Urachal carcinoma: Clinicopathologic features and long‐term outcomes of an aggressive malignancy

Abstract

Objective L‐dopa is the most widely used and most effective therapy for Parkinson disease (PD), but chronic treatment is associated with motor complications in the majority of patients. It has been hypothesized that providing more continuous delivery of L‐dopa to the brain would reduce the risk of motor complications, and that this might be accomplished by combining L‐dopa with entacapone, an inhibitor of catechol‐O‐methyltransferase, to extend its elimination half‐life. Methods We performed a prospective 134‐week double‐blind trial comparing the risk of developing dyskinesia in 747 PD patients randomized to initiate L‐dopa therapy with L‐dopa/carbidopa (LC) or L‐dopa/carbidopa/entacapone (LCE), administered 4× daily at 3.5‐hour intervals. The primary endpoint was time to onset of dyskinesia. Results In comparison to LC, patients receiving LCE had a shorter time to onset of dyskinesia (hazard ratio, 1.29; p = 0.04) and increased frequency at week 134 (42% vs 32%; p = 0.02). These effects were more pronounced in patients receiving dopamine agonists at baseline. Time to wearing off and motor scores were not significantly different, but trended in favor of LCE treatment. Patients in the LCE group received greater L‐dopa dose equivalents than LC‐treated patients (p < 0.001). Interpretation Initiating L‐dopa therapy with LCE failed to delay the time of onset or reduce the frequency of dyskinesia compared to LC. In fact, LCE was associated with a shorter time to onset and increased frequency of dyskinesia compared to LC. These results may reflect that the treatment protocol employed did not provide continuous L‐dopa availability and the higher L‐dopa dose equivalents in the LCE group. ANN NEUROL 2010;68:18–27

Urachal carcinoma with liver, lung, and brain metastases: benefit of a new combination chemotherapy (bevacizumab, 5-fluorouracil, irinotecan) &ndash; case report

“…There was one additional responder using a combination of paclitaxel, methotrexate, and cisplatin (TMP), and no response in five patients treated with methotrexate, vinblastine, adriamycin, and cisplatin (M-VAC). 16,17 Other reports suggest a single case of long-term survival with gemcitabin and cisplatin (GC), 5 S-1,cisplatin, 18 and cisplatin with irinotecan. 19 The most aggressive cisplatin based combination came from the Memorial Sloan-Kettering Cancer Center (NY, USA).…”

“…4 In contrast with the much more frequent transitional cell cancers of the bladder, urachal cancer typically occurs in a younger patient population, with many reports indicating a median age at diagnosis of approximately 47-56 years. [2][3][4] While some investigators report a predominantly male patient population, 5 others suggest a more balanced distribution between male and female patients. 3,4 Unfortunately, there are many patients who present with metastatic disease which currently is not likely to be curable.…”

“…Common metastatic sites include lung, pelvic lymph nodes, and bone. 5 Diagnosis of urachal cancer is best made by cystoscopy, although urinary cytology is positive in 38% of cases. 5 Ultrasound and CT are useful in assessing the extent of local and distant disease.…”

“…Staging systems used for traditional bladder cancers cannot be applied to urachal cancer, as the pattern of growth is intrinsically different. 5 Historically, radical cystectomy was the operation of choice for resectable urachal cancer. However, due to umbilical involvement in 7% of patients, urachal cancer surgery now consists of a partial cystectomy with en bloc resection of the umbilicus and urachal ligament.…”

The role of robotic partial cystectomy in a patient with metastatic primary adenocarcinoma of the bladder

“…1 It is typically associated with an extremely poor prognosis with many patients found to have distant metastases at the time of diagnosis. 2 The gold standard of treatment for muscle invasive bladder cancer is radical cystectomy 3,4 but the alternative of partial cystectomy (PC) has gained popularity and has been shown to provide comparable 5-year survival rates to patients treated with radical cystectomy.…”