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"In these cases, a tumor invades the inside of the renal vein, extends into the inferior vena cava, and can go all the way up above the diaphragm and into the heart, even into the right ventricle," Dr. Rodriguez says. "Surgery for this cancer tends to be quite treacherous, so it isn't done very often. In San Antonio, however, I'm completing as many as three to four tumor thrombus procedures per month." The reason: UT Medicine has become a referral center for tumor thrombus patients from throughout the region, thanks to the center's excellent relationship with University Hospital in San Antonio. "We now have a dedicated tumor thrombus team that includes cardiac anes- thesiologists, a cardiac surgeon, a vascular surgeon and a urologist, all of whom have operated with each other extensively on these cases," Dr. Rodriguez explains. "This experience has allowed us to refine the I N N OVATI N G T H E F U T U R E O F B L A D D ER C A N C ER T R E AT M EN T THE DEPARTMENT OF UROLOGY is a frequent participant in clinical trials initiated and organized by SWOG, formerly the Southwest Oncology Group. One such study is PRIME, an investigation of the efficacy of readying the immune system for intravesical bacillus Calmette-Guérin (BCG) therapy to treat superficial bladder cancer by using a pre-therapy percutaneous BCG vaccination. Robert Svatek, MD, is the trial's princi- pal investigator. "Instilling BCG into the bladder is nothing new — it's been around since the 1970s and is the standard of care for superficial bladder cancer," Dr. Svatek says. "In this trial, however, we're looking at a way to prime the immune system so that when we introduce BCG intravesically, the system will respond more robustly." The United States is currently experiencing a shortage of BCG. The primary domestic manufacturer has had production delays during the past year, forcing patients to search far and wide, and even leave the country, to find the drug. Dr. Svatek is working to introduce a Japanese-produced form of BCG, known as the Tokyo strain, to the U.S. market. "We're conducting a large trial to compare the Tokyo strain to the strain we have in the U.S.," he says. "If the Tokyo strain is just as good or better than the domestic variety, we hope to get it into the U.S. within the next five years." COV ER FE AT UR E 8 | San Antonio MD NEWS ■ M D N E W S . CO M