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National Cancer Institute®
Ultima Vez Modificado: 1 de mayo del 2002
UI - 11969046
AU - Saint F; Salomon L; Quintela R; Cicco A; Abbou CC; Chopin DK
TI - [Classification, favorable characteristics, prevention and treatment of adverse side-effects associated with Bacillus Calmette-Guerin in the treatment of superficial bladder cancer]
SO - Ann Urol (Paris) 2002 Mar;36(2):120-31
AD - Service d'urologie, hopital Henri Mondor, 51, avenue du Marechal de Lattre de Tassigny, 94000 Creteil, France.
The efficacy of Bacillus Calmette-Guerin (BCG) in the treatment of superficial bladder cancer was first reported by Morales in 1976. Several authors have since demonstrated the efficacy of BCG in the prophylaxis and treatment of high-risk superficial bladder tumors (pT1G3, CIS). Although BCG is now recommended as an adjunctive treatment for superficial bladder tumors, the optimal treatment schedule remains to be defined. Results reported by Lamm suggest that an initial induction cycle of six weekly intravesical BCG instillations is suboptimal unless maintenance therapy (three consecutive weekly instillations) is given 3, 6, 12, 18, 24, 30 and 36 months later. However, the use of maintenance therapy is hindered by troublesome adverse reactions. This article reviews adverse reactions associated with BCG treatment, proposed a classification and discusses their prevention and treatment.
UI - 11904733
AU - Reale M; Intorno R; Tenaglia R; Feliciani C; Barbacane RC; Santoni A;
TI - Conti P Production of MCP-1 and RANTES in bladder cancer patients after bacillus Calmette-Guerin immunotherapy.
SO - Cancer Immunol Immunother 2002 Apr;51(2):91-8
AD - Immunology Division, University of Chieti, Medical School, Via dei Vestini, 66013 Chieti, Italy.
Bacillus Calmette-Guerin (BCG) therapy induces a local immunological response mediated by cellular immune and inflammatory reactions that enhance its anti-tumor efficacy in bladder cancer. Monocyte chemotactic protein-1 (MCP-1) and the "regulated on activation normal T expressed and secreted" chemokine (RANTES) are potent chemotactic molecules that attract monocytes and memory T cells. MCP-1 and RANTES levels in patients with superficial bladder cancer treated with intravesical instillations of BCG are significantly higher than in untreated cancer patients and controls. In the present study, the subjects were divided into three groups: (1) control subjects; (2) bladder cancer patients who did not receive BCG treatment; (3) bladder cancer patients who received intravesical administration of BCG. No differences in the basal production and expression of MCP-1 and RANTES mRNA were observed between BCG-treated and untreated patients. BCG treatment influenced the monocyte response to phytohemagglutinin (PHA) and BCG stimulation. After 24-h incubation, monocytes from BCG-treated bladder cancer patients released more MCP-1 and RANTES than those from untreated bladder cancer patients and controls. The anti-tumor effects of BCG observed in superficial bladder cancer therapy may depend on stimulation of the investigated chemokines, which attract monocytes/macrophages and memory T cells.
UI - 11309436
AU - Au JL; Badalament RA; Wientjes MG; Young DC; Warner JA; Venema PL;
TI - Pollifrone DL; Harbrecht JD; Chin JL; Lerner SP; Miles BJ; International Mitomycin C Consortium Methods to improve efficacy of intravesical mitomycin C: results of a randomized phase III trial.
