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Surgical treatment
WHAT’S
NEW IN MEETINGS
NATIONAL CONFERENCE CANCER OF AMERICAN
ON UROLOGIC CANCER SOCIETY*
Washington, D.C. March 29 to 31, 1973 Cancer
of Kidney
Surgical Treatment Charles J. Robson, M.D. University of Toronto The treatment for renal-cell carcinoma should be radical nephrectomy in all potentially curable patients. Whether pre- or postoperative irradiation is added or hormone or chemotherapy is used, does not alter the fact that up to the present time, primary curative treatment is surgical intervention. Radical nephrectomy should include removal of the kidney, all the retroperitoneal fat contained within an intact envelope of parietal peritoneum and Gerota’s fascia, together with the lymphatic drainage near the great vessels of the side involved. The extent of dissection should be from the crus of the diaphragm to the bifurcation of the aorta and the junction of the iliac vessels. Radiation Therapy in Management of Renal Tumors Jerome M. Vaeth, M.D. University of California School of Medicine Traditionally cancer of the kidney, with the exception of Wilms’ tumors, has been regarded as radio resistant and nonradiocurable. Laboratory and clinical evidence is accumulating which indicates that, indeed, adenocarcinoma of the kidney, as well as renal pelvis cancers are radiosensitive. Radiation therapy utilizing supervoltage or megavoltage quality radiation is indicated as a surgical adjuvant either pre- or postnephrectomy-rarely as the sole modality of treatment. In situations in which postoperative irradiation is of value, preoperative radiotherapy is of value, perhaps even more so. Postoperative radiation therapy is indicated in all instances where there has been incomplete removal of the tumor, regional lymph node metastases are present, or venous invasion is present. A higher radiation dosage is necessary in the postoperative than in the preoperative period. The limiting factor in total dosage is the radiosensitivity of adjacent normal structures, such as small bowel, stomach, and spinal cord. Radiation therapy can also be of palliative value in the management of locally recurrent or metastatic disease. The Rotterdam Trial on Carcinoma of the Kidney Brigit Van Der We&Messing, M.D. Rotterdam, Netherlands The Rotterdam started in 1965.
trial on carcinoma of the kidney Patients with clinically localized
*Sponsored by: American Cancer Society; American Urological Association; American College of Surgeons; American Society of Therapeutic Radiologists; and American Academy of Pediatrics.
492
carcinoma of the kidney were treated either by nephrectomy only or by preoperative irradiation immediately followed by nephrectomy. A total of 126 cases have been admitted up to July, 1972. An analysis was presented of survival rates, the incidence of incomplete removal of the primary tumor, the causes of death, the complications, and the incidence of metastases. These data were related to the pathologic stage of the primary growth and to the type of treatment.
Chemotherapy of Renal Tumors Robert W. Talley, M.D. Henry Ford Hospital Despite the development of many new cancer chemotherapeutic programs, metastatic renal carcinoma has remained unresponsive either to single or combinations of therapeutic agents. Extensive review of the literature and personal experience at Henry Ford Hospital have failed to find either a single or a combination of agents which produces consistent response rates. Single available agents which have been employed include: (1) a variety of alkylating agents, no response in 49 patients; (2) antimetabolites, including 5fluorouracil, hydroxyurea, methotrexate, mercaptoand cytosine arabinoside, no significant purine, response in 31 patients; (3) antibiotics, Actinomycin D, no response in 5 patients; and (4) the periwinkle alkaloid antimitotic, vinblastine sulfate, 1 objective regression in 18 patients. Newer agents also have been unrewarding, with no objective remissions observed in 10 patients treated with dimethyl imidazole carboxamide, 8 patients treated with adriamycin, and 3 patients treated with 5-azacytidine. No responses were observed in 10 patients treated with the nitrosoureas. Also, combinations, including agents such as cyclophosphamide, 5-fluorouracil, vinblastine sulfate, methotrexate, and prednisone, 6 patients treated with such regimens have shown no response. A review of the literature yields only occasional well-documented objective remissions with a variety of agents.
