Search

A critical reevaluation of the preoperative classification in 96 patients with transitional cell bladder carcinomas of grade 3 (WHO) and clinical category T2 has been performed. As a result of incomplete biopsies and clinical data, it was possible to reclassify only 49 tumors (51%). 43 of these seemed to be of a lower stage than originally proposed. In addition downstaging after preoperative irradiation occurred in 77 patients (80%). In view of the uncertainties in the present series, a return to a simplified preoperative classification for clinical purposes is proposed--e.g. tumors with mucosal growth, tumors with muscle infiltration, tumors extending outside the bladder.

The bladder capacities of 75 patients with superficial bladder tumors were measured prior to and during monthly intravesical instillation therapy with adriamycin. When taken off therapy, a decrease in bladder capacity of more than 20% was observed in 18 of the patients. In 14 of the treated patients an increase in bladder capacity of more than 20% was observed. In patients with reduced bladder capacity when taken off therapy, there were no correlations between the degree of decreased bladder capacity and the number of instillations or the total instilled amount of adriamycin, indicating that the observed decrease in bladder capacity was caused by the underlying disease and not by the treatment per se.

Intravesical instillation of Adriamycin has successfully been used in the treatment of bladder tumours. The Adriamycin concentration in the bladder has been monitored and the area under the bladder concentration-time curve, AUC, is proposed to be considered rather than the amount of instilled drug when optimizing the treatment schedules. pH effects which may arise in the bladder when instilling protolytic drugs like Adriamycin are discussed.

Three hundred and seventy-four patients with invasive grade 3 bladder cancer treated with either external irradiation or preoperative irradiation and cystectomy were re-evaluated. Cancer-free survival was markedly better for patients who underwent preoperative irradiation and operation than irradiation only, even if a complete clinical response had occurred initially.

In our investigation of different chemotherapy protocols, the best results in recent years were obtained with a combination of cisplatinum and doxorubicin in patients with recurrent urinary bladder cancer. This applied both to the local bladder tumor and the metastases. With respect to the cases of advanced localized bladder cancer, refined surgery or more developed equipment in radiotherapy, even developing new particles or rays, presumably will give only marginal effects on eradication of the tumor. A new approach may be to give a combined therapy of CDDP and doxorubicin before surgery and/or radiotherapy; a pilot study is going on in Stockholm. Experience so far has shown that CDDP together with radiotherapy or after preoperative irradiation followed by cystectomy is not tolerable to the patients. Between 40 and 50 per cent of them failed to fulfill the treatment.

An 80-mg dose of adriamycin was given intravesically once a month to 58 patients with superficial transitional cell tumor of the bladder. Complete cytological remission was achieved in all 11 patients with previously untreated, flat carcinoma in situ lesions. In 19 carcinoma in situ patients, who were previously treated by other means, cytological remission occurred in 74%. In T1 and T2 papillary tumor remission occurred in 65 and 20%, respectively. Minor local side effects were observed.

22 patients with Peyronie's disease have been treated with Orgotein, the new anti-inflammatory metalloprotein which pronounced superoxide dismutase activity patients with long-standing and severe symptoms were selected for the trial. The drug was given monthly by injection into the indurated areas of penis. In 19 patients, where the sexual act could be performed with difficulties or the penile angulation made intercourse impossible, marked improvement was seen or normal function was restored. No adverse reactions by Orgotein were seen.