Search

Although GC therapy (the traditional 4-week[4W]regimen)is administered to urothelial cancer patients, discontinuation of gemcitabine after 15 days of administration is a problem. One solution is to use a 3-week (3W) regimen. Because a Japanese study comparing the 3W to the 4W regimens reported the lower efficacy and safety of the 3W regimen, we compared these regimens in a retrospective study. Leukopenia of Grade≥occurred in 18% and 18% of cases and anemia of Grade≥3 occurred in 28% and 39% of cases treated with the 3W and 4W regimens, respectively. On the other hand, thrombocytopenia of Grade≥3 occurred in 13% and 39% of cases treated with the 3W and 4W regimens, respectively (p< 0.001). In addition, overall survival was 14.8 months and 15.0 months for the 3W and 4W regimens, respectively (p=0.97). Thus, the 3W regimen as an alternative treatment instead of the 4W regimen is considered a highly tolerated regimen.

Reiter's syndrome is one of the rare complications following intravesical bovis Bacillus Calmette-Guerin (BCG) treatment. In this study we have reviewed and discussed 101 cases including our own 6 cases over the past 13 years in Japan (2000-2013). The patients comprised 70 males and 25 females (6 cases were unknown), mean age of 63.1 (range 42 - 91). Arthritis occured 4-5 days after conjunctivitis. Thirty five (55%) of 68 patients needed corticosteroid treatment to control their arthritis. HLA-B27 is known as a risk factor of Reiter's syndrome, however, positive rate was only 2.4% (n = 41).

A 78-year-old female patient with fever and general malaise was referred to our hospital. Laboratory examination showed the marked elevation of leukocyte and serum granulocyte-colony stimulating factor (GCSF) concentration without any infectious sign. A computed tomography scan demonstrated irregular enhanced mass of the right kidney with liver metastasis. The pathological findings of the needle biopsy was high-grade urothelial cancer with positive staining for G-CSF antibody. Systemic chemotherapy with gemcitabine and cisplatin was administered. The patient showed a partial response and the serum G-CSF level was normalized after 1 course of chemotherapy. After four courses of chemotherapy, the extent of liver metastasis increased and the G-CSF concentration became elevated. Although combined chemotherapy with paclitaxel and gemcitabine was administered, the patient died 7 months after her first visit.

A 61-year-old man was referred to our hospital with the chief complaint of right leg weakness. Abdominal magnetic resonance imaging (MRI) and computed tomography (CT) demonstrated a ureteral tumor and a neighboring massive retroperitoneal tumor in addition to retroperitoneal lymph node and right renal metastases. The tumor was diagnosed as upper tract urothelial carcinoma (cT4N1M1) by percutaneous tumor biopsy. As the patient achieved a partial response after three courses of combination chemotherapy with gemcitabine and cisplatin, he received total nephroureterectomy and lymph node dissection. The pathology showed no viable cancer cells, demonstrating a pathological complete response. He remains alive after 26 months with no evidence of disease.

An 85-year-old man had planned a laparoscopic right nephrouretectomy for a right lower ureteral cancer, pT1, G3. Two months prior to the surgery, he was re-examined because of continuing macrohematuria. He had a 50 mm tumor in his urinary bladder and tumors from the right upper to lower urinary tract by computed tomographic (CT) examination and cystoscopy. He did not have any metastasis. We diagnosed a cT3N0M0 for the right ureteral cancer and a cT3N0M0 for the bladder cancer. A right nephrouretectomy and cystectomy were then performed. The histopathologic examination revealed an urothelial carcinoma with a choriocarcinoma.

A 74-year-old female consulted our hospital for follow up of bilateral megaureter. She requested continued follow-up, but in February 2009, she had gross hematuria. We could not make a diagnosis by drip infusion pyelography and retropyelography, so enhanced computed tomography (CT) and magnetic resonance-urography were performed. They revealed right ureteral cancer with severe megaureter. Right nephroureterectomy and partial cystectomy was performed in August 2009. The pathological findings were urothelial carcinoma. She did not receive adjuvant chemotherapy and has had no recurrence for 6 months.

A 70-year-old man visited a urological clinic on May 2008 complaining of dysuria and nocturia since 2 years prior. He was diagnosed as having gross benign prostatic hypertrophy, and was referred to a nearby hospital for transurethral resection of prostate (TURP). During TURP, a papillary tumor was found in the prostatic urethra on the left side and a biopsy was performed. A pathological examination revealed urothelial carcinoma G3. Cystoprostatectomy was planned, but the patient refused the procedure. Therefore, he underwent three courses of MVAC intra-arterial chemotherapy (methotrexate, vinblastin, doxorubicin, cisplatinum) at our hospital. After chemotherapy, no tumor was found in the prostatic urethra and a pathological report of repeat TUR showed no tumor. Currently, the patient is alive and there has been no evidence of recurrence for 1 year and 10 month.

To identify the risk factors for developing subsequent bladder carcinoma in patients undergoing surgical management of urothelial carcinoma (UC) of the upper urinary tract, we retrospectively studied 119 (median age 69, 81 males and 38 females) patients who underwent surgical resection at Yokohama Municipal Citizen's Hospital, Yokosuka Kyousai Hospital and Chigasaki Municipal Hospital from August 1980 to September 2006. After a median follow up of 37.7 months, 42 cases (35.3%) developed recurrent bladder cancer and the intravesical recurrence-free survival rate at 5 years (Kaplan-Meier method) was 57.7%. Bladder cancer was significantly more common in patients who had smaller primary tumors (less than 3 cm: p0.0444) by univariate analysis. This factor was also identified as independent predictor for the intravesical recurrence by multivariated analysis (p0.0495, Hazard ratio 2.099). In 42 intravesical recurrence cases, invasive recurrence was seen in 9 cases (21.4%). Invasive recurrence appeared to occur in the patients who were older and had longer interval by intravesical recurrence.

A 48-year-old man presented complaining of lower abdominal pain, and was diagnosed with invasive bladder cancer. After neoadjuvant chemotherapy, cystoprostatourethrectomy and ileal conduit diversion were performed. At 53 years of age, bladder cancer recurred in the upper urinary tract and he underwent complete urinary tract extirpation. Histological examination revealed an urothelial carcinoma in an ileal conduit. Three years later, a local recurrence led to combined modality therapy including chemotherapy and radiotherapy. He is receiving maintenance chemotherapy for metastatic tumors. Urothelial carcinoma arising in an ileal conduit after radical cystectomy for bladder cancer is infrequently reported. To our knowledge, only 12 cases, including ours, have been reported.

We report a case of port-site metastasis of bladder cancer after left retroperitoneoscopy-assisted nephroureterectomy and cystectomy. The patient was a 73-year-old man with a chief complaint of gross hematuria. The diagnosis was invasive bladder cancer with bone metastasis. He received two courses of chemotherapy (methotrexate, vinblastine, adriamycin, cisplatin), and this resulted in resolution of the bone metastases. Two months later, abdominal and pelvic computed tomography showed a bladder tumor invading the left lower ureter with hydronephrosis. Left retroperitoneoscopy-assisted nephroureterectomy and cystectomy were performed. The patient was unable to undergo systemic chemotherapy because of renal dysfunction. Four months later, a lateral abdominal wall tumor was found at a port-site, and needle biopsy confirmed this to be metastatic urothelial carcinoma. Clinicians need to be aware of port-site metastasis, particularly in patients with UC, and take steps to prevent it during laparoscopic procedures.