Hormone Treatment of Advanced Adenocarcinoma of the Kidney H. J. G. Bloom, M.D. The Royal Marsden Hospital, London Ten publications between 1964 and 1971 suggest that tumor regression can be induced by hormone therapy in a limited number of patients with metastatic renal cancer. Subjective improvement occurs in about 50 per cent of treated cases. Of 272 collected cases from the various reports (including a personal series of 80) who were treated with progestins and/or androgens, the overall objective response rate was 15 per cent, the range being 6 to 33 per cent. In this author’s series, if gravely ill patients who died within
UROLOGY
/ MAY 1973
/ VOLUME
I, NUMBER
5
NEW IN MEETINGS
NATIONAL CONFERENCE CANCER OF AMERICAN
ON UROLOGIC CANCER SOCIETY*
Washington, D.C. March 29 to 31, 1973 Cancer
of Kidney
Surgical Treatment Charles J. Robson, M.D. University of Toronto The treatment for renal-cell carcinoma should be radical nephrectomy in all potentially curable patients. Whether pre- or postoperative irradiation is added or hormone or chemotherapy is used, does not alter the fact that up to the present time, primary curative treatment is surgical intervention. Radical nephrectomy should include removal of the kidney, all the retroperitoneal fat contained within an intact envelope of parietal peritoneum and Gerota’s fascia, together with the lymphatic drainage near the great vessels of the side involved. The extent of dissection should be from the crus of the diaphragm to the bifurcation of the aorta and the junction of the iliac vessels. Radiation Therapy in Management of Renal Tumors Jerome M. Vaeth, M.D. University of California School of Medicine Traditionally cancer of the kidney, with the exception of Wilms’ tumors, has been regarded as radio resistant and nonradiocurable. Laboratory and clinical evidence is accumulating which indicates that, indeed, adenocarcinoma of the kidney, as well as renal pelvis cancers are radiosensitive. Radiation therapy utilizing supervoltage or megavoltage quality radiation is indicated as a surgical adjuvant either pre- or postnephrectomy-rarely as the sole modality of treatment. In situations in which postoperative irradiation is of value, preoperative radiotherapy is of value, perhaps even more so. Postoperative radiation therapy is indicated in all instances where there has been incomplete removal of the tumor, regional lymph node metastases are present, or venous invasion is present. A higher radiation dosage is necessary in the postoperative than in the preoperative period. The limiting factor in total dosage is the radiosensitivity of adjacent normal structures, such as small bowel, stomach, and spinal cord. Radiation therapy can also be of palliative value in the management of locally recurrent or metastatic disease. The Rotterdam Trial on Carcinoma of the Kidney Brigit Van Der We&Messing, M.D. Rotterdam, Netherlands The Rotterdam started in 1965.
trial on carcinoma of the kidney Patients with clinically localized
*Sponsored by: American Cancer Society; American Urological Association; American College of Surgeons; American Society of Therapeutic Radiologists; and American Academy of Pediatrics.
492
carcinoma of the kidney were treated either by nephrectomy only or by preoperative irradiation immediately followed by nephrectomy. A total of 126 cases have been admitted up to July, 1972. An analysis was presented of survival rates, the incidence of incomplete removal of the primary tumor, the causes of death, the complications, and the incidence of metastases. These data were related to the pathologic stage of the primary growth and to the type of treatment.
Chemotherapy of Renal Tumors Robert W. Talley, M.D. Henry Ford Hospital Despite the development of many new cancer chemotherapeutic programs, metastatic renal carcinoma has remained unresponsive either to single or combinations of therapeutic agents. Extensive review of the literature and personal experience at Henry Ford Hospital have failed to find either a single or a combination of agents which produces consistent response rates. Single available agents which have been employed include: (1) a variety of alkylating agents, no response in 49 patients; (2) antimetabolites, including 5fluorouracil, hydroxyurea, methotrexate, mercaptoand cytosine arabinoside, no significant purine, response in 31 patients; (3) antibiotics, Actinomycin D, no response in 5 patients; and (4) the periwinkle alkaloid antimitotic, vinblastine sulfate, 1 objective regression in 18 patients. Newer agents also have been unrewarding, with no objective remissions observed in 10 patients treated with dimethyl imidazole carboxamide, 8 patients treated with adriamycin, and 3 patients treated with 5-azacytidine. No responses were observed in 10 patients treated with the nitrosoureas. Also, combinations, including agents such as cyclophosphamide, 5-fluorouracil, vinblastine sulfate, methotrexate, and prednisone, 6 patients treated with such regimens have shown no response. A review of the literature yields only occasional well-documented objective remissions with a variety of agents.
Hormone Treatment of Advanced Adenocarcinoma of the Kidney H. J. G. Bloom, M.D. The Royal Marsden Hospital, London Ten publications between 1964 and 1971 suggest that tumor regression can be induced by hormone therapy in a limited number of patients with metastatic renal cancer. Subjective improvement occurs in about 50 per cent of treated cases. Of 272 collected cases from the various reports (including a personal series of 80) who were treated with progestins and/or androgens, the overall objective response rate was 15 per cent, the range being 6 to 33 per cent. In this author’s series, if gravely ill patients who died within
UROLOGY
/ MAY 1973
/ VOLUME
I, NUMBER
5