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Between 1980 and 1989, 186 patients with testicular tumors were seen at Roswell Park Memorial Institute. Of these, 66.6 percent (124/186) were diagnosed to have nonseminomatous germ cell tumors (NSGT) and 22 percent (41/186) were clinically determined to have Stage I disease. Patients with clinical Stage I NSGT either underwent observation or retroperitoneal lymph node dissection (RPLND). Recurrence in the observation group of patients was 23.5 percent (4/17) between four and eighteen months (mean 10 months) with the retroperitoneum being the most common site. All but 1 patient (80%) were salvaged with platinum-based combination chemotherapy. Of the 24 patients who had RPLND, 21 percent (5/24) had a false-negative metastatic evaluation. All the patients who had surgically documented metastatic disease were successfully treated with chemotherapy. The similar recurrence rates in the observation group and the false-negative RPLND group suggest that the failure rate in the observation group is a result of the inability to stage accurately patients with NSGT. RPLND continues to be the standard therapy in patients with clinical Stage I disease. Despite its high recurrence rate, observation should, however, be offered to well-motivated and selected patients since salvage platinum-based combination chemotherapy is very effective and the majority of patients in this group are spared a major operative procedure.

The bioCarbon ureterostomy device is a stomal prosthesis for upper tract urinary diversion that has had preliminary successes in animal and human trials in Europe and Peru. Implantation of a pure carbon stomal prosthesis offers the potential advantages of high biocompatibility, lack of encrustation, and elimination of stomal stenosis which is frequently associated with cutaneous ureterostomy. Nine bioCarbon ureterostomy devices were implanted from August, 1984 through July, 1985. Although successful implantation was achieved in 2 patients, the complication rate was high. The bioCarbon ureterostomy device has potential as an alternative form of urinary diversion. However, significant problems need to be remedied before it can be recommended for routine clinical application.

From July, 1980, to June, 1983, 319 patients with newly diagnosed metastatic prostatic cancer were randomized to one of three treatment protocols: diethylstilbestrol (DES) or bilateral orchiectomy, cyclophosphamide plus 5-fluorouracil plus DES, and estramustine phosphate (Emcyt). Ninety-three per cent of 296 patients were eligible for evaluation. This report shows no difference in survival, disease-free progression time, or status regarding pain at entry. Other prognostic factors failed to reveal any difference within any of the treatment protocols.

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.

A retrospective study was conducted to evaluate the prognostic significance of hypercalcemia associated with renal cell carcinoma and the efficacy of different treatment modalities. Twenty-seven of 160 (16.8%) patients with renal cell carcinoma were found to have tumor-induced hypercalcemia: 24 had Stage IV disease, 1 Stage III disease, and 2 Stage I disease. There was no evidence of bone metastasis in 13 of 27 (48%) patients. A total of 89 episodes of acute hypercalcemia were treated: 36 episodes resulted in a complete response ([CR] calcium levels returning to normal), 24 partial response ([PR] calcium decrease greater than 1 mg/dL, but above normal) and 29 negligible response ([NR] calcium decrease less than 1 mg/dL) to treatment modalities used. One patient with Stage I disease and 3 with Stage IV disease underwent nephrectomies resulting in 2 CR and 1 PR. There was a complete response (CR) to mithramycin in 7 of 10 (70%) acute hypercalcemic episodes, to furosemide and mithramycin in 12 of 20 (60%), to steroids or furosemide and steroids in 3 of 7 (43%), to hydration in 4 of 13 (31%), and to furosemide in 7 of 25 (28%). The response rates to phosphates, indomethacin, and calcitonin were low but involved a small number of patients. Survival in 24 patients with Stage IV disease was 5-239 days (av 87.3 days). There was essentially no survival difference between patients who had an initial calcium elevation less than or greater than 13 mg/dL. We conclude that mithramycin is more effective in controlling acute hypercalcemia secondary to renal cell carcinoma than furosemide or hydration. Steroids appear to be effective but our experience was limited. Surprisingly, the degree of calcium elevation did not show a significant correlation with survival.

During the period of 1968 through 1975 renal allografts were performed using cadaveric or living related donors. At that time the typing as it is known today was unavailable. Despite this serious limitation 8 long-term survivors living from eight to more than fourteen years postrenal allotransplantation are presented. All had normal renal function and are without detectable serious side effects of long-term immunosuppression.

Twenty-seven patients with metastatic adenocarcinoma of the prostate were treated with the new luteinizing hormone-releasing hormone analog, Zoladex (ICI 118,630) for up to ninety-eight weeks. Initially, treatment was randomized between Zoladex 250 micrograms and 500 micrograms self-injected subcutaneously every day for a minimum period of twelve weeks following which a sustained-release, once-monthly depot formulation of Zoladex 3.6 mg s.c. was used. Acute rises in serum gonadotropins and testosterone during the first two days were followed by declines in hormone levels over the following three weeks. Median time to castration with 500 micrograms/day was twenty-two days compared with forty-three days with 250 micrograms/day (p = 0.06). No significant endocrinologic changes occurred during the transfer to the depot, and serum testosterone remained 95 per cent suppressed throughout the duration of the study. After three months the median daily serum Zoladex concentrations ranged between 0.47 and 0.53 ng/ml and were not significantly different among the three dosage forms. No specific correlation among serum Zoladex concentrations, endocrinologic parameters, and tumor response rates were found. Hot flashes initially, and decreased libido were the only common complaints. Zoladex was well tolerated, and no side effects required dose-modification or removal from the study. Tumor response rates up to one year appeared to be comparable to the conventional endocrine therapies. This analog in monthly depot formulation is recommended for further clinical evaluation.