SO - J Natl Cancer Inst 2001 Apr 18;93(8):597-604
AD - Ohio State University, 496 W. 12th Ave., Columbus, OH 43210, USA. email@example.com
BACKGROUND: Intravesical chemotherapy (i.e., placement of the drug directly in the bladder) with mitomycin C is beneficial for patients with superficial bladder cancer who are at high risk of recurrence, but standard therapy is empirically based and patient response rates have been variable, in part because of inadequate drug delivery. We carried out a prospective, two-arm, randomized, multi-institutional phase III trial to test whether enhancing the drug's concentration in urine would improve its efficacy. METHODS: Patients with histologically proven transitional cell carcinoma and at high risk for recurrence were eligible for the trial. Patients in the optimized-treatment arm (n = 119) received a 40-mg dose of mitomycin C, pharmacokinetic manipulations to increase drug concentration by decreasing urine volume, and urine alkalinization to stabilize the drug. Patients in the standard-treatment arm (n = 111) received a 20-mg dose without pharmacokinetic manipulations or urine alkalinization. Both treatments were given weekly for 6 weeks. Primary endpoints were recurrence and time to recurrence. Treatment outcome was examined by use of Kaplan-Meier analysis with log-rank tests. Statistical tests were two-sided. RESULTS: Patients in the two arms did not differ in demographics or history of intravesical therapy. Dysuria occurred more frequently in the optimized arm but did not lead to more frequent treatment termination. In an intent-to-treat analysis, patients in the optimized arm showed a longer median time to recurrence (29.1 months; 95% confidence interval [CI] = 14.0 to 44.2 months) and a greater recurrence-free fraction (41.0%; 95% CI = 30.9% to 51.1%) at 5 years than patients in the standard arm (11.8 months; 95% CI = 7.2 to 16.4 months) and 24.6% (95% CI = 14.9% to 34.3%) (P =.005, log-rank test for time to recurrence). Improvements were found in all risk groups defined by tumor stage, grade, focality, and recurrence. CONCLUSIONS: This study identified a pharmacologically optimized intravesical mitomycin C treatment with statistically significantly enhanced efficacy.
UI - 11955743
AU - Rodel C; Grabenbauer GG; Kuhn R; Zorcher T; Papadopoulos T; Dunst J;
TI - Schrott KM; Sauer R Organ preservation in patients with invasive bladder cancer: initial results of an intensified protocol of transurethral surgery and radiation therapy plus concurrent cisplatin and 5-fluorouracil.
SO - Int J Radiat Oncol Biol Phys 2002 Apr 1;52(5):1303-9
AD - Department of Radiation Therapy, University of Erlangen, Erlangen, Germany. firstname.lastname@example.org
PURPOSE: To assess safety, tolerance, and disease control of transurethral resection of the bladder tumor (TURB) plus concurrent cisplatin, 5-fluorouracil (5-FU), and radiation therapy (RT) with selective organ preservation in patients with bladder cancer. PATIENTS AND METHODS: Forty-five patients with muscle-invading or high-risk T1 (G3, associated carcinoma in situ, multifocality, >5 cm) bladder cancer were entered into a protocol of TURB followed by concurrent cisplatin (20 mg/m(2)/day, 20-min infusion) and 5-FU (600 mg/m(2)/day, 120-hour continuous infusion), administered on Day 1-5 and 29-33 of RT (single dose 1.8 Gy, total dose to the bladder 54-59.4 Gy). Response was evaluated by restaging TURB 6 weeks later. In case of invasive residual or recurrent tumor, salvage cystectomy was recommended. Median follow-up was 35 months (range: 8-80 months). RESULTS: Thirty-nine patients (87%) had no detectable tumor at restaging TURB; 29 patients (64%) have been continuously free of tumor in their bladders. A superficial relapse occurred in 4 patients, a muscle-invasive relapse in 6 patients. Overall survival and survival with preserved bladder was 67% and 54%, respectively, at 5 years. Hematologic Grade 3/4 toxicity occurred in 10%/4%; Grade 3 diarrhea occurred in 9%. Thirty-four patients (76%) completed the protocol as scheduled or with only minor deviations. One patient required salvage cystectomy because of a shrinking bladder. CONCLUSION: This protocol of concurrent cisplatin/5-FU and RT has been associated with acceptable toxicity. The complete response rate of 87% and the 5-year survival with intact bladder of 54% are encouraging and compare favorably with our historical control series using RT with carboplatin and cisplatin alone.
