A new experimental trial using repeated heating every 24 hours for local hyperthermic therapy with bleomycin in vivo.

This report presents the effect of repeated heating every 24 hrs using bleomycin (BLM) which, although seemingly contrary to the usual agreement that hyperthermia should be carried out with a long interval due to thermotolerance, holds many possibilities. FM3A cells on the foot pad of C3H mouse were immersed in a heated water bath at 43 and 44 degrees C for 30 min. The effect of repeated heating was appreciated by an improved growth curve and 50 day survival compared to mice which received heating twice with a 96-hr interval. Repeated heating every 24 hrs 5 times with BLM suppressed tumor growth significantly as compared to heating twice with a 96-hr interval without BLM. The longest survival time was obtained by the repeated heating with BLM among all protocols. There is therefore a good possibility that more effective results could be obtained clinically by repeated heating over a short period.     

A phase II trial of imatinib mesylate in patients with prostate specific antigen progression after local therapy for prostate cancer

PURPOSE: To test the hypothesis that progression of androgen sensitive prostate cancer is dependent on growth factors, such as platelet derived growth factor (PDGF), and inhibition of PDGF receptor (PDGF-R) with imatinib will induce anti-tumor activity. PATIENTS AND METHODS: This phase II study evaluated imatinib in patients with androgen sensitive prostate cancer and prostate specific antigen (PSA) progression after local therapy. Patients received 400 mg of imatinib orally twice a day for 24 weeks (six cycles). Patients were monitored every 4 weeks for an effect on PSA and toxicity. Immunohistochemistry (IHC) for PDGF-R was performed in available tumor specimens. RESULTS: Twenty-one patients were enrolled on this trial with a median age of 64 years. A total of 72 cycles of therapy were administered. Sixteen patients were evaluable for a response. Nine of the 16 patients demonstrated a stable PSA. Seven patients demonstrated PSA progression. Grade 3 and 4 toxicity included rash (4.1%), hematuria (1.4%), diarrhea (1.4%), and neutropenia (2.7%). Testosterone levels did not change during therapy. Four patients with available tumor demonstrated PDGF-R alpha and beta by IHC. CONCLUSIONS: This first study evaluated the efficacy and safety of imatinib in patients with early androgen sensitive prostate cancer following local therapy. As a single agent at this dosing, imatinib had limited biochemical activity.     

Medical expulsive therapy using alfuzosin for patient presenting with ureteral stone less than 10 mm: A prospective randomized controlled trial

Objectives: To assess the spontaneous passage rate for patients being treated with alfuzosin 10 mg daily after presenting with an acute ureteral stone compared with a control group, and to assess the respective pain control status. Methods: This was a prospective randomized controlled trial. Patients presenting with an acute ureteral stone (size 5–10 mm) were enrolled and randomized into a medical expulsive therapy (MET) group or control group. The MET group received alfuzosin slow release (SR) 10 mg daily for 4 weeks and dologesic (paracetamol + dextropropoxyphene, four tablets daily on demand) for 2 weeks. The control group received the same analgesics for 2 weeks only. Diclofenac sodium SR 100 mg daily for 2 weeks was added in case of suboptimal pain control. All the patients were assessed through phone interview at week 2 and with kidney–ureter–bladder X‐ray at week 5 to check for any evidence of stone passage. Results: A total of 67 patients were included in the analysis. The overall spontaneous passage rate was increased by 31.8% with MET (P = 0.006). For an upper ureteral stone, the rate was increased by 51.3% (P = 0.01). The MET group used significantly less dicolofenac sodium (1.5 tablets vs 6.7 tablets, P = 0.031). Conclusions: MET using alfuzosin SR 10 mg daily is effective to enhance the ureteral stone spontaneous passage rate, particularly for upper ureteral stones. Fewer analgesic drugs are consumed and more patients can avoid ureteroscopic lithotripsy and/or extracorporeal shock wave lithotripsy.     

A multicentre, prospective, randomized trial: comparative efficacy of tamsulosin and nifedipine in medical expulsive therapy for distal ureteric stones with renal colic

Study Type – Therapy (RCT) Level of Evidence 1b What’s known on the subject? and What does the study add? α‐blocker tamsulosin in medical expusion therapy was determined to be safe and effective for distal ureteric stones with renal colic. This trial further demonstrates that the tamsulosin in MET is more efficative and more safer than nifedipine for distal ureteric stones with renal colic.

OBJECTIVE

• ? To determine the comparative efficacy of tamsulosin and nifedipine in medical expulsive therapy (MET) for distal ureteric stones with renal colic.

PATIENTS AND METHODS

• ? We evaluated the comparative efficacy of tamsulosin and nifedipine in MET in a prospective randomized trial of 3189 outpatients from 10 centres in China.
• ? Eligible patients randomly received tamsulosin or nifedipine. Efficacies of the two agents in MET were compared at 4 weeks.
• ? The primary endpoint was overall stone‐expulsion rate.
• ? Secondary endpoints were stone‐expulsion time, rate of pain relief therapy, mean analgesic consumption for renal colic recurrence, and side‐effects incidence.

RESULTS

• ? Stone‐expulsion rates in the tamsulosin group (group 1) were greater than those in the nifedipine group (group 2; P < 0.01).
• ? There was a significant variation in stone‐expulsion rates and times between groups 1 and 2 (P < 0.01); with improvements in stone‐expulsion rate and time significantly better in group 1 than in group 2.
• ? There was a significant variation in the rate of pain relief therapy for renal colic recurrence between groups 1 and 2 (P < 0.01); patients in group 1 required significantly less analgesics than those in group 2 (P < 0.01).
• ? There were no statistically significant differences in side‐effects incidence between the groups.

CONCLUSIONS

• ? Administration of tamsulosin and nifedipine in MET was determined to be safe and effective for distal ureteric stones with renal colic.
• ? Tamsulosin was significantly better than nifedipine in relieving renal colic and facilitating ureteric stone expulsion.