Carcinoma of the Kidney and Testis, and Rare Urologic Malignancies: Innovations in Management PDF
Preview Carcinoma of the Kidney and Testis, and Rare Urologic Malignancies: Innovations in Management
MEDICAL RADIOLOGY Diagnostic Imaging and Radiation Oncology Editorial Board Founding Editors L.W. Brady, M.W. Donner(t), H.-P. Heilmann, EH.W. Heuck Current Editors Diagnostic Imaging A.L. Baert, Leuven EH.W. Heuck, Stuttgart J.E. Youker, Milwaukee Radiation Oncology L.W. Brady, Philadelphia H.-P. Heilmann, Hamburg Springer Berlin Heidelberg New York Barcelona Hong Kong London Milan Paris Singapore Tokyo Z. Petrovich· L. Baert . L.W. Brady (Eds.) Carcinoma of the Kidney and Testis, and Rare Urologic Malignancies Innovations in Management With Contributions by J. A. L. L. Baert . L. Baert . M. Bamberg· A. Belldegrun . G. A. Bogaert . R. Bouillon L.W. Brady· C. Catton· J. Classen· F. A. Corso· P. Dal Cin . D. J. M. K. De Ridder H. Dumez . M. Dzeda . R. A. Figlin . A. J. Figueroa· S. C. Formenti . B. E. Henderson S. Horenblas . G. Jozsef . B. A. Kogan· J. E. Lahaniatis . R. Lavey· B. K. Lee· B. Micaily J. M. Michalski· A. Mohrbacher . P. W. Nichols· R. J. M. Nijman . R. H. Oyen H. Ozer . A. Pawinski . C. L. Pearce· Z. Petrovich· H. Raat . M. Roach III . T. Roskams R. K. Ross· C. E. Salem· D. G. Skinner· E. C. Skinner· J. P. Stein· L. Stockx o. E. Streeter· S. J. Tucker· B. Van Damme . H. Van den Berghe . A. Van den Bruel A. Van Oosterom . H. P. Van Poppel . L. Vanuytsel . B. M. Verbist . G. A. Verswijvel W. Wynendaele . M. C. Yu . J.-M. Yuan· C.-S. Zee Foreword by 1.W. Brady and H.-P. Heilmann Preface by Z. Petrovich· 1. Baert· 1. W. Brady With 189 Figures in 266 Separate Illustrations, Some in Color and 92 Tables Springer ZBIGNIEW PETROVICH, MD, FACR Professor of Radiation Oncology and Urology Chairman, Department of Radiation Oncology University of Southern California School of Medicine Kenneth Norris Jr. Cancer Hospital and Research Institute 1441 Eastlake Avenue Los Angeles, CA 90033-004 USA Luc BAERT, MD, PhD Professor and Chairman, Department of Urology Catholic University of Leuven, University Hospitals Gasthuisberg 49, Herestraat B-3000 Leuven Belgium LUTHER W. BRADY, MD Hylda Cohn/American Cancer Society Professor of Clinical Oncology, and Professor, Department of Radiation Oncology Allegheny University of the Health Sciences Allegheny University Hospitals, Hahnemann Broad & Vine Sts., Mail Stop 200, Philadelphia, PA 19102-1192 USA MEDICAL RADIOLOGY· Diagnostic Imaging and Radiation Oncology Continuation of Handbuch der medizinischen Radiologie Encyclopedia of Medical Radiology ISSN 0942-5373 ISBN -13: 978-3-642-64144-2 e-ISBN -13: 978-3-642-59839-5 DOl: 10.1007/978-3-642-59839-5 Library of Congress Cataloging-in-Publication Data. Carcinoma of the kidney and testis, and rare urologic malignancies: innovations in management / Z. Petrovich, L. Baert, L.W. Brady (eds.) ; with contributions by J.A.L.L. Baert. .. let al.] ; fore word by L. W. Brady and H.-P. Heilmann. p. cm. --(Medical radiology) Includes bibliographical references and index. ISBN-13:978-3-642-64144-2 (alk. paper) l. Genitourinary organs--Cancer. 2. Kidneys--Cancer. 3. Testis--Cancer. I. Petrovich, Zbigniew. II. Baert, L. (Luc) III. Brady, Luther w., 1925-. IV. Series [DNLM: 1. Urogenital Neoplasms--therapy. WJ 160 C265 1999] RC280.G4C37 1999 616.99'46--dc21 DNLM/DLC for Library of Congress 98-21388 CIP This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer-Verlag. Violations are liable for prosecution under the German Copyright Law. © Springer-Verlag Berlin Heidelberg 1999 Softcover reprint of the hardcover 1st edition 1999 The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. . Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature. Typesetting: Best-set Typesetter Ltd., Hong Kong SPIN: 10546236 2113135 - 5432 1 0 - Printed on acid-free paper This book is dedicated to Zofia Petrovich, MD and Mrs. Bea Baert Foreword In the United States in 1997, 28800 new cases of malignant tumors of the kidney and renal pelvis were diagnosed along with 2100 new cases of malignant tumors of the ureter and other urinary organs, 7200 primary malignant tumors of the testis, and 1300 primary malignant tumors of the penis and other genital organs. In large measure, surgery is the treatment of choice for these tumors, but radiation therapy is in creasingly recognized as having significant and important curative and palliative bene fits in each of these tumor sites. Surgery is the standard form of treatment for non metastatic renal cell carcinomas as well as for malignancies of the renal pelvis and ureter, with radical nephrectomy and radical uretectomy being employed. However, postoperative radiation therapy is of value for those patients who demonstrate evi dence of residual tumor following surgery, transection of tumor during surgery, or positive regional lymph node drainage. As regards the rare tumors that involve the female urethra, surgical resection is appropriate for those that are limited and local in character and amenable to partial ureterectomy. With tumors that are more advanced in character, however, local recurrence and lymphatic dissemination are significant problems, and treatmentby radiation therapy programs alone yield satisfactory control rates as well as limited recurrences and long-term survivors. For primary tumors involving the testis, the major approach to nonseminomatous tumors is surgical resection with postsurgical systemic chemotherapy. On the other hand, seminomas are best managed by surgical resection with orchiectomy and high cord ligation along with postoperative radiation therapy in the appropriate circum stances; this strategy produces significant survival figures in patients with seminomas. Tumors that involve the penis and the male urethra are difficult problems to tackle because of both the location and the pattern of local tumor spread. Generally, surgical management is the appropriate approach to the problem but when there is evidence of regional lymph node involvement, radiation therapy can be used with good results; certainly radiation therapy has the primary advantage of preserving the phallus intact. The current volume, Carcinoma of the Kidney and Testis, and Rare Urologic Malignancies. Innovation in Management, compiles all of the pertinent data with regard to epidemiology, workup, and treatment for these tumor types, presenting results relative to management; it also discusses basic research and clinical research into appropriate treatment regimens for each of these tumor sites. The authors of this volume stress the need for careful selection of cases for each treatment regimen, careful follow-up, and carefully carried out treatment programs. Philadelphia LUTHER W. BRADY Hamburg HANS-PETER HEILMANN Preface During the past decade, major advances have taken place in the diagnosis and manage ment of patients with carcinoma of the kidney and testicle. At the same time quality of life issues have reached a level of importance nearly equal to that of patient survival rates. It appears appropriate and relevant to summarize these important advances in the present volume. Renal cell carcinoma (RCC) is the predominant primary tumor of the kidney. It is an important and relatively common tumor. In the past decade in the United States there has been an approximate 20% increase in the incidence of RCC with a simultan eous major improvement in patient survival. This improvement in survival has pri marily been, due to major progress in the imaging modalities and better understanding of the natural history of this disease, permitting early diagnosis and timely application of appropriate surgical therapy. Radical nephrectomy remains the only effective therapy in the management of primary RCC, with newer surgical techniques such as partial nephrectomy becoming an important and widely recognized treatment in properly selected patients. RCC patients presenting with or relapsing with metastatic disease remain a major challenge to uro-oncology in spite of recent developments in immunotherapy and a possibility of applying gene therapy. Contemporary radio therapy has become an important palliative treatment