UI - 11872027
AU - Yiou R; Patard JJ; Benhard H; Abbou CC; Chopin DK
TI - Outcome of radical cystectomy for bladder cancer according to the disease type at presentation.
SO - BJU Int 2002 Mar;89(4):374-8
AD - Service d'Urologie, CHU Henri Mondor, EMI INSERM 99-09, Creteil, France.
OBJECTIVE: To examine whether the outcome of cystectomy for invasive transitional cell carcinoma (TCC) of the bladder was influenced by the type of disease at initial presentation. PATIENTS AND METHODS: The charts of 76 patients treated for TCC by radical cystectomy from 1987 to 1997 in our unit were reviewed. The patients were divided into three groups: group 1 comprised 43 patients with primary invasive disease; group 2 included 12 patients with progression of an initial superficial bladder tumour after failure of conservative treatment; and group 3 comprised 21 patients who had a radical cystectomy for superficial TCC, with a high risk of progression after attempts at conservative treatment. The pathological findings on transurethral resection and cystectomy specimens, cancer-specific survival and the time to progression were compared among the three groups. RESULTS: The rate of pT0 in cystectomy specimens was 16%, 41% and 24% in groups 1, 2 and 3, respectively. Under-staging occurred in 24% of cases in group 3. The 10-year cancer-specific survival rates were 48%, 47% and 82% in groups 1, 2 and 3, respectively. The cancer-specific survival rate and progression rate were not significantly different between groups 1 and 2, but were significantly lower/higher in these patients than in group 3 (P < 0.01). CONCLUSIONS: These data suggest that the prognosis of superficial TCC which progresses despite conservative management is no better than that of invasive TCC at initial presentation, despite the closer follow-up received by the former patients. Early identification of this group of patients may improve the cancer-specific survival, as early cystectomy for high-risk superficial TCC yields better results.
UI - 11889593
AU - Helpap B; Kloppel G
TI - Neuroendocrine carcinomas of the prostate and urinary bladder: a diagnostic and therapeutic challenge.
SO - Virchows Arch 2002 Mar;440(3):241-8
AD - Department of Pathology, Academic Hospital of the University of Freiburg, Postfach 720, 78207 Singen, Germany. email@example.com
This review addresses the various morphological, immunohistochemical and cell kinetic aspects of pure and mixed neuroendocrine carcinomas of the prostate and urinary bladder and of carcinomas with focal neuroendocrine differentiation. It is important that neuroendocrine tumours of the prostate and urinary bladder be clearly distinguished from their nonneuroendocrine counterparts because of differences in treatment and prognosis. In the case of high-grade neuroendocrine carcinomas, early diagnosis and initiation of appropriate chemotherapy may increase survival and potentially induce complete remission in individual cases.
UI - 11796234
AU - de Braud F; Maffezzini M; Vitale V; Bruzzi P; Gatta G; Hendry WF;
TI - Sternberg CN Bladder cancer.
SO - Crit Rev Oncol Hematol 2002 Jan;41(1):89-106
AD - START Project, European School of Oncology, Viale Beatrice d'Este 37, 20122 Milan, Italy.
Bladder cancer is the second most frequent tumour of the urogenital tract. Tobacco smoke has been shown to increase the risk of bladder cancer two- to fivefold as well as the exposure to metabolites of aniline dyes and other aromatic amines. Seventy-five per cent of bladder cancers are superficial at initial presentation, limited to the mucosa, submucosa, or lamina propria. Recurrence rates after initial treatment are 50-80%, with progression to muscle-invading tumour in 10-25%. In muscle-invading bladder cancers, there is a 50% risk of distant metastases. Surgery is the mainstay of standard treatment both in the form of transurethral endoscopic resection, mainly for superficial disease, and in the form of open ablative surgery with urinary diversion for muscle invasive disease. Endovesical administration of BCG has been employed after endoscopic resection as the most effective agent for both prophylaxis of disease recurrence and progression from superficial to invasive disease. The accepted treatment for muscle infiltrative disease is radical cystectomy. Response rates to combination chemotherapy regimens of up to 70% in patients with advanced metastatic disease have led to an investigation of its use for locally invasive disease in combination with conventional modalities of treatment.
