean disease-free interval was significnatly longer (11.8 as against 7.1 months) in the doxorubicin group. These preliminary results suggest that preoperative doxorubicin instillation might be effective for prolongation of the disease-free interval in patients with recurrent bladder cancer.