Clinical efficiency of combination therapy using testosterone replacement therapy, phosphodiesterase 5 inhibitors and Kampo herbal medicine for eugonadal patients with late-onset hypogonadism syndrome.

In the present study, the initial treatment efficiency of combination therapy using testosterone replacement therapy (TRT), herbal medicine and phosphodiesterase 5 inhibitors (PDE5i) in male patients with late-onset hypogonadism (LOH) were assessed. A total of 21 patients were enrolled and after 12 weeks, the clinical efficacy was evaluated based on improvement of LOH symptoms via laboratory parameters and several questionnaires, including the Ageing Males' Symptoms (AMS) scale. The overall AMS scores, as well as the psychological, physical and sexual AMS factors prior to and after treatment in the TRT, testosterone enanthate (T enanthate) monotherapy and T enanthate + PDE5i treatment groups were significantly improved. In the herbal medicine group, only the AMS physiological factors were significantly improved after treatment compared with the baseline. The improvement of the overall AMS scores, as well as the physiological and sexual AMS factors, were significantly negatively correlated with the free testosterone (FT) value prior to treatment. In conclusion, treatment with combination therapy using TRT, herbal medicine and PDE5i improved AMS scores in patients with LOH syndrome. Particularly in patients with LOH syndrome and low FT, the symptoms were significantly improved following combination therapy.

[Current Status of Prostate Cancer and Its Relation to Home Medical Care].

Because ofboth the indolent and aggressive nature ofprostate cancers, it is not easy to select the best treatment for patients receiving home medical care who already have many diseases. Since the growth ofprostate cancer is generally slow and all treatments adversely affect the quality of life to some degree, conservative treatment may well be the best option for these patients with prostate cancer. However, it is also true that we often encounter home medical care patients with a locally advanced cancer who had symptoms such as difficulty to urine, macrohematuria and/or lumbago. Such patients need to be diagnosed soon and treated with mainly hormonal therapy after consultation with the specialist. Thus, after a careful evaluation ofthe nature ofthe cancer and comorbidity, we need to provide the best option ofdiagnosis and treatment for home medical care patients to maintain their quality of life.

Clinical characteristics in urolithiasis formation according to body mass index.

Although urolithiasis is considered to be strongly associated with lifestyle habits, there are numerous cases in which urolithiasis develops despite a non-obese body type or healthy lifestyle habits. However, in clinical practice, the diet therapy and lifestyle changes instructed for the prevention of recurrence of urolithiasis are almost identical in numerous cases. Therefore, the present study examined the effect of body mass index (BMI) on urolithiasis and its surrounding environment in patients, by analyzing the number of normal- and high-BMI (healthy and overweight) patients with urolithiasis. The present study analyzed 63 patients with urolithiasis for whom height and weight were measured at our hospital (Tokyo Medical University Ibaraki Medical Center). BMI <25 represents healthy body types and BMI ≥25 BMI defines overweight body types. Thus, patients were then grouped by BMI-defined body type using a threshold value of 25 accordingly. It was observed that a higher percentage of males were obese compared with females. Upon comparing the normal- and high-BMI groups, no significant difference was observed in uric acid level, urine pH or calculus number between the two groups. Liver computed tomography (CT) values were significantly lower in the high-BMI group compared with the normal-BMI group. There was no significant correlation between calculus size counts and BMI. However, a significant negative correlation was observed between BMI and the liver CT value. These results suggest that liver CT values correlated negatively with BMI, but the data indicates that other mechanisms unassociated with a fatty liver may be involved in urolithiasis in non-obese patients. The results of the present study suggest that physicians should consider the mechanism involved in preventing the recurrence of urolithiasis.

Molecular targeted therapies of renal cell carcinoma considering life stage of the patient: Two case reports.

