mesna and Kidney-Neoplasms

Bilateral Wilms' tumors represent a therapeutic challenge. The primary aim of management is eradication of the neoplasm and preservation of renal function. We present our experience in the management of such cases in a single-center experience.. This was a retrospective study of 22 patients with histologically proven bilateral nephroblastoma who were treated from 1993 to 2008 at our center. Of the 22 patients, 12 were girls and 10 were boys, with a median age of 3 years (range 1-9); 19 had a synchronous presentation and 3 a metachronous presentation. Of the 22 patients, 6 underwent initial surgical resection followed by chemotherapy and 16 underwent initial biopsy and preoperative chemotherapy. The final oncologic and renal outcomes were assessed.. The median follow-up period was 3 years (range 1-11). Of the 22 patients, 8 died, for an overall survival rate of 63.5%. The survival for the initial chemotherapy and initial surgery groups was essentially similar. Of all the variables studied, unfavorable histologic findings had a significant negative effect on survival. Of the 5 patients with unfavorable histologic findings, 4 died during the follow-up period. The median volume of preserved renal parenchyma was 40%. All patients had good renal function during follow-up, except for 1 patient who had undergone bilateral nephrectomy.. Bilateral Wilms' tumors impose 2 conflicting issues: elimination of the pathology and preservation of the renal function. Currently, treatment regimens involving initial chemotherapy followed by conservative surgery can achieve these goals in an important proportion of patients.

Topics: Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Adjuvant; Child; Child, Preschool; Combined Modality Therapy; Dactinomycin; Doxorubicin; Egypt; Etoposide; Female; Follow-Up Studies; Humans; Ifosfamide; Infant; Kaplan-Meier Estimate; Kidney Neoplasms; Male; Mesna; Neoadjuvant Therapy; Neoplasms, Multiple Primary; Neoplasms, Second Primary; Nephrectomy; Retrospective Studies; Treatment Outcome; Vincristine; Wilms Tumor

The sarcomatoid variant of renal-cell carcinoma (SRCC), a clinically aggressive subtype of renal parenchymal tumors, is typically resistant to systemic treatments and carries a poor prognosis. The authors report a case of a 57-year-old male with advanced SRCC who had a durable complete response after MAID (mesna, adriamycin, ifosfamide and dacarbazine) chemotherapy, and remains free of disease four years after completing treatment. To the authors' knowledge, this is the first report of a remission from MAID chemotherapy in SRCC. A review of published literature revealed occasional responses after systemic chemotherapy. Notably, all responses were seen with doxorubicin containing regimens, suggesting that doxorubicin is a critical component in chemotherapy regimens for SRCC.

Topics: Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Renal Cell; Dacarbazine; Doxorubicin; Humans; Ifosfamide; Kidney Neoplasms; Male; Mesna; Middle Aged; Sarcoma; Tomography, X-Ray Computed

Pigmented banding of the nails and hyperpigmentation of hands and feet may occur during cyclophosphamide therapy. Ifosfamide, an analogue of cyclophosphamide, might be expected to cause similar pigmentary changes, but, to the knowledge of the authors, there are no reports of this.. The authors describe skin pigment changes in a 5-year-old patient receiving ifosfamide, MESNA, and etoposide for the treatment of relapsed Wilms tumor.. A review of the literature concerning cyclophosphamide-induced pigmentary changes is presented, along with a discussion of the possible correlation of renal dysfunction with pigmentary changes.. This case should alert health care providers to this uncommon adverse effect of ifosfamide.

Topics: Child, Preschool; Etoposide; Humans; Ifosfamide; Kidney Neoplasms; Lung Neoplasms; Male; Mesna; Pigmentation Disorders; Wilms Tumor

