Rotoresection versus transurethral resection of the prostate: short-term evaluation of a prospective randomized study

PURPOSE: We compared in a prospective fashion the short-term outcome of rotoresection to transurethral resection of the prostate. MATERIALS AND METHODS: A total of 50 patients with bladder outlet obstruction secondary to benign prostatic hyperplasia were randomized into 2 groups, rotoresection and transurethral resection of the prostate. Mean+/-SD patient age was 60.76+/-5.85 years in the rotoresection and 64.24+/-6.84 in the transurethral resection groups. All patients had an International Prostate Symptom Score of 8 or more, maximum free flow rate less than 15 ml per second, prostate volume 20 to 100 ml and prostate specific antigen 1 to 4 ng/ml. Pressure flow study revealed bladder outlet obstruction (Schafer's grade 3 or more). Patients were assessed at 1, 3 and 6 months by International Prostate Symptom Score, maximum free flow rate, transrectal ultrasound, pressure flow study, hemoglobin and urinalysis. RESULTS: At 6 months International Prostate Symptom Score decreased from 26.2+/-4.06 to 5.32+/-1.52 in the rotoresection group and from 22.84+/-4.56 to 7+/-1.4 in the transurethral resection group. Maximum free flow rate increased from 7.87+/-2.24 to 25.29+/-10.39 ml per second in the rotoresection group and from 9.44+/-2.29 to 25.2+/-5.8 ml per second in the transurethral group. Prostate volume decreased from 41.2+/-16.58 to 17.24+/-7.61 ml in the rotoresection group and from 40.6+/-16.93 to 18.28+/-8.75 ml in the transurethral group. Detrusor pressure at maximum flow and Schafer grade decreased from 79.84+/-26.8 cm H2O and 4.24+/-0.97 to 38.8+/-18.8 cm H2O and 1.24+/-0.93 in the rotoresection group, and from 63.04+/-21.08 cm H2O and 3.48+/-0.65 to 34.16+/-12.7 cm H2O and 1+/-0.7 in the transurethral group. Dilutional hyponatremia was higher with transurethral resection of the prostate (p=0.005) but no patient showed manifestations of the transurethral syndrome. Mild stress urinary incontinence was noted in 4 patients in the rotoresection group and in 3 in the transurethral group. CONCLUSIONS: Rotoresection is a safe and effective method of treating bladder outlet obstruction resulting from benign prostatic hyperplasia, and its efficacy is comparable to transurethral resection of the prostate.     

Neoadjuvant chemotherapy followed by concurrent chemo-radiation therapy in locally advanced nasopharyngeal carcinoma

PURPOSE: To evaluate the efficacy and outcomes of neoadjuvant cisplatinum and epirubicin chemotherapy followed by concurrent cisplatinum chemotherapy with radiotherapy in patients with locally advanced nasopharyngeal carcinoma. METHODS AND MATERIALS: One hundred ten patients (80 male, 30 female) with locally advanced nasopharyngeal carcinoma, staged according to the 1997 International Union Against Cancer/American Joint Committee on Cancer classification system as IIB (n = 9), III (n = 20), IVA (n = 32), and IVB (n = 49), World Health Organization types II (n = 25) and III (n = 85), were included in this protocol between January 1998 and July 2000 at King Faisal Specialist Hospital and Research Centre. Patients underwent two cycles of induction chemotherapy with cisplatinum 100 mg/m(2) and epirubicin 70 mg/m(2) on Days 1 and 21, followed by a radical course of radiotherapy (6,600 cGy in 6.5 weeks, 200 cGy/fraction) starting on Day 42, with three cycles of concurrent cisplatinum 25 mg/m(2) for 4 days on Days 42, 63, and 84. RESULTS: Of 110 patients included in this study, intracranial extension was present in 32 (29%), and nodal stage was N3 in 49 (45%). Complete remission and partial remission were achieved in 87 patients (79%) and 23 patients (21%), respectively. At a median follow-up for surviving patients of 37 months (22-55 months), 49 of 110 patients (44%) had failed treatment: 12 with local, 9 with regional nodes, 4 locoregional, 5 locoregional plus distant areas, and 19 with distant metastases. At the time of writing, 34 patients had died; all deaths were related to the patients' cancer except for 1 patient with treatment-related toxicity. Three-year actuarial overall survival, relapse-free survival, locoregional control, and distant metastasis-free survival rates were 89%, 78%, 88%, and 89% for patients with stage IIB; 71%, 70%, 89%, and 74% for stage III; 68%, 49%, 61%, and 77% for stage IVA; and 70%, 45%, 60%, and 69% for stage IVB, respectively. One patient received only one induction cycle; all others received two cycles; however, 9 of them required 20% reduction in the second cycle dose. Ninety patients (82%) completed two or more concurrent cycles of cisplatinum. Rates of Grade 3 and 4 reactions after induction chemotherapy were as follows: anemia 1% and 0%, leukopenia 8% and 4%, nausea 27% and 0%, vomiting 25% and 0%, and infection 4% and 4%, respectively. Acute Grade 3 and 4 reactions were also observed during chemoradiotherapy: anemia 1% and 0%, leukopenia 31% and 4%, nausea 35% and 0%, vomiting 26% and 2%, infection in 4% and 2%, mucositis in 49% and 0%, and skin reaction in 39% and 0%, respectively. CONCLUSIONS: Neoadjuvant chemotherapy followed by concurrent chemoradiotherapy is a safe and effective method of treatment for locally advanced nasopharyngeal carcinoma. Further investigations in prospective studies are required to evaluate this regimen.