Local Microwave Hyperthermia in Treatment of Advanced Prostatic Adenocarcinoma

210

CALCULUS

Phase II studies in humans with advanced prostatic cancer have shown response rates in previously untreated patients ranging from 66 to 90 per cent with stabilization of the disease for up to 30 weeks. Some side effects have been observed but flutamide seems to have little effect on libido and potency. However, the trials comparing flutamide with conventional therapy are few. The authors report their study of the comparison of flutamide versus estrogen therapy for previously untreated patients with advanced carcinoma of the prostate. In a prospective randomized study the effect of 750 mg. flutamide daily was compared to that of 3 mg. diethylstilbestrol daily in the treatment of 40 previously untreated patients with advanced prostatic cancer. There was a good subjective response to both treatments. After 12 months a response was demonstrated in 13 of 20 patients treated with flutamide and 8 of 20 treated with diethylstilbestrol. The difference was not statistically significant. Treatment with diethylstilbestrol caused more frequent and more severe side effects than flutamide. 5 tables, 6 references William W. Hoffman, M.D. Dallas, Texas

Local Microwave Hyperthermia in Treatment of Advanced Prostatic Adenocarcinoma S. SzMIGIELSKI, H. ZIELINSKI, B. STAWARZ, J. GIL, J. SOBCZYNSKI, G. SOKOLSKA, J. JELJASZEWICZ AND G. PULVERER, Center for Radiobiology, Department of Clini-

cal Urology, MMA Postgraduate Medical School, National Institute of Hygiene, Warsaw, Poland and Institute of Hygiene, University of Cologne, Cologne, Federal Republic of Germany Urol. Res., 16: 1-7 (Jan.) 1988 The authors report on the effects of local microwave hyperthermia in 15 patients with advanced prostatic adenocarcinoma. Of the patients 12 with clinically progressive disease completed previous treatment at least 6 months before local microwave hyperthermia. Three patients with advanced neoplasms were qualified for local microwave hyperthermia without any former therapy. For intrarectal interstitial local microwave hyperthermia the authors designed and constructed an original applicator matched for 2,450 MHz. microwave radiation. Local microwave hyperthermia was given in 2 sets of 3 sessions lasting 30 minutes each, with a 4-week break between sets, with single sessions in the set applied every 3 days (twice weekly). Of 15 patients treated with local microwave hyperthermia 3 had a complete remission lasting for at least 1.5 years (in 2 of these 3 the bony metastasis disappeared). Five patients showed improvement in general clinical state as evidenced by the disappearance of pain and relief of bladder outlet obstruction. The nonresponders showed a much larger prostatic volume (mean volume 97.3 cm. 3 ) compared to the responders (mean volume 33 cm. 3 ). Based on these results the authors believe that local microwave hyperthermia may be useful for palliative treatment of advancedprostatic cancer, especially when other forms of therapy have failed. Combination local microwave hyperthermia with other anticancer modalities may significantly increase the

chance of complete remission in patients with advanced prostatic cancer. 3 figures, 4 tables, 26 references Pramod R. Rege, M.D. Cincinnati, Ohio

CALCULUS Renal Calcification Incidence in Very Low Birth Weight Infants J. S. JACINTO, H. D. MODANLOU, STRAUSS AND S. K. Bosu, Division

M. CRADE, A. A. of Neonatal-Perinatal Medicine, Miller Children's Hospital, Memorial Medical Center of Long Beach, University of California, Irvine, California

Pediatrics, 81: 31-35 (Jan.) 1988 A study was designed to establish the incidence of renal calcification in premature infants and to examine those factors that lead to an increased risk of calcification in this select group. The authors studied 31 neonates less than 1,500 gm. serially with ultrasonography to detect the incidence of renal calcification. Of the patients 20 (64 per cent) had renal calcifications at a mean age of 39 days. Increased risks included shorter gestation (28 versus 31 weeks), low birth weight (924 versus 1,338 gm.) and furosemide administration (65 versus 9.1 per cent). The combination of furosemide, a calciuric diuretic agent, and parenteral calcium supplements given to neonates may increase the risk of renal calcification in these low birth weight infants. The long-term sequelae of these calcifications are not known although no neonate had any abnormality in blood pressure or renal function. The authors recommend close monitoring of small low birth weight neonates for renal calcification by serial ultrasonography, and monitoring of the renal function by urinary calcium and creatinine excretions. 2 figures, 2 tables, 18 references Robert Kay, M.D. Cleveland, Ohio

Editorial comment. This is a high and impressive incidence of renal calcifications in an otherwise unselected series of low birth weight infants. Every pediatric urologist has seen such patients, often in consultation because of fever of unknown origin. The urine seldom is infected. Because of the small size of these patients even when they are several months old Drs. K. S. Kim and C. C. Carson and I devised an extension to the back support of the Dornier lithotriptor to allow us to treat small patients. We tried it on 4 to 4½ kg. rabbits (under anesthesia) and we were able to position the kidneys in the shock zone without running a risk of submerging them. We then successfully treated a 5.3 kg. male infant with persistent pain and hematuria secondary to stones when he was 8 months old. Five calculi (3 in 1 kidney and 2 in the other) were fragmented successfully at a single session and he has since remained free of stone. We believed that business would be brisk. However, it seems that many of these stones formed particularly in small infants when on furosemide and they usually dissolve spontaneously as the child ages and the need for the diuretic is reduced. More information is needed on the natural history of this disease. Lowell R. King, M.D. Durham, North Carolina