Batracylin (NSC-320846) is a dual inhibitor of DNA topoisomerases I and II. Batracylin advanced as an anticancer agent to Phase I clinical trials where dose limiting hemorrhagic cystitis (bladder inflammation and bleeding) was observed. To further investigate batracylin's mechanism of toxicity, studies were conducted in Fischer 344 rats. Once daily oral administration of 16 or 32 mg/kg batracylin to rats for 4 days caused overt toxicity. Abnormal clinical observations and adverse effects on clinical pathology, urinalysis, and histology indicated acute renal damage and urothelial damage and bone marrow dysfunction. Scanning electron microscopy revealed sloughing of the superficial and intermediate urothelial layers. DNA damage was evident in kidney and bone marrow as indicated by histone γ-H2AX immunofluorescence. After a single oral administration of 16 or 32 mg/kg, the majority of batracylin was converted to N-acetylbatracylin (NAB) with a half-life of 4 hr to 11 hr. Mesna (Mesnex™), a drug known to reduce the incidence of hemorrhagic cystitis induced by ifosfamide or cyclophosphamide, was administered to rats prior to batracylin, but did not alleviate batracylin-induced bladder and renal toxicity. These findings suggest that batracylin results in DNA damage-based mechanisms of toxicity and not an acrolein-based mechanism of toxicity as occurs after ifosfamide or cyclophosphamide administration.

Topics: Animals; Biomarkers, Tumor; Body Weight; Female; Glycosuria; Histones; Kidney Neoplasms; Male; Mesna; Phosphoproteins; Quinazolines; Random Allocation; Rats; Urinary Bladder Neoplasms

Malignant fibrous histiocytoma (MFH) of the kidney is a rare sarcoma that often undergoes local recurrence and/or distant metastasis. However, little is known about the outcome of metastatic diseases. We present the case of a 46-year-old male suffering from renal MFH with pulmonary metastasis, who has undergone complete response for 3 years after surgical resection and MAID chemotherapy. He is now well, and without any evidence of recurrent disease.

Topics: Antineoplastic Combined Chemotherapy Protocols; Biopsy; Chemotherapy, Adjuvant; Dacarbazine; Doxorubicin; Histiocytoma, Malignant Fibrous; Humans; Ifosfamide; Kidney Neoplasms; Lung Neoplasms; Male; Mesna; Middle Aged; Nephrectomy; Thoracoscopy; Tomography, X-Ray Computed; Treatment Outcome

Topics: Animals; Carcinogens; Female; Kidney Neoplasms; Male; Mesna; Ochratoxins; Protective Agents; Rats; Rats, Inbred Lew

Topics: Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Adjuvant; Combined Modality Therapy; Doxorubicin; Epithelial Cells; Female; Humans; Ifosfamide; Kidney Neoplasms; Mesna; Middle Aged; Nephrectomy; Radiotherapy, Adjuvant; Stromal Cells

Sodium 2-mercaptoethane sulfonate (Mesna) reacts with urotoxic metabolites of oxazaphosphorine drugs (e.g. cyclophosphamide or ifosfamide) and has been used clinically to protect against damage induced by these aggressive anti-neoplastic drugs in the kidney and lower urinary and genital tracts. Ochratoxin A (OTA) is a potent nephrotoxin in several species. In order to elucidate whether mesna has curative or preventive effects on OTA-induced renal damage or renal tumor development, we administered OTA and/or mesna to both DA and Lewis rats for their life-time and examined kidney, urethra and urinary bladder histologically. OTA induced sex- and strain-specific renal tumors. However, there was no evidence of any effect of mesna on the incidence and distribution of any type of tumor or non-neoplastic finding in the kidney in either strain or treated group. In this study, we have confirmed that mesna treatment did not show any curative or preventive effects on either OTA-induced kidney damage or renal tumor development in two different strains that have distinct metabolic characteristics.

Topics: Animals; Body Weight; Carcinogens; Female; Kidney Neoplasms; Male; Mesna; Ochratoxins; Organ Size; Protective Agents; Random Allocation; Rats; Rats, Inbred Lew; Sex Factors; Urethral Neoplasms; Urinary Bladder Neoplasms

A right-sided renal mass in an 11-month-old girl was diagnosed by percutaneous needle biopsy as Wilms tumor, which on histologic examination was found to be predominantly rhabdomyomatous. As part of the examination, serum creatine kinase (CK) and CK-MB levels were measured and were significantly elevated at 994 U/L (reference range, 42-180 U/L) and 40 U/L (reference range, 0-3 U/L), respectively. Subsequently, an 8-month-old girl was admitted to the hospital with septicemia and was found to have an abdominal mass. A diagnosis of bilateral Wilms tumor was made following percutaneous biopsy of both kidneys; histologic examination confirmed that the tumor was predominantly rhabdomyomatous. Serum CK and CK-MB levels also were measured and were significantly elevated at 685 U/L and 84.4 U/L, respectively. In both cases, the serum CK and CK-MB levels reflected the clinical course; elevation in serum levels was associated with tumor recurrence, infarction, or chemotherapy-related necrosis. We conclude that these enzymes have clinical usefulness as markers for Wilms tumor showing rhabdomyomatous morphologic features.