in many RCC patients with metastasis. Testicular tumors are relatively small in number but important malignancies with an estimated 7600 patients expected to be diagnosed in the United States in 1998. In the past decade these tumors have shown a nearly 30% increase in incidence, which is most apparent in white males. The management of testicular tumors has become a success story through the use of surgery in combination with systemic chemotherapy. In the early 1960s in the United States, the 5-year survival of patients with testicular carci noma was less than 63% but it had increased to more than 95% by the early 1990s. This increase in survival was largely due to advances in chemotherapy. Current efforts in therapy for testicular tumors are directed towards improvement in quality of life of the treated patients who are expected to have survival rates similar to those of a matched group of males in the general population. The importance of these quality of life issues is reflected in the four chapters dedicated to this topic in this volume. The management of uncommon tumors of the genitourinary tract presents a special problem. Due to their rarity only major medical centers acquire the experience needed for the frequently complex management of these tumors. In view of the above the authors believe that patients with rare urologic malignancies should be referred for treatment to centers specializing in the management of genitourinary tumors. x Preface This work, together with the previously published two volumes including carcinoma of the prostate and bladder, attempts to present the state-of-the-art in the diagnosis and management of patients with genitourinary tumors. It is apparent that successful management of these tumors depends on the presence and frequent interaction of a multidisciplinary team of specialists dedicated to genitourinary carcinoma. This team of specialists should include: urologists, medical oncologists, radiation oncologists, diagnostic radiologists, pathologists, epidemiologists, geneticists, immunologists, molecular biologists, highly skilled technologists, and nursing staff. z. Los Angeles PETROVICH Leuven L.BAERT Philadelphia L.W.BRADY Contents Renal Cell Carcinoma ........................................................1 1 Epidemiology of Renal Cell Carcinoma M. C. Yu, J.-M. YUAN, and R. K. Ross ......................................... 3 2 Pathology of Renal Cell Carcinoma T. ROSKAMS and B. VAN DAMME ............................................ 15 3 Genetics of Renal Cell Carcinoma P. DAL CIN and H. VAN DEN BERGHE ........................................ 25 4 Imaging of Renal Parenchymal Tumors R. H. OYEN and G. A. VERSWIJVEL .......................................... 33 5 Radical Nephrectomy J. P. STEIN and D. G. SKINNER .............................................. 57 6 Nephron-Sparing Surgery H. P. VAN POPPEL and L. BAERT ............................................ 79 7 Palliative Surgical Therapy H. VAN POPPEL and L. BAERT .............................................. 95 8 Preoperative and Palliative Embolization L. STOCKX and H. RAAT .................................................. 111 9 Immunotherapy and Chemotherapy for Metastatic Renal Cell Carcinoma S.J. TuCKER, A. BELLDEGRUN, and R.A.FIGLIN ............................... 117 10 The Role of Radiotherapy in the Management of Patients with Renal Cell Carcinoma Z. PETROVICH, G. JOZSEF, C. Yu, and C.-S. ZEE ............................... 131 11 Radiation Therapy for Carcinoma of the Renal Pelvis and Ureters J. E. LAHANIATIS, J. M. MICHALSKI, and L. W. BRADY .......................... 149 12 Diagnosis and Management of Tumors of the Adrenal Gland A. VAN DEN BRUEL, R. OYEN, and R. BOUILLON ............................... 157 13 Surgical Treatment of Adrenal Gland Tumors J. P. STEIN and D. G. SKINNER ............................................. 169 14 Diagnosis and Management of Retroperitoneal Tumors in Pediatric Patients G. A. BOGAERT and B. A. KOGAN ........................................... 187
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