Molecular targeted therapies have markedly improved the prognosis of metastatic renal cell carcinoma (RCC) and patients are able to receive specific treatments depending on their condition. The cases of two patients who presented with large RCC with very different statuses were examined in the current study. One of the patients was elderly with numerous comorbidities, and the other was young and had Case 1 was an elderly female with various comorbidities including a history of cerebral infarction and impaired eyesight. A 7 cm solid mass in the left kidney, pulmonary metastases and a shrunken right kidney were identified. Conservative treatment was selected and the patient underwent treatment with oral sorafenib for 5 years without experiencing disease progression. Case 2 was a middle-aged male in a good general condition who had a 19 cm left renal mass and multiple metastases. Due to the tumor size, the patient was initially treated with oral pazopanib to reduce the renal tumor volume and was able to undergo left radical nephrectomy after 6 months. Molecular targeted therapies were thus used to treat these patients taking into account each patient's life stage; case 1 was treated without surgery for six years and case 2 received treatment as a neoadjuvant.

Clinicopathological Assessment of Gastric Xanthoma as Potential Predictive Marker of Gastric Cancer.

BACKGROUND/AIMS: Gastric xanthomas are frequently observed in the stomach as small yellowish plaques or nodules. A close relationship among Helicobacter pylori infection, atrophic gastritis, and xanthomas has been reported. We assessed the clinicopathological features of gastric cancer with or without xanthomas. METHODS: A total of 91 patients who were diagnosed as having early gastric cancer were enrolled. We evaluated the gastritis status using scores for gastritis and atrophy, positivity of H. pylori infection, the prevalence rate of xanthomas, and the clinicopathological features of gastric cancer. RESULTS: Gastric xanthomas were observed in 72.5% of early gastric cancer cases. Scores for gastritis and atrophy were significantly higher in the xanthoma-positive group than those in the xanthoma-negative group. A higher prevalence of differentiated-type adenocarcinoma was found in the xanthoma-positive group. Among the cases with multiple gastric xanthomas, the prevalence of males was significantly higher than that of females. CONCLUSION: A high prevalence rate of gastric xanthomas in gastric cancer cases was shown. Xanthomas were highly associated with age, the severities of gastritis and atrophy, and differentiated-type adenocarcinoma. Regardless of the eradication of H. pylori, xanthomas may be useful predictive markers for the development of differentiated-type adenocarcinoma.

Clinical significance of the prostate-specific antigen doubling time prior to and following radical prostatectomy to predict the outcome of prostate cancer.

With the advent of serum prostate-specific antigen (PSA), a larger number of prostate cancers in the early phase have been successfully detected. Although decisions to perform prostate biopsies are routinely based on PSA levels, the PSA level is easily influenced by benign prostatic hyperplasia, with poor specificity. Therefore, the aim of the present study was to assess the clinical significance of prostate-specific antigen doubling time (PSADT) prior to and following radical prostatectomy. In total, 488 patients with T1c-3N0M0 prostate cancer who underwent radical prostatectomy were included. Preoperative and postoperative PSADT were retrospectively correlated with pathological and clinical outcomes. Preoperative PSADT was measured in 204 of the 488 patients. In total, 16 out of 20 patients with a preoperative PSADT of >24 months had a cancer confined to the prostate compared with 105 of 184 patients with a PSADT of <24 months. The PSA non-recurrence rate at 5 years for patients with a preoperative PSADT of >24 months was significantly better compared with those with a preoperative PSADT of <24 months (P=0.011). Patients with a PSADT of >24 months and stable PSADT were associated with PSA recurrence following surgery, based on multivariate analysis. Postoperative PSADT was measured in 51 of 111 patients with PSA failure following surgery. Pathologically, 7 of 8 patients with a post-PSADT of >24 months had a cancer confined to the prostate compared with 14 of 43 patients with a post-PSADT of <24 months. These results suggest that patients with longer preoperative PSADTs appeared to have a favorable pathological result and a higher PSA non-recurrence rate compared with those with shorter preoperative PSADTs. A longer postoperative PSADT may facilitate the observation of patients with PSA recurrence without immediate secondary treatments.

