Adult Wilms' tumour: review of 14 patients.

Wilms' tumour, or nephroblastoma, is the commonest renal neoplasm found in children, but is rarely found in adults, the world literature recording only approximately 200 cases. Individual case reports continue to be published but only within the last 10 years have definitive treatment regimes been suggested. In order to determine the UK experience of adult Wilms' tumour, members of the British Association of Urological Surgeons were circulated with a questionnaire, and from 141 replies, 13 members reported 17 cases. Critical review of the original histology slides excluded 3 of these; the 14 remaining cases are described and their management discussed in the light of current recommended treatment.

Bladder cancer: inter-relationships between chemotherapy and radiotherapy.

There has been increasing interest in the role of chemotherapy as primary treatments for patients with urothelial cancer and because of the poor prognosis of locally advanced tumours with conventional treatment, trials have been initiated comparing radiotherapy with chemotherapy as primary therapies. In this context it is important to assess the relationship between the responses to chemotherapy and radiotherapy, and this we have examined in 64 patients treated with MVMJ (methotrexate, vinblastine, mitozantrone and carboplatin). Either a complete or a partial response was found in 29 of the 64 patients, 15 had stable disease and 13 had progression of disease. Seven patients died within the first treatment month. The survival of the responding patients ranged from 114 to 1184 days. Six of 15 patients who had had pelvic irradiation prior to chemotherapy responded to MVMJ, the maximum duration of response being more than 3 years. Twenty-two patients had radiotherapy following their chemotherapy. One of 13 patients not responding to MVMJ had a transient response to radical radiotherapy. Only 1 of 9 patients responding to chemotherapy and then relapsing responded to subsequent radical radiotherapy. Patients with metastatic disease or with recurrent disease after radiotherapy have a worthwhile chance of responding to chemotherapy and achieve durable remissions. In contrast, radiotherapy appears relatively ineffective in patients whose disease progresses or relapses after chemotherapy given as primary treatment with curative intent.

Treatment of bladder carcinoma using a germ cell chemotherapy protocol.

Elevated levels of circulating beta-human chorionic gonadotrophin (beta-HCG) are commonly associated with a variety of tumours of germ cell origin. Other carcinomas may possess choriocarcinomatous elements but only rarely have there been reports of transitional cell carcinomas of the bladder associated with raised germ cell tumour markers, possibly because assays are not routinely performed. We present 3 patients with advanced transitional cell carcinoma of the bladder, 2 with metastatic and 1 with locally invasive disease, who had raised levels of germ cell tumour markers. These patients were therefore treated with combination chemotherapy appropriate to such tumours, with excellent results, as shown by clinical improvement and return to normal of tumour marker levels. Recent reports of the association between bladder carcinoma and ectopic synthesis of beta-HCG are reviewed. It was concluded that the production of beta-HCG is probably not rare, but that when it is found, the adoption of an appropriate chemotherapeutic regime may be successful.

New combination chemotherapy programme for bladder cancer.

Forty patients with either metastatic, post-radiotherapy recurrent, or poor prognosis locally advanced transitional cell carcinoma of the bladder were treated in a new combination chemotherapy programme with methotrexate, vinblastine, mitozantrone and JM8 (carboplatin); 33 patients were assessable for response. There were 9 complete responses (27%), 12 partial responses (36%) and 7 disease stabilizations (21%); 5 patients (15%) had progressive disease. The median duration of complete response has not been reached and is in excess of 9 months (range 4- greater than 18 months). This regimen was without significant toxicity and this is in contrast with M-VAC, which is thought to be currently the most effective treatment for urothelial cancer.