pirarubicin and Ureteral-Neoplasms

A 58-year-old man visited our hospital with a complaint of asymptomatic gross hematuria for three weeks. The urine cytology at another clinic had indicated Papanicolaou class V. A physical examination revealed soft abdominal distention in lower abdomen. Ultrasonography demonstrated an extremely dilated left pelvis, calyx and ureter in which a round mass was detected. Enhancement CT showed a mass 2 cm in diameter in the middle part of the dilated left ureter. These findings suggested the diagnosis of left ureteral cancer having developed in the megaureter. Neither VUR nor UVJ stenosis were identified by VCG and RP. MR-urography showed a severely dilated left pelvis and tortuous megaureter. On the diagnosis of left ureteral cancer left nephroureterectomy with cuff of bladder was performed. Gross findings showed a 2 cm sized papillary tumor in the extremely dilated ureter, and pathological findings showed grade 2, papillary transitional cell carcinoma and non-specific ureteritis in the dilated ureter. Postoperative course was non-eventful. Postoperative 3 months later multiple bladder tumors were detected all over the bladder, and so TUR-Bt and intravesical instillation therapy with pirarubisin was performed. However multiple bladder tumors had been relapsed and so finally radical cystectomy and right cutaneous ureterostomy were undergone postoperative 6 months later. He has been well 48 months postoperatively.

Topics: Administration, Intravesical; Antineoplastic Agents; Carcinoma, Transitional Cell; Combined Modality Therapy; Cystectomy; Diagnostic Imaging; Doxorubicin; Humans; Male; Middle Aged; Nephrectomy; Treatment Outcome; Ureter; Ureteral Neoplasms; Ureterostomy

We report a case of advanced ureteral cancer successfully treated with systemic chemotherapy combined with irradiation. A 47-year-old man was diagnosed as having a right ureteral cancer at the clinical stage of T4, N2 and M1 (liver). A papillary tumor was also found in the bladder and the resected specimen showed a grade 1 transitional cell carcinoma. Although three cycles of methotrexate, vinblastine, pirarubicin and cisplatin (MVAC) gave partial response to the ureteral tumor, new metastases to the lung and pelvic bone were observed. The patient received 50 Gy external irradiation to the pelvis, 11 cycles of paclitaxel (270 mg) and cisplatin (60-80 mg) followed by four cycles of docetaxel (100 mg) and cisplatin. Thereafter, he underwent bone biopsy, partial hepatectomy, total nephroureterectomy and lymph node resection, by which a complete response was achieved pathologically. The patient has been alive without evidence of disease for 12 months.

Topics: Antineoplastic Combined Chemotherapy Protocols; Biopsy, Needle; Carcinoma; Chemotherapy, Adjuvant; Cisplatin; Combined Modality Therapy; Dose-Response Relationship, Drug; Doxorubicin; Drug Administration Schedule; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Male; Methotrexate; Middle Aged; Neoplasm Staging; Paclitaxel; Radiotherapy, Adjuvant; Tomography, X-Ray Computed; Treatment Outcome; Ureteral Neoplasms; Vinblastine