Granulomatosis with Polyangiitis (Wegener's Granulomatosis) Accompanied by Dysuria.

A 65-year-old male visited us with complaints of retarded urination, dysuria, gross hematuria, and fever. Urinalysis showed pyuria. Prostatic tumor with lung metastasis was suspected from computed tomography and magnetic resonance imaging. Transurethral prostatic biopsy and bronchoscopic biopsy only revealed fibrinoid necrosis and inflammatory infiltration. Right lateral maxillary sinusitis was also found by MRI. ANCA testing was positive with specificity for anti-PR3 (PR3-ANCA). On the basis of these results, Granulomatosis with polyangiitis (GPA) was diagnosed. GPA involving the prostate gland is unusual, and only a few cases have previously been reported.

Predominance of M2-polarized macrophages in bladder cancer affects angiogenesis, tumor grade and invasiveness.

Tumor-associated macrophages (TAMs) often assume an immunoregulatory M2 phenotype. Thus, the aim of the present study was to clarify the correlation of vascularity and TAMs, in particular the M2 phenotype in the stroma and tumor areas, with the clinical and pathological outcomes of patients with bladder cancer. The TAM counts and microvessel counts (MVCs) were determined immunohistochemically in 21 patients with bladder cancer. The number of infiltrating TAMs was measured using immunohistochemistry with anti-cluster of differentiation (CD)68 and anti-CD163 antibodies, to identify a macrophage lineage marker and an M2-polarized-specific cell surface receptor, respectively. CD68+ and CD163+ macrophages were evaluated in the stroma and tumor areas, and areas with a high density of infiltrating cell spots were counted. MVCs were determined using immunohistochemistry with anti-CD34 antibodies. The results revealed that the higher ratio of CD163+/CD68+ macrophages in the stroma, tumor and total tumor tissues were correlated with a higher stage and grade (P<0.05). In addition, the low ratio of CD68+/CD34+ microvessels was correlated with a higher stage (P<0.05). There was also a positive correlation between TAMs and MVC (r2=0.25; P<0.05). These results suggest that the TAM polarized M2 phenotype affects microvessels, pathological outcome, tumor grade and invasiveness.

CDODA-Me decreases specificity protein transcription factors and induces apoptosis in bladder cancer cells through induction of reactive oxygen species.

OBJECTIVE: The objective is to determine whether methyl 2-cyano-3,11-dioxo-18b-olean-1,12-dien-30-oate (CDODA-Me) has therapeutic potential in bladder cancer. We investigated the effects of CDODA-Me on the growth and survival of bladder cancer cells, and expression of specificity protein (Sp) transcription factors that regulate genes associated with cancer cell proliferation and survival. METHODS: J82, RT4P, and 253JB-V bladder cancer cell lines were treated with vehicle alone or with CDODA-Me with or without the antioxidant l-glutathione. Cell viability and DNA fragmentation were measured by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay and propidium iodide-fluorescence-activated cell sorting (FACS) analysis, respectively. Intracellular reactive oxygen species (ROS) were measured by 2',7'-dichlorofluorescin diacetate-FACS analysis. We assessed CDODA's effects on the levels of Sp and Sp-regulated proteins and induction of apoptosis in bladder cancer cells by Western blotting. We also assessed the anticancer effects of CDODA-Me in nude mice bearing RT4v6 bladder cancer. RESULTS: 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay and FACS analysis revealed that CDODA-Me inhibited the proliferation and survival of the 3 bladder cancer cell lines in a dose-dependent manner. FACS analysis also indicated that CDODA-Me-induced intracellular ROS, and Western blot analysis indicated that CDODA-Me decreased levels of Sp and Sp-regulated proteins and induced apoptosis in a dose-dependent and time-dependent manner. l-Glutathione attenuated CDODA-Me's down-regulation of Sp and Sp-regulated proteins. Compared with the control treatment, CDODA-Me substantially inhibited tumor growth in vivo. CONCLUSIONS: CDODA-Me has antineoplastic activity in bladder cancer cells by inducing ROS, which down-regulate Sp and Sp-regulated proteins. Thus, CDODA-Me has therapeutic potential in bladder cancer, and additional studies of the agent's efficacy and mode of action are warranted.