UI - 11930736
AU - Zhou X; Mei H; Gao X
TI - [Clinical study of detenia cecal-ascending colon continent cutaneous urinary reservoir]
SO - Zhonghua Wai Ke Za Zhi 2001 Nov;39(11):842-4
AD - Department of Urology, Third Affiliated Hospital, Sun Yat-Sen University of Medical Sciences, Guangzhou 510630, China.
OBJECTIVE: To construct a good continent urinary diversion which is easy to be performed and has a low incidence of complications. METHODS: 26 cases of bladder cancer were given radical cystectomy before the cecal-ascending colon was excluded and 15-20 cm of the cecal-ascending colon was isolated. The colon teniae were then incised at the interval of 0.5-1.0 cm to construct the detenia cecal-ascending colon continent urinary diversion open to the umbilicus. RESULTS: All the patients were followed up for 21.1 +/- 10.1 months. Reliable continence was achieved in all with a low incidence of complications. The capacity of the reservoirs reached 350-600 ml 6 month after operation. Self catherizations were carried out every 3 to 6 hours, Urodynamic data showed a mean maximum filling pressure of 58.7 +/- 24.5 cmH2O, and a mean maximum urethral (efferent) closure pressure of 104.3 +/- 33.8 cmH2O. CONCLUSION: Detenia cecal-ascending colon continent urinary diversion is an ideal method.
UI - 11930737
AU - Xu Y; Qiao Y; Sa Y
TI - [Enhanced continent mechanism of the tapered ileum in continent urinary reservoir]
SO - Zhonghua Wai Ke Za Zhi 2001 Nov;39(11):845-7
AD - Department of Urology, Shanghai Sixth Municipal Hospital, Shanghai 200233, China.
OBJECTIVE: To construct a reliable continent tube that is easy to tapered as an efferent tube and the partial efferent tube was placed between the back surface of the rectus muscle and the wall of the ileal pouch. The internal orifice of the tapered ileum was anastomosed to the ileal pouch and its external orifice of the tapered ileum was anastomosed to the umbilicus. Urodynamic study of the efferent tubes and pouch was done 1.5 to 3 months and 6 to 17 months after operation. RESULTS: The stoma was easily catheterized with a 16 F catheter in all patients. One patient died of heart disease 55 days after the operation, while 18 of the remaining 19 were completely continent day and night. At 1.5 to 3 months, the urodynamic study of the efferent tubes showed the maximum close pressure with a full pouch of 46-124 cmH2O(91.53 +/- 17.21), and when the pouch was empty it was 34-84 cmH2O(66.68 +/- 11.60). The difference in the mean maximum closure pressure in full and empty pouches was statistically significant (t = 10.59, P < 0.01). At 6 to 17 months, urodynamic study was performed in 12 patients, the maximum closure pressure in the efferent tube was 77 to 154 cmH2O (100.92 +/- 20.88) when the pouch was filled with saline. When the pouch was empty, it was 56 to 115 cmH2O (74.08 +/- 14.59). The difference in the mean maximum closure pressure in full and empty pouches was statistically significant (t = 8.54, P < 0.01). Reservoir capacity was 360 to 750 ml (455 +/- 110.74). When it was filled to the maximum, the reservoir pressure was 16 to 35 cmH2O (23.17 +/- 5.82). There was no contractive wave in filling in any patient. CONCLUSIONS: This study indicates that the continent mechanism of the tapered ileum can be greatly enhanced by fixing it between the abdominal and pouch walls. This maneuver also provides easy catheterization and surgical simplicity.
