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The aim of this prospective study was to examine the prognostic pathomorphological factors in urothelial cancer of the urinary bladder. Clinical and morphological variables were evaluated by univariate and multivariate analysis in 70 patients with invasive transitional-cell carcinoma of the bladder (pTI-pT4a). The patients were treated according to a prospective program consisting of radical cystectomy and pelvic-node dissection, either alone or followed by adjuvant cisplatinum chemotherapy. Nodal status was pN0 in 89% of the patients. The median follow-up time was 5.75 years and the 5-year survival was 58%. Among the morphologic variables, deep invasion of the bladder wall and squamous differentiation indicated a poorer prognosis. Differentiation grade, pattern of growth (infiltrating versus expanding), angioinvasive growth, glandular differentiation and concomitant prostate carcinoma (pT1) were not significative factors for survival. By contrast, a significant reduction in mortality rate was found in patients with concomitant carcinoma in situ. Multivariate analysis confirmed that depth of invasion is an independent prognostic factor of outcome. The results confirm the primary importance of tumor stage in the prediction of survival after radical cystectomy.

At present there are no firm data for the routine use of adjuvant chemotherapy in stage II testicular cancer after retroperitoneal lymph node dissection. The possible advantage of adjuvant chemotherapy in terms of reduced relapse rate and continuously disease free survival have to be weighed against the increasing cure rates with modern chemotherapy regimen, applied at the time of advanced and recurrent disease. About 10-15% of stage I and 40-50% of stage II patients relapse after RPLND. Depending on risk factors such as total tumor burden, histology and disease sites and symptoms at the time of presentation, 30-90% of these patients are brought into complete remission with modern chemotherapy (overall between 50 and 70%). Based on these results, a subgroup of patients with a low risk of relapse and a more than 90% chance of cure with salvage chemotherapy may be defined. They do not need adjuvant chemotherapy with its associated toxicity. On the other hand, in a high risk group, which demonstrates poor results with salvage chemotherapy, adjuvant chemotherapy seems to have the potential to significantly improve the cure rate. A third group of patients, presenting with bulky abdominal disease may need immediate postdiagnostic intensive chemotherapy, with surgical exploration only at the time of maximum response. The question of definition of optimal treatment strategies in the various subgroups of patients with testicular cancer can only be solved by ongoing and future randomized clinical trials.

A study was designed to evaluate the effectiveness of prednisone therapy in poor-risk patients with multiple myeloma. Patients were treated with melphalan alone or in combination with prednisone at doses of either 0.6 mg/kg or 0.3 mg/kg. The group of patients receiving melphalan and prednisone 0.6 mg/kg had significantly improved responses in hemoglobin, lowering of the M-protein concentration, and reduction of azotemia. Significant benefits attributable to prednisone were not demonstrated in the group receiving 0.3 mg/kg. Good responses have been shown to produce improved survival. The combination of melphalan and prednisone is effective in producing good responses, but the dose of steroids is important. A dose of prednisone of 0.6 mg/kg in gradually decreasing doses has been found to be effective in production of good responses, especially in the uremic patient.

Twenty-three patients with non-small cell lung cancer were treated with a combination of cis-dichlorodiammineplatinum (II) 100 mg/m2 IV on day 1 and VP 16-213 80 mg/m2 IV on days 1-3. Eighteen patients are evaluable for response. Seven partial remissions with a median duration of 3 months (range, 1-13+) have been observed. Three patients exhibit stable disease, and eight patients show tumor progression. Overall survival was 5+ months (range, 1-13+); 7.5 months (range, 3-13+) for responders and 3+ months (range, 1-9+) for non-responders. Hematologic toxicity was acceptable, but poor subjective tolerance (nausea, vomiting, loss of appetite) was the main factor limiting treatment duration.