Annular rectal constriction caused by infiltrating bladder cancer: A case report.

A 69-year-old man was referred to our hospital with chief complaints of urinary incontinence, pollakiuria, thin stools and edema of the left lower extremity. Computed tomography and magnetic resonance imaging revealed bilateral hydronephrosis, thickening of the rectal and posterolateral bladder walls, and enlargement of the left obturator lymph nodes, suggesting metastasis. The carcinoembryonic antigen and carbohydrate antigen 19-9 levels were 5.6 ng/ml and 460.1 U/ml, respectively. A transurethral bladder biopsy revealed grade 2 urothelial carcinoma with glandular differentiation. A transrectal needle biopsy suggested cancer infiltration of the rectal wall and an annular rectal constriction caused by an infiltrating bladder cancer was diagnosed. Three courses of gemcitabine and cisplatin chemotherapy were administered and demonstrated good efficacy.

Incidental Presacral Myelolipoma Resembling the Liposarcoma: A Case Report and Literature Review.

Presacral myelolipomas are rare, benign, asymptomatic tumors composed of mature adipose tissue and hematopoietic elements, but fewer than 50 cases have been reported in the literature. They are usually discovered incidentally during imaging studies and are often misdiagnosed as liposarcoma, which have a malignant nature, because the imaging findings of myelolipoma can be similar to those of liposarcoma. It is challenging to distinguish presacral myelolipomas from other presacral fat-containing tumors without performing a histological examination. We should consider the possibility of a malignant tumor, and imaging-guided biopsy carries a risk of tumor spread along the biopsy tract. Therefore, surgical management might sometimes be required; however, it is not necessary in all cases. We present an incidentally detected case of presacral myelolipoma that was difficult to differentiate from other malignant tumors in a 71-year-old male.

Sequential gemcitabine and tamoxifen treatment enhances apoptosis and blocks transformation in bladder cancer cells.

Bladder cancer is a common malignancy for which regional or metastatic disease is identified at diagnosis. The aim of this study was to determine whether tamoxifen (Tam), an estrogen receptor (ER) antagonist, can sensitize bladder cancer cell lines to gemcitabine (Gem) chemotherapy. ERα and ERß protein levels were determined in each cell line using western blot analysis. The TCC-Sup, 5637, and RT4 bladder cancer cells were exposed to various concentrations and regimens of Tam or Gem alone or in combination. Cell viability and apoptosis were assessed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay and propidium iodide followed by flow cytometry. Apoptosis was then evaluated by western blot analysis. Treated TCC-Sup cells were subjected to soft agar colony formation assay to determine the cellular transformation. Western blot analysis results revealed ER expression in the three cell lines. TCC-Sup and 5637 cells treated with a combination of Tam and Gem had lower cell viabilities than those treated with Tam or Gem alone for 72 h in TCC-Sup and 5637. Compared with the other treatments, sequential Gem followed by Tam (Gem→Tam) treatment caused the largest increase in DNA fragmentation at 72 h in TCC-Sup cells. Western blot analysis results revealed that this sequential Gem→Tam treatment increased poly(ADP-ribose) polymerase cleavage in TCC-Sup cells. Sequential Gem→Tam inhibited the cell transformation in TCC-Sup cells. In conclusion, sequential Gem→Tam enhanced the cytotoxicity of Gem in vitro. This regimen be useful to enhance the efficacy of Gem in bladder cancer. However, future in vivo studies are required to verify the results.

Factors predicting incisional surgical site infection in patients undergoing open radical cystectomy for bladder cancer.