UI - 11930738
AU - Lu H; Zang Y; Liu L
TI - [Orthotopic detenia cecal-ascending colon urinary reservoir: report of 18 cases]
SO - Zhonghua Wai Ke Za Zhi 2001 Nov;39(11):848-9
AD - Department of Urology, People's Hospital of Weifang, Weifang 261041, China.
OBJECTIVE: To improve the technique of detenia cecal-ascending colon continent urinary reservoir for farther improving the life quality of the patient. METHODS: Orthotopic detenia cecal-ascending colon urinary reservoir was carried out by complete resection of all the tenia and multiple transverse incision of colonic circular muscular layer for 18 patients with bladder cancer underwent radical cystectomy. RESULTS: The patients have been followed up for 6-20 months. All were completely continent during the day and 13 patients got complete continence at the night. Only 3 patients had nocturnal incontinence. The capacity of the urine reservoir was 410-520 ml. The maximum intrareservoir pressure was 39-60 cmH2O, while the post-micturition residual volume was 15-46 ml and the maximum flow rate was 12-28 ml/per second. No evidence of ureter reflux and ureteral obstruction was observed and serum electrolytes were normal in all patients. CONCLUSIONS: Orthotopic detenia cecal-ascending colon urinary reservoir shows good clinical and functional results, and the simple technique, exerts low pressure in the reservoir and produces minimal complications.
UI - 11836593
AU - Matsushima H; Kawabe K; Fujime M; Kitamura T; Homma Y; Kishi H; Kawamura
TI - T; Umeda T; Ohishi Y; Murai M; Kawai T; Yoshida H; Fukuda T Treatment of patients with superficial bladder cancer by intravesical instillation of anticancer drugs plus oral chemotherapy following TUR-Bt: a randomized controlled trial.
SO - Oncol Rep 2002 Mar-Apr;9(2):283-8
AD - Department of Urology, Tokyo Metropolitan Police Hospital 10-41, Chiyoda-ku, Tokyo 102-0071, Japan. firstname.lastname@example.org
We conducted a randomized controlled trial to compare local recurrence rate after transurethral resection of superficial bladder cancer treated by either intravesical instillation of an anticancer drug alone (method A) and the intravesical instillation plus oral chemotherapy (doxifluridine, 5'-DFUR, an intermediate metabolite of capecitabine) (method B). Results between groups showed no difference in recurrence-free survival curves in 196 patients subjected to primary analysis. However, patients subjected to secondary analysis (method B, over 3 months administration of 5'-DFUR) showed a significantly better prognosis than method A (p=0.0244, Wilcoxon). Regarding correlation between thymidine phosphorylase (TP, an enzyme to convert 5'-DFUR to 5-fluorouracil) level and prognosis, method A patients showed poorer prognosis in higher TP level cases than in lower TP levels. However, there was no significant difference in prognosis between those with higher and lower TP levels. In method B patients, there was no difference in prognosis between those with higher and lower TP levels. Method A patients tended to show a slightly better prognosis than those with lower TP levels, while method B patients tended to have a slightly better prognosis with higher TP levels, but no significant difference was observed. These findings suggested 5'-DFUR showed a mild efficacy in patients with higher TP levels and that patients with higher TP levels resulted in poorer prognosis.
UI - 11989907
AU - Bernardi D
TI - Is it possible to use anthracyclines in patients older than 70 years? Pro.
SO - Tumori 2002 Jan-Feb;88(1 Suppl 1):S133-5
AD - Centro di Riferimento Oncologico, Divisione di Oncologia Medica A, Aviano (PN).
UI - 11876735
AU - Gaitonde K; Goyal A; Nagaonkar S; Patil N; Singh DR; Srinivas V
TI - Retrospective review and long-term follow-up of radical cystectomy in a developing country.
