Neoadjuvant transcatheter arterial chemoembolization and systemic chemotherapy for treatment of clear cell sarcoma of the kidney in children.

BACKGROUND: Clear cell sarcoma of the kidney (CCSK) is a rare and aggressive malignant renal tumor. We describe our experience with neoadjuvant transcatheter arterial chemoembolization (TACE) and systematic chemotherapy for the treatment of advanced CCSK in children. METHODS: Between January 2010 and December 2016, seven patients (3 boys and 4 girls; median 2.2 years) with advanced CCSK received preoperative TACE of renal artery and systemic chemotherapy. The chemoembolic emulsion for TACE consisted of cisplatin, pirarubicin, vindesine, and iodized oil. Preoperative systemic chemotherapy with vindesine, ifosfamide, and etoposide was administered three weeks after TACE. Nephrectomy was performed three weeks after systemic chemotherapy. After surgery, patients received radiotherapy and postoperative chemotherapy. RESULTS: No cardiotoxicity, renal insufficiency, or hepatic dysfunction was found in any patients. Grade II-III marrow suppression developed in four patients. One patient with tumor progress during neoadjuvant therapy failed to successfully undergo surgery and died. Six patients underwent nephrectomy after neoadjuvant therapy. Median follow-up period was 49.5 months (range, 11-83 months). Five patients have recurrence-free survival. One patient is still in postoperative chemotherapy after nephrectomy, radiotherapy and thoracoscopic resection of lung metastases. CONCLUSIONS: Neoadjuvant TACE and systemic chemotherapy appeared to be feasible in the treatment of advanced CCSK in this pilot study. THE TYPE OF STUDY: A case series with no comparison group. LEVEL OF EVIDENCE: Level IV.

[Effects of some traditional Chinese drugs on Mdr1 gene and its expression product in K562/A02 cells].

This study was purposed to investigate the effects of angelicasinensis (Oliv) Diel compound injection, vauqueline, ephedrine and strychnine on human erythroleukemia multidrug resistance (MDR) K562/A02 cell line Mdr1 gene and p-glycoprotein. The MTT and trypan blue methods were used to analyze the cytotoxic effect of above-mentioned traditional Chinese drug; the expressions of K562/A02 cells Mdr1 gene and p-glycoprotein were detected by semi-quantitative reverse transcription polymerase chain reaction (RT-PCR) and Western blot respectively. The results showed that after K562/A02 cell were treated with angelicasinensis (Oliv) diels compound injection, vauqueline and ephedrine, mRNA transcription of Mdr1 gene was reduced significantly (p < 0.01); the expression of P-gp also decreased (p < 0.01). The expression level P-gp in group treated with vauqueline was the lowest, but the Mdr1 mRNA level and expression of P-gp of K562/A02 cells treated with strychnine did not obviously changed. It is concluded that angelicasinensis (Oliv) diels compound injection, vauqueline, ephedrine can partly reverse the multidrug resistance of K562/A02 cells, the down-regulation of Mdr1 gene causing decrease of p-glycoprotein expression may be one of the MDR reversal mechanisms in K562/A02 cells.