Re: Laparoscopic ureteroneocystostomy and psoas hitch for post-hysterectomy ureterovaginal fistula: P. Modi, R. Gupta and S. J. Rizvi, J Urol 2008; 180: 615-617.

摘要

Recent advances in chemotherapy for advanced renal cell carcinoma have been made possible by exploiting the molecular mechanisms that are altered in various forms of renal cell carcinoma. One promising area is using agents such as sunitinib which work through antiangiogenic pathways. Thomas et al (page 518) from Cleveland, Ohio report the results of a new adjuvant trial of sunitinib in high risk patients with renal cell carcinoma who were deemed unsuitable for initial nephrectomy due to either locally advanced disease or extensive metastatic burden. Patients were treated with 50 mg sunitinib daily for 4 weeks. In the 25 patients studied mean tumor size was 10.5 cm. Although no patient experienced complete response, partial responses were noted in 16% of patients and 37% had stabilization of disease. Unfortunately, 47% of patients had disease progression of the primary tumor. At a median followup of 6 months 4 patients had undergone nephrectomy for viable tumor. Sunitinib was associated with grade 3-4 toxicity in 37% of patients. This trial demonstrates that sunitinib can lead to a reduction in tumor burden in a select group of patients, allowing subsequent nephrectomy. It is also noteworthy that 42% of patients experienced primary tumor shrinkage. However, the authors warn that investigative biases may have affected determination of tumor resectabil-ity.