(Objective) We report the short-term results of intensity modulated radiotherapy (IMRT) for localized and locally advanced prostate cancer. (Patients and methods) The study was conducted on the total of 53 patients receiving IMRT in our hospital from July 2007 to November 2010 (25 patients receiving IMRT alone and 28 patients receiving neoadjuvant hormone therapy before IMRT). (Results) The period of neoadjuvant hormone therapy was 1 to 29 months (median 7 months). 6 patients were in the low risk group, 15 in the intermediate risk group, and 32 in the high risk group according to the D'Amico risk classification criteria. With the prescribed dose of 70 Gy to 74 Gy, prostates were irradiated locally. The follow-up period was 18 to 48 months (median 30 months). The overall 3-year PSA relapse-free survival rate was 90.0%. The 3-year PSA relapse-free survival rate for the patients in low-, intermediate- and high-risk groups were 80.0%, 93.3%and 90.0%, respectively. The 3-year PSA relapse-free survival rate based on the presence or absence of neoadjuvant hormone therapy were 95.8%and 81.7%, respectively. Acute-phase adverse events (NCI/CTCAE) were observed in 32 patients (60.4%), and all were grade 1 or 2. No late adverse events were observed. (Conclusion) IMRT is possible treatment for localized and locally advanced prostate cancer without high-grade toxicity. We continue to evaluate the efficacy and durability of IMRT.
(Objective) Direct vision internal urethrotomy (DVIU) has been considered to be a low invasive and widely used therapeutic modality for male urethral stricture. However, its efficacy is still controversial. We herein evaluated the efficacy of DVIU for male urethral stricture. (Patients and methods) Nineteen patients 27 to 78 years old (median age=59) underwent DVIU for urethral strictures at our hospital were included in this study. Strictures were at bulbar urethra in 17 patients, membranous urethra in 1 patient, and pendulous urethra in 1 patient. The stricture lengths estimated on retrograde urethrography were less than 1 cm in 13 patients, 1-2 cm in 2 patients, and more than 2 cm in 4 patients. The etiology of stricture was straddle injury in 7 patients, post transurethral surgery in 7 patients, pelvic fracture in 1 patient, and unknown in 4 patients. The operation was done by cold knife incision using guidewire. The duration of postoperative urethral catheterization was 5 to 35 days (mean 12.8 days). Follow up duration ranged from 1 month to 139 months (mean 48.2 months). The definition of postoperative re-stricture was the confirmation of re-stricture on retrograde urethrography or deterioration of symptom. (Results) While no severe complication was observed, postoperative re-stricture was seen in 13 patients. Stricture-free rates at 3 months, 6 months, and 5 years after the first DVIU were 44.4%, 38.1%, 20.3%respectively. Although second DVIU was done for 7 patients with re-stricture, six patients resulted in failure. Stricture-free rates at 3 months, 6 months, and 5 years after the second DVIU were 42.2%, 28.6%, 14.3%respectively. Though the third DVIU was done for two of them, they were unable to void just immediately after the removal of urethral catheters. Stricture-free rate in stricture less than 1 cm was higher than that in 1 cm or longer, though it did not reach significant difference (p=0.1813). (Conclusion) The efficacy of DVIU is lesser than we expected. DVIU seems to be excessively applied to male urethral strictures and should not be performed for long and recurrent urethral stricture.
Angiosarcoma is rare and highly malignant vascular neoplasm, and primary retroperitoneal angiosarcoma is extremely rare. Preoperative diagnosis is very difficult because there are no specific imaging features, and definitively effective treatment has not yet been established. We recently treated a patient with primary retroperitoneal angiosarcoma in which a prompt and exact diagnosis was difficult to obtain. One month after surgery, local recurrence appeared, but salvage immunotherapy using recombinant interleukin-2 (rIL-2) showed good efficacy, and the patient obtained complete response. Here we report this rare case of angiosarcoma. A 60-year-old woman with abdominal pain was diagnosed with a left retroperitoneal mass on CT scan. The tumor was about 9 cm in diameter and positioned above the left kidney. Further study using MRI, 131I-MIBG scintigraphy, and enhanced CT suggested chronic expanding hematoma and the patient underwent surgical resection. Histopathological diagnosis was primary retroperitoneal angiosarcoma based on positive staining for VIII factor, CD31, CD34, and p53. One month after surgery, FDG-PET revealed local recurrence adjacent to the psoas major. We initiated salvage immunotherapy using rIL-2. The patient was treated effectively and achieved complete response. She is alive and well 19 months after surgery and rIL-2 treatment.
We reported a case of primary seminal vesicle cancer, detected by FDG-PET/CT. A 65-year-old man with constipation and appetite loss was admitted to our hospital. An ultrasound examination revealed evidence of bilateral hydronephrosis. He was diagnosed as acute post renal failure, and nephrostomy was done. CT and MRI showed a solid mass in the area of seminal vesicle. He underwent transrectal core biopsy, which histologically showed poorly differentiated adenocarcinoma. Immunohistochemistry showed the tumor to be CA125 positive, CEA positive and CK7 positive but PSA negative. FDG-PET/CT revealed an increased uptake of FDG only in the area of seminal vesicle. Serum CA125 was elevated and PSA stayed within normal limit. Primaly rectal carcinoma was ruled out by colonoscopy. The result of transperineal prostate biopsy was negative. We diagnosed him as suffering from primary seminal vesicle carcinoma. Anti-androgen blockade and radiotherapy to whole pelvis were performed, and serum CA125 level was improved. But, 6 months later serum CA125 re-elevated and 19 months later multiple liver metastases were noted. The patient received two cycles of docetaxel and cisplatin chemotherapy, however he developed pulmonaly embolism and rectal bleeding by tumor invasion and he died of his disease 22 months after the diagnosis.
A 40-year-old man was referred to our department for left renal tumor pointed out on a checkup ultrasonography. CT (computed tomography) and MRI (magnetic resonance imaging) demonstrated left renal tumor, clinically T2N0M0. Percutaneous renal needle biopsy was performed because of malignant lymphoma was suspected. Pathological diagnosis was malignant tumor. However, malignant lymphoma could not denied. Therefore, left nephrectomy was performed retroperitonealy. Histological examination revealed myeloid sarcoma of the kidney. Myeloid sarcoma is a rare tumor composed of leukemia cells and usually progresses to acute myelogenous leukemia. To our knowledge, our case is the first report of myeloid sarcoma of the kidney in Japan.