BACKGROUND: The risk factors of incisional surgical site infection (iSSI) after open radical cystectomy (ORC) have not been fully investigated. The aim of the present study is to examine factors correlated with iSSI development after ORC with intestinal urinary diversion. METHODS: A total of 178 patients who had undergone ORC with intestinal urinary diversion between 2003 and 2012 at our institution were included in this retrospective study. Correlations between different perioperative factors and iSSI development were determined using univariate and multivariate logistic regression analyses. RESULTS: iSSI was observed in 53 patients (29.8 %). In the univariate analysis, age, diabetes mellitus, thickness of subcutaneous fat (TSF), and allogeneic transfusion were significant predictors of iSSI development. Although subcutaneous closed-suction drainage (SCSD) was not a significant factor in univariate analysis, SCSD, age, and TSF were all finally identified as independent predictors of iSSI development (P = 0.020, P < 0.001, and P = 0.022, respectively). Further analyses demonstrated that SCSD was frequently used in patients with relatively thick subcutaneous fat tissue and that SCSD significantly decreased iSSI development in these patients. CONCLUSIONS: Advanced patient age, thick subcutaneous fat tissue, and the absence of SCSD were significantly associated with iSSI development in bladder cancer patients who underwent ORC with intestinal urinary diversion. SCSD may be a useful procedure for iSSI prevention, especially in patients with relatively thick subcutaneous fat tissue.

Predictors for positive surgical margins after robot-assisted radical prostatectomy: a single surgeon's series in Japan.

OBJECTIVE: Positive surgical margin after radical prostatectomy has been shown to be an independent predictive factor for biochemical and local recurrence in patients with prostate cancer. The present study was undertaken to identify predictive factors for positive surgical margin after robot-assisted radical prostatectomy in Japanese patients. METHODS: Between August 2006 and September 2011, a cohort of 244 men underwent robot-assisted radical prostatectomy carried out by a single surgeon. Univariate and multivariate logistic regression analyses were carried out to identify clinical covariates significantly associated with an increased positive surgical margin. The preoperative variables included age, body mass index, prostate-specific antigen level, prostate-specific antigen density, clinical T stage, prostate volume, surgeon volume, number of positive cores and percentage of positive cores. RESULTS: In the univariate analyses, serum prostate-specific antigen level, prostate-specific antigen density and surgeon volume were significantly associated with positive surgical margin. In the multivariate analysis, prostate-specific antigen density (hazard ratio 3.13, 95% confidence interval 1.57-6.24; P = 0.001) and surgeon volume (hazard ratio 2.15, 95% confidence interval 1.06-4.35; P = 0.034) were independent predictive factors for positive surgical margin. Using these two independent factors, we divided the patients into four groups and calculated the predictive probability of positive surgical margin. The predictive probability for positive surgical margin in each group was well correlated with the rates at 10.8% and 10.2%, 19.8% and 20.0%, 26.4% and 26.4%, an 43.5% and 43.3%, respectively. CONCLUSION: Prostate-specific antigen density and surgeon volume are independent predictors of positive surgical margin after robot-assisted radical prostatectomy. A combination of these two factors can provide useful information about positive surgical margins.

Prevalence and characteristics of nodular gastritis in Japanese elderly.

BACKGROUND AND AIM: Nodular gastritis (NG) is defined as antral gastritis with endoscopic findings usually characterized by a miliary pattern resembling "goose flesh." There is a possible association between NG and gastric cancer. The aim of our study is to investigate whether there are some differences between young and elderly people in incidence and characteristics of NG and estimate potential risk factors for gastric cancer in adults with NG. METHODS: Patients underwent upper gastrointestinal endoscopy for abdominal symptoms or cancer screening. Incidence rates and relationship between an elderly group (40 years or older) and young group (< 40 years) were assessed by endoscopic grade of NG, atrophic grade, concomitant diseases, and serum pepsinogen (PG). RESULTS: NG was found in 62 cases (0.94%) out of 6623 patients who underwent endoscopy, with a mean age of 47.3 ± 13.3 years. Female patients were present at a significantly higher rate in the elderly group (P < 0.001). The grade of neutrophil infiltration in the greater curvature of the upper gastric body was recognized at a significantly higher rate in the elderly group (P < 0.05). PG II was present at a higher rate and PG I/II at a lower rate in the elderly group (P < 0.05). The odds ratio for the risk of gastric cancer in patients with NG was 2.1 (95% confidence interval 0.3-15.3) in the elderly group. CONCLUSION: NG in the elderly was also suggested to be a risk factor for gastric cancer as well as in the young.

