[Evidence-based medicine for urological cancer chemotherapy].
We reviewed the treatment results of urological cancer chemotherapy from the standpoint of evidence based medicine. In the treatment of advanced transitional cell carcinoma of the urothelium, M-VAC (MTX + VBL + ADM + CDDP) is regarded as the standard regimen; however, durable event-free survival is rare. There is no level 1 evidence to date showing that the use of neoadjuvant or adjuvant cisplatin-based regimens will improve survival in cases of locally advanced bladder cancer. Immunotherapy with interferon or interleukin-2 produces a small survival advantage in patients with metastatic renal cell carcinoma. There is no evidence that adjuvant interferon-alpha administration will improve the survival in those with non-metastatic renal cell carcinoma. Systematized cisplatin-based treatment protocols have been established in patients with advanced testicular germ cell tumor by means of many randomized controlled trials. Several clinical trials are under way to prove the efficacy of high dose chemotherapy (with autologous stem-cell support) in patients with poor risk germ cell tumors. We do not yet have sufficient data to conclude whether maximal androgen blockade will prolong the survival in patients with metastatic prostate cancer, nor to conclude whether neoadjuvant androgen depletion treatment improve disease free survival of the patients after radical prostatectomy.
Tsukamoto
S
S
Dept. of Urology, University of Tsukuba, Japan.
Miyanaga
N
N
Kawai
K
K
Akaza
H
H
D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000601:surgery / Q000628:therapy; D018572:Disease-Free Survival; D019317:Evidence-Based Medicine; D006801:Humans; D007167:Immunotherapy; D011468:Prostatectomy / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D014571:Urologic Neoplasms / Q000188:drug therapy* / Q000601:surgery / Q000628:therapy