Outpatient treatment with subcutaneous interleukin-2 and interferon alfa administration in combination with fluorouracil in patients with metastatic renal cell carcinoma: results of a sequential nonrandomized phase II study. Subcutaneous Administration Propeukin Program Cooperative Group.

PURPOSE: We report the results of the Subcutaneous Administration Propeukin Program (SCAPP) II trial of an outpatient treatment in renal cell carcinoma using interleukin-2 (IL-2) and interferon alfa-2a (IFN-alpha) administered subcutaneously in combination with fluorouracil (5-FU). The objective of this multicenter trial was to confirm that the combination of IL-2, IFN-alpha, and 5-FU leads to a response rate greater than 20%. PATIENTS AND METHODS: Patients with metastatic renal cell carcinoma were included in this study. During the induction phase of the treatment, which lasted 10 weeks, IL-2 and IFN-alpha were administered subcutaneously three times a week for 8 weeks at doses of 18 MIU and 9 MIU, respectively. During these 8 weeks, every Monday, 5-FU was administered at a dose of 750 mg by intravenous infusion over 30 minutes. After evaluation, responding patients or patients with stable disease (SD) were given maintenance treatment, until disease progression (PD) or the appearance of unacceptable toxicity. Each maintenance cycle consisted of a 2-week treatment followed by a three-week rest period. During treatment, IL-2 and IFN-alpha were administered subcutaneously three times a week at doses of 18 MIU and 9 MIU, respectively. Every Monday, 5-FU was administered at a dose of 750 mg by intravenous infusion over 30 minutes. RESULTS: This trial was closed when the sixth sequential analysis showed the lack of benefit from this combination. At the end of the induction period, of 62 patients, 12 (19%; 95% confidence interval [CI], 10% to 31%) reached an objective response, including one complete response (CR), 16 presented with SD, and 27 showed PD. Twenty-seven patients (43%) developed severe toxicity that required reduction of the planned doses (13 patients), delayed treatment (eight patients), or treatment termination (six patients). Seventeen patients were given maintenance treatment. One- and 2-year survival rates were estimated at 55% and 33%, respectively. The 2-year survival rate was 15% in 11 patients who presented with three poor-prognosis factors and 41% in 51 patients who initially presented with no, one, or two poor-prognosis factors (P = .04). CONCLUSION: As in other recently published studies that used 5-FU, IL-2, and IFN-alpha, the multicenter SCAPP II trial in patients with metastatic renal cell carcinoma generated severe toxicity. This sequential trial failed to confirm the favorable results previously obtained by Atzpodien and Sella with this combination of three drugs. Its efficacy, assessed on the response and survival rates, is near to the results observed in programs that used IL-2 alone given subcutaneously.

[Incision of the prostate. Apropos of 57 cases]. / L'incision de la prostate. A propos de 57 observations.

57 cervico-prostatic incisions have been performed, for prostatic hypertrophy in 56 cases and for dysuria without prostatic hypertrophy in one case. 36 patients underwent a mono-incision and 21 had a bi-incision. The operative technique is simple and the results are satisfactory. After 3 months, the dysuria was improved in 93.5% of cases and the pollakiuria was improved in 92.8% of cases. In 20 patients in whom the quality of ejaculation was defined prior to the operation, this persisted after the operation in 17 cases (85%); it was normal in 8 cases and diminished in 9 cases.

[Adenocarcinoma of the rete testis. Review of the literature apropos of a new case]. / L'adénocarcinome du rete testis. Revue de la littérature à propos d'une nouvelle observation.

The authors report the case of a 66 year old man with a Boden stage I adenocarcinoma of the rete testis treated by orchiectomy and adjuvant chemotherapy. Lung metastases developed 46 months later and were responsible for death despite further chemotherapy. Adenocarcinoma of the rete testis is an exceptional tumour, as only 23 cases satisfying the criteria defined by Feek and Hunter have been reported in the literature. The prognosis is poor even in the apparently localized forms (5 year survival less than 25%) and local recurrences and lung and/or hepatic metastases are frequent. Radiotherapy and chemotherapy appear to have little value.

[Intra-diverticular tumors of the bladder. Natural history and management perspectives]. / Tumeurs intra-diverticulaires de la vessie. Histoire naturelle et perspectives d'approche.

The review of the literature and our study of 15 tumors in bladder diverticula (IDT) show us that these tumors are rare and mainly observed in elderly adult males. Bleeding is the major symptom. Diagnosis is difficult and treatment is not well defined. Prognosis is good for low stage tumors and catastrophic in the short term for high stage tumors. Nearly half of IDT were primary tumors, and one third of them stay primary until death of the patients. Most of the high stage tumors contained a squamous cell differentiation and all the tumors with these features were deeply invasive. The bad prognosis is mainly related to the difficult and delayed diagnosis, with a long symptomatic period, regardless of treatment. This emphasizes the need for further investigations (biopsies, sonography, computer tomography) when the diagnosis is not evident. The treatment of these tumors depends on the general status of patients and the volume and stage of tumors. Low stage tumors (Ta) and diverticula could be treated either by transurethral resection or by open surgery with good results. In (T1) tumors, only open surgery is recommended to avoid loco-regional relapse. High stage tumors (greater than or equal to P T3) were treated by either TUR or open palliative surgery with the same bad prognosis. No radical treatment was indicated since patients have a bad performance status and most of the tumors extended beyond the diverticulum. Adjuvant treatments were not helpful. While preventive diverticulectomy is to be discussed case by case, we think that an important step in improving the prognosis of these tumors is to make the diagnosis at an earlier stage.