The powerful impact of double-layered posterior rhabdosphincter reconstruction on early recovery of urinary continence after robot-assisted radical prostatectomy.

BACKGROUND AND PURPOSE: The usefulness of posterior rhabdosphincter reconstruction (PR) during robot-assisted radical prostatectomy (RARP) has still been controversial. We investigated the association of several factors, including the Rocco original double-layered PR, with early recovery of urinary continence after RARP. PATIENTS AND METHODS: Between August 2006 and April 2011, a single surgeon at Tokyo Medical University Hospital performed 206 RARPs. Of these 206 patients, 199 eligible patients were enrolled in this study. We retrospectively analyzed the correlation of several perioperative factors, including surgical techniques, with early recovery of urinary continence 1 month after catheter removal. Continence was defined as no use or the use of only one safety pad. RESULTS: Univariate analysis showed that surgeon experience, lateral approach of bladder neck preservation, bladder neck reconstruction, anterior reconstruction, and the Rocco double-layered PR were significantly associated with early recovery of urinary continence 1 month after catheter removal. Preoperative prostate-specific antigen level, body mass index, and attempted nerve-sparing (NS) procedures, however, were not significantly associated with early recovery of urinary continence. Multivariate logistic regression analysis showed that the Rocco PR and attempted NS were the only independent predictive factors of urinary continence recovery 1 month after catheter removal (odds ratio [OR], 15.01; 95% confidence interval [CI], 3.413-66.67; P=0.0003 and OR, 2.248; 95% CI, 1.048-4.975; P=0.0402, respectively). When we applied NS as well as the Rocco PR, the recovery rates of continence at 1 month after catheter removal was 85.3%. CONCLUSIONS: The Rocco double-layered PR and attempted NS and not surgeon experience were the significant independent predictive factors of early recovery of urinary continence after RARP. NS procedures positively influenced early recovery of urinary continence only when they were applied with the PR technique.

A mechanism for abnormal angiogenesis in human radiation proctitis: analysis of expression profile for angiogenic factors.

BACKGROUND: Radiation proctitis is an increasingly prevalent problem, with many patients being treated with radiotherapy for pelvic cancers. However, the mechanisms by which radiation proctitis develops in humans are not well understood. In this study, the expression profiles of angiogenic factors were analyzed to clarify their role in the etiology of radiation proctitis. METHODS: Rectal biopsies were taken from 8 patients with radiation proctitis and 8 normal subjects. Protein lysates of the tissues were applied to an antibody array for angiogenesis-related factors. The mRNA level of each factor was evaluated by Taqman real-time PCR. Immunohistochemistry was performed using the labeled streptavidin biotin method. RESULTS: Antibody array analysis revealed 2.12- to 7.31-fold higher expression levels of angiogenin, fibroblast growth factor 1 (FGF1), endoglin, matrix metalloproteinase (MMP)-8, urokinase-type plasminogen activator (uPA) and maspin in radiation proctitis tissues compared with normal rectal mucosa. The mRNA level of each factor in radiation proctitis tissue was significantly higher than in normal rectal mucosa, suggesting their transcriptional activation. Immunohistochemical staining showed strong expression of angiogenin and maspin in rectal epithelia, MMP-8 and uPA in infiltrating lymphocytes, FGF1 in fibroblasts and endoglin in endothelial cells. The expression of VEGF was not evident. CONCLUSIONS: Our results suggest that in radiation proctitis, MMP-8 and uPA cooperatively degrade the extracellular matrix and basement membrane to provide space for angiogenesis. Simultaneously, angiogenin and FGF1 promote endothelial cell proliferation, and endoglin induces vessel formation, culminating in angiogenesis. Inhibitors of angiogenic factors such as angiogenin and FGF1 may be effective for treating radiation proctitis.

