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[Intracavitary bacillus Calmette-Guerin therapy for upper tract transitional cell carcinoma]
H Mori1, B Miyaji, M Takahashi
1Department of Urology, Fukui Medical School, Japan.
Hinyokika Kiyo. Acta Urologica Japonica
|April 1, 1996
Summary
Bacillus Calmette-Guerin (BCG) therapy showed mixed results for upper urinary tract transitional cell carcinoma. While some patients responded, others required nephrectomy, highlighting the need for careful management to prevent complications.
Area of Science:
- Urology
- Oncology
- Nephrology
Background:
- Transitional cell carcinoma (TCC) of the upper urinary tract is a rare malignancy.
- Bacillus Calmette-Guerin (BCG) is an immunotherapy agent commonly used for bladder cancer.
- Limited data exists on BCG efficacy and safety for upper tract TCC.
Observation:
- Four patients with upper tract TCC received BCG via percutaneous nephrostomy or ureteral catheter.
- Two patients achieved a response, while two others with residual tumor underwent nephrectomy.
- Histopathology revealed extensive tuberculous granulomas and, in one case, renal parenchymal invasion.
Findings:
- BCG perfusion therapy demonstrated a 71% efficacy rate (27/38 renal units) in literature for upper tract tumors.
- Severe complications occurred in 5 cases, including sepsis, high fever, and ureteral stricture.
- The kidney's rich blood supply and thin-walled collecting system necessitate cautious BCG administration.
Implications:
- BCG therapy presents a potential treatment option for upper tract TCC, but with significant risks.
- Careful patient selection and monitoring are crucial to mitigate adverse events.
- Further research is needed to optimize BCG delivery and management protocols for upper tract malignancies.