[Uro-colonic tumors. Etiopathogenic data and practical implications]. / Tumeurs uro-coliques. Données étiopathogéniques et implications pratiques.

The authors report a case of uro-colonic tumour developing four years after ureterosigmoidostomy in a male patient treated for invasive bladder tumour. After a current follow-up of five years for this colonic tumour, they studied their case in comparison with the data from the literature and the experimental model in order to better understand the natural history of these tumours. The following principal points are discussed: time to onset, histological nature and course of these tumours; essential elements in this type of carcinogenesis, practical clinical implications and follow-up of patients after ureterosigmoidostomy.

[The "double J" endo-ureteral prosthesis. Experience apropos of 21 cases]. / La prothèse endo-urétérale "double J". Expérience à propos de vingt et un cas.

Following Finney's work on the subject, the authors propose an endo-ureteral diversion using the new double J ureteral catheter stent. In the light of their experience of 21 cases, the authors stress the speed and simplicity of this very minor operation, and propose wider indications.

[Renal transitional carcinoma and caval tumor thrombus]. / Carcinome transitionnel rénal et thrombus tumoral cave.

Transitional cell carcinoma of the kidney with caval tumour thrombus is extremely rare. The authors describe the radiological signs suggesting the preoperative diagnosis and guiding the therapeutic approach. They present the case of a 51-year-old patient with excluded caliceal stones, and review 17 cases published over a period of 24 years during which considerable progress has been made in radiological investigations. Only CT appears to be able to indicate this aetiology and allows retrograde ureteropyelography looking for a tumour of the urinary tract. MRI provides the best assessment of tumour involvement of the inferior vena cava. Nephroureterectomy with excision of a perimeatal bladder cuff and cavotomy is the only oncological surgical procedure, despite the extremely poor prognosis.

[Stenosis of the vesico-urethral anastomosis. Our experience with 114 radical prostatectomies]. / Sténose de l'anastomose vésico-uréthrale. Notre expérience sur 114 prostatectomies radicales.

The authors report a retrospective series of 114 radical prostatectomies performed over a ten-year period. This study was designed to investigate the factors likely to cause complications in order to prevent them. Stenosis of the vesicourethral anastomosis was observed in 22 patients and represented the commonest complication (19.2%). It generally occurred before the 12th month, while late stenoses. An anastomotic leak after removal of the bladder catheter appears to be the most significant factor. The decreasing incidence of these stenoses over the ten-year study period illustrates the role of operator experience. The most effective treatment for these stenoses is mono-incision which, completed by dilatation sessions, prevents recurrence without compromising continence.

[Bilateral ureteral stenosis after pancreatitis]. / Sténose urétérale bilatérale après pancréatite.

The authors report a rare case of bilateral ureteric stenosis associated with necrotic infiltration due to acute alcoholic pancreatitis. The obstruction was caused by bilateral ureteric fibrosis with calcified incrustations on the right side and massive obstructive calculi on the left side. Only one faintly similar case has been reported in the literature out of 17 cases of unilateral or bilateral ureteric stenosis complicating acute or chronic pancreatitis.

[Uretero-acetabular fistula: report of a case]. / Fistule urétéro-cotyloïdienne: à propos d'un cas.

We present a case report of uretero-acetabular fistula in a female complicating orthopaedic surgery of congenital coxal difformity. An ileal pedicle graft was used to replace the terminal ureter. The difficulty of such complication is to choose the best the rapeutic strategy between surgical and non surgical techniques. We review here the various urological armamentarium to affront such a rare and multifactorial complication.

[Hydatid cyst of the kidney. Contribution of imaging techniques]. / Kyste hydatique du rein. Apport de l'imagerie.

The authors report a case of renal hydatid disease, a rare disease in France. After reviewing the recent data of the literature, they stress the value of computed tomography and especially MRI in the presumptive diagnosis.

[Transurethral incision of the prostate. 5 years of follow-up. Apropos of 57 patients]. / Incision transuréthrale de la prostate. Cinq années de recul. A propos de 57 patients.

Fifty-seven bladder neck incisions were studied with a minimum follow-up of 5 years. The results published after one year were very satisfactory, but became more disappointing after 5 years, with a 38.7 reoperation rate. The weight of the prostate appears to be the determining factor. The indications, 5 years ago, were much wider than they are today, with prostate weights of up to 45 g on digital rectal examination. This type of operation should now be reserved for young subjects wishing to retain antegrade ejaculation with a prostate not exceeding 20 to 30 g and in high surgical risk patients unsuitable for transurethral resection.