Topics: Antineoplastic Combined Chemotherapy Protocols; Biomarkers, Tumor; Creatine Kinase; Dactinomycin; Disease Progression; Disease-Free Survival; Doxorubicin; Etoposide; Fatal Outcome; Female; Humans; Ifosfamide; Infant; Kidney Neoplasms; Mesna; Neoplasm Recurrence, Local; Nephrectomy; Reference Standards; Rhabdomyoma; Vincristine; Wilms Tumor

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Doxorubicin; Female; Humans; Ifosfamide; Kidney Neoplasms; Mesna; Neoplasms, Germ Cell and Embryonal; Radiotherapy, Adjuvant

Quinone metabolites of catechol estrogens have been postulated to mediate estradiol-induced carcinogenesis. In this study, this postulate was examined by investigating the effect of modulators of quinone metabolism on estradiol-induced tumor incidence in male Syrian hamsters. 2(3)-t-Butyl-4-hydroxyanisol (BHA) and dicumarol which are known to stimulate or inhibit respectively, the activity of quinone reductase, lowered tumor incidence by 33 and 42% respectively (3/9 and 5/12 tumor-free animals/total respectively), from 100% (13/13) observed with 17 beta-estradiol (E2) treatment only. Ebselen, a substance with glutathione peroxidase-like activity, and sodium 2-mercaptoethanesulfonate (Mesna), a cytoprotective thiol-containing agent, were only marginally effective in decreasing the estradiol-induced kidney tumor incidence (3/11 and 4/19 tumor-free animals/total respectively). The lowering of tumor incidence by BHA and dicumarol correlated well with a 40-45% decrease in renal peroxidatic activity of cytochrome P450 in hamsters treated with these substances plus estradiol for 1 month. In addition, these compounds also inhibited the oxidation of diethylstilbestrol to its corresponding quinone in vitro. An influence on quinone reductase or other detoxifying enzymes in chronically treated male Syrian hamsters could not be detected. These data support a mediation of estradiol-induced carcinogenesis by quinones formed by metabolic oxidation of catechol estrogens.

Topics: Animals; Antioxidants; Azoles; Butylated Hydroxyanisole; Cricetinae; Dicumarol; Estradiol; Glutathione Peroxidase; Isoindoles; Kidney Neoplasms; Male; Mercaptoethanol; Mesna; Mesocricetus; NADPH-Ferrihemoprotein Reductase; Organoselenium Compounds; Quinone Reductases; Quinones; Selenium

The purpose of this study was to evaluate the antitumor activity and tolerability of ifosfamide (IFO) at a dose of 3 g/m2, given on 2 consecutive days every 2 weeks, in advanced Wilms' tumor patients in whom conventional therapy had failed. Mesna and hyperhydration were concomitantly given to minimize bladder toxicity. A total of 21 patients with advanced Wilms' tumor were entered in the study. The response observed after two courses was complete in 6 patients and partial in 5; 10 did not respond; the median duration of response was 2 months (range, 1-7 months). Leucopenia caused a delay in therapy for 1 or 2 weeks in only three cases. Neither fever nor infection were observed. Of 7 patients who developed hematuria, 3 were among the 17 who concurrently received mesna. The urotoxicity did not interfere with subsequent therapy in these three cases.

Topics: Adolescent; Adult; Child; Child, Preschool; Drug Evaluation; Drug Therapy, Combination; Humans; Ifosfamide; Infant; Kidney Neoplasms; Mesna; Neoplasm Recurrence, Local; Remission Induction; Time Factors; Wilms Tumor

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Diagnosis-Related Groups; Drug Evaluation; Female; Humans; Ifosfamide; Kidney Neoplasms; Male; Mercaptoethanol; Mesna; Middle Aged

Topics: Animals; Cisplatin; Kidney Diseases; Kidney Neoplasms; Mercaptoethanol; Mesna; Rats