The efficacy and safety of gemcitabine plus cisplatin regimen for patients with advanced urothelial carcinoma after failure of M-VAC regimen.

BACKGROUND: Our aim was to study the efficacy and safety of combination chemotherapy with gemcitabine plus cisplatin (GC) for patients with advanced urothelial carcinoma (UC) after failure of methotrexate, vinblastin, adriamycin, and cisplatin (M-VAC) chemotherapy. METHODS: We studied a total of 33 patients with advanced UC. All patients were treated with M-VAC with a mean of 3.2 courses per patient and had showed disease progression or no response. Clinical and pathological features were correlated to survival rates, and the incidence and degree of toxicities were also retrospectively reviewed. RESULTS: A total of 132 courses of GC with a mean of 4.0 courses per patients were undergone. Two (6.0%) complete responses and 11 (33.3%) partial responses produced an overall response rate of 39.4%. In 55 assessable lesions, there were 2 (4%) complete responses, 13 (23%) partial responses, 31 (55%) with stable disease, and 10 (18%) with progressive disease. Overall, mean of survival time after GC chemotherapy was 10.5 months (range, 3.0-22.9 months). In univariate analysis, the patients with higher serum hemoglobin or single metastasis or no liver metastasis tended to survive longer than those with lower hemoglobin or multiple metastases or existence of liver metastasis. Although grade 3-4 neutropenia was seen in 22 patients (66.7%) and grade 3-4 thrombocytopenia was seen in 10 patients (30.3%), fatal side effects were not observed. CONCLUSIONS: The combination chemotherapy with GC seems feasible with no severe side effects and may provide a survival benefit for patients with advanced UC after failure of M-VAC chemotherapy.

Argon plasma coagulation treatment of hemorrhagic radiation proctopathy: the optimal settings for application and long-term outcome.

BACKGROUND: No standard treatment exists for hemorrhagic radiation proctopathy (HRP). Recently it was reported that argon plasma coagulation (APC) is effective for HRP. However, previous studies documented complications such as ulcers, strictures, and perforations in as many as 20% of APC-treated patients. OBJECTIVE: The aim of this study was to determine the optimal parameters for APC by using swine rectum and to assess the safety and effectiveness of APC in HRP patients. DESIGN: Prospective case series. SETTING: University teaching hospital. PATIENTS: Sixty-five patients with HRP were prospectively enrolled between 2000 and 2010. INTERVENTIONS: APC for HRP. MAIN OUTCOME MEASUREMENTS: Optimal APC parameters, number of treatments, success rate, complications, clinical remissions. RESULTS: APC in swine rectal wall ex vivo was optimal with a 40-W current, 1.2-L/min gas flow rate, and 2-second application, which was sufficient to treat the submucosal telangiectasia but did not adversely affect the muscle layer. Sixty-five patients (46 men, 19 women; median age 72 years) with HRP occurring at a mean of 20 months after radiotherapy were studied. Proctopathy was classified as grade A (mild) in 7 patients (10.8%), grade B (moderate) in 41 (63.1%), and grade C (severe) in 17 (26.2%). The treatment success rate was 98.5% after a median of 2 (range 1-5) APC sessions. The median clinical score for rectal bleeding was significantly decreased after APC (P < .0001), and the hemoglobin level was significantly increased (P < .0001). APC was well tolerated, and no significant side effects or complications occurred. During a mean follow-up of 34.6 months (range 3.6 -121.1 months), 4 patients (6.3%) had minor recurrent rectal bleeding and 60 (93.8%) remained in remission. LIMITATIONS: Nonrandomized study. CONCLUSIONS: HRP treatment with optimal APC settings yields a high success rate and long-lasting clinical remission with no significant complications.