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国立がん研究センター 中央病院

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Department of Urology

Hiroyuki Fujimoto, Motokiyo Komiyama, Tomohiko Hara, Yasuo Shinoda, Aiko Maejima

Introduction

In the Department of Urology, all urogenital malignant diseases, including kidney cancer, urothelial cancer, prostate cancer, testicular germ cell tumors and retroperitoneal tumors, are the subject of diagnosis and treatment with comprehensive approaches, including radical surgery, irradiation, and chemotherapy.

Routine activities

The urology team consists of four staff physicians and one chief-resident and two residents. In addition, with the participation of a radiation oncologist, multi-disciplinary treatments for advanced disease including renal cancer, urothelial cancer, hormone-refractory prostate cancer and metastatic germ cell tumors, are performed. Every morning clinical rounds are started at 7:30 a.m., and a weekly conference to discuss inpatient management is held on Monday evenings.

Major urological malignant diseases are treated according to the following strategies:

  1. Renal cell carcinoma: M0, partial or radical nephrectomy; M1: chemotherapy with target drugs with TKI or mTOR with or without palliative nephrectomy.
  2. Bladder cancer. Carcinoma in situ: BCG instillation therapy. Ta, T1, transurethral resection of bladder cancer (TURBT), often combined with preoperative or postoperative BCG instillation. T2-T4, radical cystectomy with neoadjuvant chemotherapy by an M-VAC/GC regimen. N+, systemic chemotherapy, radiation; sometimes urinary diversion alone. M+, chemotherapy with a M-VAC or GC regimen.
  3. Prostate cancer. Organ-confined disease, active surveillance, robotic-assisted or open radical prostatectomy, irradiation, or endocrine therapy. Specimen-confined disease, extended radical prostatectomy without neoadjuvant endocrine therapy, radiation therapy with endocrine therapy, or endocrine therapy alone. M1 disease, endocrine therapy and palliative radiation if necessary. For castration refractory disease, DTX chemotherapy is indicated.
  4. Testicular germ cell tumor (GCT): Stage I, careful observation regardless of a pathological element. Stage II or higher, EP (etoposide + CDDP) or BEP (BLM + etoposide + CDDP) chemotherapy as the 1st line. In nonseminomatous cases, a salvage operation is performed after induction chemotherapy. In seminoma cases, careful observation rather than surgery is selected.

Research activities

We are constantly seeking ways to improve the treatment for malignant urological tumors.

  1. Urothelial cancer: The effectiveness of a phase III study to confirm the efficacy of BCG instillation for high grade T1 bladder cancer (JCOG1019) is ongoing. For metastatic disease, a weekly CBDCA + PTX regimen has been indicated.
  2. Prostate cancer: A phase II study to evaluate the efficacy of robotic-assisted laparoscopic radical prostatectomy for T1c-T3a prostate cancer is ongoing. A new operative method to achieve a complete surgical margin (extended radical prostatectomy) has been developed, and its efficacy in patients with specimenconfined disease has been evaluated without neoadjuvant endocrine therapy. This method was introduced in robotic-assisted laparoscopic radical prostatectomy with extended lymph node dissection. To provide a more precise preoperative diagnosis, a new imaging strategy using 3.0 Tesla MRI has been developed. For DTX refractory prostate cancer, a study on a vaccine regime with IKT1 is ongoing.
  3. Testicular germ cell tumors: Advanced and/ or refractory cases: A so-called “desperate operation”, which was designed for patients whose tumor markers do not normalize after induction chemotherapy, has been shown to be both efficacious and of clinical significance. For CDDP-refractory germ cell tumors, a second line TIP/TIN regimen has completed enrollment.

Clinical trials

We are actively involved in the following mainly ongoing protocol studies:

  1. A phase III study: BCG instillation for highgrade T1 bladder cancer (JCOG1019)
  2. A phase III study: Anti PD-L1 antibody (ATEZOLIZUMAB) for muscle invasive bladder cancer
  3. A phase II study: Robotic-assisted laparoscopic prostatectomy for low and intermediate risk prostate cancer
  4. A phase II study: IKT1 for chemo-refractory prostate cancer

Table 1. Patients' statistics: Major treatment

List of papers published in 2015

Journal

  1. Narukawa T, Hara T, Arai E, Komiyama M, Kawahara T, Kanai Y, Fujimoto H. Tumour multifocality and grade predict intravesical recurrence after nephroureterectomy in patients with upper urinary tract urothelial carcinoma without a history of bladder cancer. Jpn J Clin Oncol, 45:488-493, 2015
  2. Kanayama HO, Fukumori T, Fujimoto H, Nakanishi H, Ohyama C, Suzuki K, Nishiyama H, Eto M, Miki T, Kamoi K, Kubota Y, Takahashi S, Homma Y, Naito S. Clinicopathological characteristics and oncological outcomes in patients with renal cell carcinoma registered in 2007: The first large-scale multicenter study from the Cancer Registration Committee of the Japanese Urological Association. Int J Urol, 22:S1-S7, 2015
  3. Hara T, Fujimoto H, Sakura M, Inokuchi J, Nishiyama H, Miyazaki J, Ohyama C, Koie T, Kikuchi E, Hinotsu S, Cancer Registration Committee of the Japanese Urological Association. Prognostic factors of recurrent disease in upper urinary tract urothelial cancer after radical nephroureterectomy: Subanalysis of the multi-institutional national database of the Japanese Urological Association. Int J Urol, 22:1013-1020, 2015
  4. Miyazaki J, Nishiyama H, Fujimoto H, Ohyama C, Koie T, Hinotsu S, Kikuchi E, Sakura M, Inokuchi J, Hara T, Cancer Registration Committee of the Japanese Urological Association. Impact of smoking on the age at diagnosis of upper tract urothelial carcinoma: Subanalysis of the Japanese Urological Association multi-institutional national database. Int J Urol, 22:1023-1027, 2015