Targeted therapies in retinoblastoma: GD2-directed immunotherapy following autologous stem cell transplantation and evaluation of alternative target B7-H3.

BACKGROUND: GD2-directed immunotherapy is highly effective in the treatment of high-risk neuroblastoma (NB), and might be an interesting target also in other high-risk tumors. METHODS: The German-Austrian Retinoblastoma Registry, Essen, was searched for patients, who were treated with anti-GD2 monoclonal antibody (mAb) dinutuximab beta (Db) in order to evaluate toxicity, response and outcome in these patients. Additionally, we evaluated anti-GD2 antibody-dependent cell-mediated cytotoxicity (ADCC) and complement-dependent cytotoxicity (CDC) in retinoblastoma cell lines in vitro. Furthermore, in vitro cytotoxicity assays directed against B7-H3 (CD276), a new identified potential target in RB, were performed. RESULTS: We identified four patients with relapsed stage IV retinoblastoma, who were treated with Db following autologous stem cell transplantation (ASCT). Two out of two evaluable patients with detectable tumors responded to immunotherapy. One of these and another patient who received immunotherapy without residual disease relapsed 10 and 12 months after start of Db. The other patients remained in remission until last follow-up 26 and 45 months, respectively. In vitro, significant lysis of RB cell lines by ADCC and CDC with samples from patients and healthy donors and anti-GD2 and anti-CD276-mAbs were demonstrated. CONCLUSION: Anti-GD2-directed immunotherapy represents an additional therapeutic option in high-risk metastasized RB. Moreover, CD276 is another target of interest.

Measuring quality of life in patients with kidney stone disease: is it the future in endourology?

PURPOSE OF REVIEW: Kidney stone disease is recognized to negatively impact quality of life. This pertains to acute episodes, surgical interventions and even during asymptomatic periods. Over time there has been increased attention towards assessing this subjective parameter, including as a determinant of treatment success. Our aim was to evaluate the current status and emerging trends in this field. RECENT FINDINGS: Patient groups most affected appear to be recurrent stone formers, cystine stone formers, women, younger populations, non-Caucasians and low-income populations. Several stone specific patient reported outcome measures are now available of which, WISQol has been implemented the most in clinical research studies. More invasive interventions such as percutaneous nephrolithotomy impede quality of life to greater extent than alternatives such as shockwave lithotripsy. SUMMARY: There are certain patient groups who are more vulnerable to the negative impact of kidney stone disease on their quality of life. Urologists can improve patient care by recognizing these particular populations as well as by implemented patient reported outcome measures in their routine clinical practice and when performing research.

Transurethral GreenLight laser enucleation of the prostate--a feasibility study.

BACKGROUND AND PURPOSE: GreenLight laser vaporization is established as a minimally invasive procedure to treat patients with benign prostatic hyperplasia. Despite good functional results, it may be difficult to achieve adequate tissue removal for large prostates. In this study, we evaluated whether a transurethral enucleation technique is feasible with the GreenLight laser as a possible way to improve the amount of tissue removed. PATIENTS AND METHODS: Following the technique described by Gilling for the holmium laser, we carried out transurethral enucleation of prostate adenoma with the 120W HPS GreenLight laser in 21 consecutive patients. Preoperative data were collected prospectively; prostate volume, International Prostate Symptom Score (IPSS), postvoid residual (PVR), prostate-specific antigen level, peak urinary flow rate, operative time, catherization period, length of hospitalization, and perioperative complications were recorded as well as the weight of the enucleated tissue and the applied laser energy. For follow-up, IPSS and PVR were recorded. Data are presented as mean±standard deviation. RESULTS: Fifty-two percent of the patients had preoperative urinary retention. Preoperative prostate volume was 74.6±21.7 cc; 34.7±21.7 g of tissue were enucleated. IPSS was reduced from 25±6 to 5±9 (P=0.0001), PVR from 126±80 to 11±18 (P=0.002) by GreenLight laser enucleation. Serious complications were not observed. Operative time was 112±27 minutes. Catheter time was 1.2±0.4 days. The length of hospitalization was 3.6±0.9 days. CONCLUSION: GreenLight laser enucleation is feasible and safe. Tissue reduction is complete, and good functional results are achieved. All patients were able to void properly. Major complications were not observed. The procedure is technically demanding, resulting in long operative times at the first interventions.

Novel electromagnetic lithotriptor for upper tract stones with and without a ureteral stent.

PURPOSE: We compared the treatment efficacy and safety of the novel Lithoskop electromagnetic extracorporeal shock wave lithotriptor for upper urinary tract stones with and without prior ureteral stent placement. MATERIALS AND METHODS: A total of 665 consecutive patients harboring single renal or ureteral stones underwent shock wave lithotripsy between August 2006 and July 2008. In 75 and 46 patients with renal and ureteral stones, respectively, stents were placed before the first shock wave lithotripsy session. Treatment outcome was assessed in relation to stent placement. All data were derived from a prospectively maintained database. RESULTS: The mean size of nonstented vs stented renal and ureteral stones was 8.6 vs 12.5 mm (p <0.0001) and 7.1 vs 7.3 mm (p = 0.6), respectively. The stone-free rate in nonstented vs stented renal and ureteral stone cases was 76.3% vs 77.3% and 91.4% vs 93.5%, respectively (each p >0.99). The total energy applied per stone was 110 +/- 83 vs 150 +/- 89 J (p <0.0001) and 183 +/- 131 vs 209 +/- 125 J (p = 0.1), respectively. Auxiliary measures were required after shock wave lithotripsy for renal and ureteral stones in 5.4% and 10.8% of nonstented, and in 1.3% and 4.3% of stented cases, respectively. No complications were detected in stented renal and ureteral stone cases compared to 2.9% and 6.9% in nonstented cases, respectively. CONCLUSIONS: A high success rate and a low complication rate were achieved in renal and ureteral stone cases with and without prior ureteral stent placement. Total energy needed to achieve a stone-free state did not differ between stented and nonstented ureteral cases, suggesting the absence of a significant influence of the stent. Overall stents decreased complications necessitating hospitalization and auxiliary invasive measures.

Morphological and biological predictors for treatment outcome of transurethral microwave thermotherapy.

The proliferation of prostatic tissue as a result of ageing typically leads to prostatic enlargement, which often causes obstruction of urine outflow from the bladder, clinically lower urinary tract symptoms, detrusor instability, incomplete bladder emptying, urinary infection, and finally acute urinary retention. The first approach to therapy depending on the severity of the symptoms is usually medical management (phytotherapy, alpha-blockers, 5 alpha-reductase inhibitors) before surgical procedures are performed. The reference standard for treatment of benign prostatic hyperplasia is transurethral resection of the prostate, although the introduction of minimally invasive alternatives such as transurethral microwave thermotherapy has led to a new era in surgical management. Suitable patients must be selected carefully on the basis of individual parameters that predict a favourable result.