Treatment Of Low-grade Tumors Research Articles

PSA screening for prostate cancer.

Screening of prostate cancer with prostate-specific antigen (PSA) is a highly controversial issue. One part of the controversy is due to the confusion between population screening and early diagnosis, another derives from problems related to the quality of existing screening studies, the results of radical curative treatment for low grade tumors and the complications resulting from treatments that affect the patient's quality of life. Our review aimed to critically analyze the current recommendations for PSA testing, based on new data provided by the re-evaluation of the ongoing studies and the updated USPSTF recommendation statement, and to propose a more rational and selective use of PSA compared with baseline values obtained at an approximate age of 40 to 50 years.

Thermo reversible hydrogel based delivery of mitomycin C for treatment of upper tract urothelial carcinoma (UTUC).

e16089 Background: There is a large unmet need for novel drug delivery systems and effective therapy for UTUC, especially for patients with CKD and anatomic solitary kidneys. A temperature sensitive water-soluble gel formulation of Mitomycin C (MMC) demonstrated increased drug delivery time (4 to 6 hrs) and safety in the pelvicalyceal system of swine and human bladders. We report the efficacy and safety of gel+MMC as primary treatment (tx) of UTUC on a compassionate use basis. Methods: Compassionate use approval was obtained on an individual patient basis from the respective regulatory authorities and IRBs. 22 patients were approved for tx to date from 14 institutions in 4 countries. Tx included 6 weekly instillations instilled via ureteral catheter or percutaneous nephrostomy. Gel volume ranged from 5-20cc and MMC concentration was 2-6 mg/cc. Adverse events were recorded throughout treatment. Ureteroscopy was performed 2-6 weeks following tx completion for response determination. Results: Median age of the cohort was 75 yrs, with 15 males. 18 patients (pts) had low-grade (LG) tumor, 2 high-grade (HG), and 2 indeterminate grade. 16 (73%) completed treatment - 9 pts had a complete response, CR (41%; 59% of those who completed tx), 5 pts had a partial response, PR (23%; 31%), and 2 pts had no response, NR (9.1%, 12.5%). 4 patients could not complete tx due to adverse events (pyelonephritis, acute renal failure, pancytopenia, and unstable cardiac condition), 1 patient was diagnosed with a non-urothelial cancer during treatment, and 1 patient died prior to the third instillation due to suspected pulmonary embolus, determined to be unrelated to treatment with MitoGel. A total of 77 adverse events were recorded with 6 events related to MitoGel and serious (requiring intervention), and 21 events related to treatment and not serious. CR (9) and PR (5) were observed in 14 of 15 evaluable patients completing treatment for LG tumors. Conclusions: This compassionate use program of a thermosensitive gel+MMC for chemoablation of UTUC demonstrates proof of concept for treatment of low-grade tumors. A single arm Phase III multi-center registration trial to treat patients with low-grade renal pelvis tumors has been activated.

A Prospective Study of the Size, Number and Histopathology of New and Recurrent Bladder Tumors

IntroductionWe prospectively registered the grade, stage, number and size of bladder tumor recurrences as to our knowledge this has not yet been done. New tumors were included in the study for comparative purposes. MethodsAll 581 transurethral resections, random biopsies and fulgurations for a suspected bladder tumor were prospectively registered during a 15-month period at a single institution. Tumor size was determined using the size of the resection loop or biopsy forceps as a reference. ResultsOf all suspected new and recurrent bladder tumors 22% were benign or inflammatory lesions. A total of 167 patients with a new urothelial tumor and 214 recurrences in 166 patients were registered during the study period. Compared to new tumors, recurrences were more often noninvasive (88% vs 67%, p <0.001), more often 10 mm or less in diameter (63% vs 18%, p <0.001) and more often multifocal (55% vs 38%, p <0.01). New and recurrent tumors had a median size of 20 and 8 mm, respectively. ConclusionsThe absolute majority of suspected bladder tumor recurrences are benign or low grade noninvasive malignant tumors and are less than 10 mm in diameter. This finding suggests that there is great potential for cost reductions when a significant proportion of patients with suspected recurrences after treatment of low grade tumors could undergo biopsy and fulguration using local anesthesia in the office instead of general anesthesia.

Neuroendocrine Carcinoma of Unknown Primary Site

Neuroendocrine carcinomas of unknown primary site are uncommon, diverse tumors with variable clinical behavior, predicted by tumor grade or differentiation. Most of these carcinomas probably arise from an occult/clinically undetectable primary site in one of several locations (bronchus, pancreas, stomach, colon, rectum and several other sites). Patients with these tumors are a subset of unknown primary carcinoma with relatively favorable prognoses. Low-grade or well-differentiated tumors are frequently indolent and cases should be managed similar to advanced carcinoid tumors. Targeted therapies may have a role in the treatment of low-grade tumors. The high-grade or poorly differentiated carcinomas, including small cell and large cell neuroendocrine tumors, are rapidly growing and aggressive but responsive to platinum-based combination chemotherapy. Poorly differentiated large cell neuroendocrine tumors, first reported in 1988, are usually not recognized by routine hematoxylin and eosin light microscopy but require immunohistochemical stains or electron microscopy for their diagnosis. A review of cytotoxic chemotherapy for patients with high-grade neuroendocrine carcinomas, including a series of 99 patients, revealed an overall response rate of 70%, with a 20% complete response rate. The median survival was 15 months, and a minority of patients (13%) had long-term survival. Tumor grade/differentiation currently is an important determinant of the management of these patients, and therapy in the future will be based on a more precise knowledge of the unique biology of these tumors.

Cognitive and Adaptive Outcome in Extracerebellar Low-Grade Brain Tumors in Children: A Report From the Children's Oncology Group

To determine whether pediatric patients treated with surgery only for low-grade tumors in the cerebral hemispheres, supratentorial midline, and exophytic brainstem evidence neurocognitive, academic, adaptive, or emotional/behavioral sequelae. Ninety-three patients from a natural history study of low-grade astrocytomas were tested an average of 111 days after surgery. Rates of below average (< or = 25th percentile) scores in this sample were compared with test norms, and performances were compared across anatomic sites. Finally, the relationships of pre-, peri-, and postsurgical complications to outcome were investigated. For the entire sample, there was a significantly elevated rate of below average scores across intelligence quotient, achievement, and adaptive behavior, but not behavioral/emotional adjustment measures. Patients with hemispheric, midline, and brainstem tumors did not differ significantly. Patients with left hemisphere tumors generally performed worse than those with right hemisphere tumors. Finally, neurobehavioral outcome was unrelated to pre-, peri-, or postsurgery complications. After surgery for low-grade brain tumors, a significant number of patients was found to function below average, by as much as 55% compared with 25% in the normative population. Moreover, these results suggest greater risk for patients with lesions situated in the left cerebral hemisphere. Routine neuropsychological follow-up of children after treatment for low-grade tumors is recommended.