SO - BJU Int 2002 Mar;89 Suppl 1():57-61
AD - Department of Urology, PD Hinduja National Hospital and Medical Research Centre, Mahim, Mumbai 400016, India.
OBJECTIVE: To retrospectively review the clinical data from patients undergoing radical cystectomy for bladder cancer, and to analyse the complications and survival rates associated with this operation in a developing country. PATIENTS AND METHODS: The study comprised 105 patients who underwent radical cystectomy from 1986 to 1993. Data were collected from retrospective reviews of hospital and physician's office records, and by contact with the patients. Metastatic status was evaluated before surgery and tumours staged using the Tumour-Nodes-Metastasis classification. The indication for surgery was histologically confirmed muscle invasion after transurethral resection biopsy, or endoscopically uncontrollable superficial disease. The data were analysed to assess the perioperative complications and long-term survival, with 5-year survival rates determined using Kaplan-Meier survival curves. RESULTS: The complication rate was 27.6%; most of the complications were managed conservatively with good results and re-operation was required in only two patients. There were two deaths (1.9%) at 15-45 days after surgery, but none during surgery. Patients were divided into node-negative and node-positive groups for analysis and 5-year survival rates determined; for node-negative organ-confined disease (< or =pT3A) the survival was 68% and for nonorgan-confined disease (> or =pT3B) 25%. The 5-year survival rate in the presence of nodal metastases was 13% for N1 and none for N2 disease. Six patients developed urethral recurrence, detected on follow-up urethral-wash cytology. Five of these patients underwent urethrectomy, and four of the six survived for 5 years. Pelvic recurrence occurred in five patients (4.7%), none of whom survived for 5 years. CONCLUSION: Radical cystectomy and pelvic lymph node dissection remains the mainstay of treatment in muscle-invasive bladder cancer. This is a relatively safe procedure with minimal morbidity and mortality; 68% of the present patients with organ-confined disease survived 5 years and 12 patients were alive at 10 years, indicating the effectiveness of this operation in selected cases. However, < 29% of patients with nonorgan-confined and nodal metastatic disease survived 5 years, thereby implying the need for more effective adjuvant therapy in these patients. Radical cystectomy is a viable option in developing countries, with 5-year survival rates comparable with most large published series.
UI - 11687012
AU - Shelley MD; Barber J; Mason MD
TI - Surgery versus radiotherapy for muscle invasive bladder cancer.
SO - Cochrane Database Syst Rev 2001;(3):CD002079
AD - Research Laboratories, Velindre NHS Trust, Velindre Road, Whitchurch, Cardiff, Wales, UK, CF4 7XL. email@example.com
BACKGROUND: Muscle invasive bladder cancer is a serious clinical problem and is fatal for the majority of patients. Alternative treatments for this condition are radical cystectomy or radical radiotherapy. The choice of treatment varies according to the resident country. The ideal treatment would be a bladder preserving therapy with total eradication of the tumour without compromising survival. OBJECTIVES: The objective of this review was to compare the survival after radical surgery (cystectomy) versus radical radiotherapy in patients with muscle invasive cancer. SEARCH STRATEGY: We searched the Cochrane Controlled authors of unpublished data were undertaken. SELECTION CRITERIA: Randomised trials comparing surgery versus radiotherapy were eligible for assessment. DATA COLLECTION AND ANALYSIS: Three reviewers assessed trial quality based on the Cochrane Guidelines. Data was extracted from the text of the article or extrapolated from the Kaplan-Meier plot. The Peto odds ratio was determined to compare the overall-survival and disease-specific survival. Analysis was performed on an intention-to-treat basis and treatment actually received. MAIN RESULTS: Three randomised trials comparing pre-operative radiotherapy followed by radical cystectomy (surgery) versus radical radiotherapy with salvage cystectomy (radical radiotherapy) were eligible for assessment. These trials represented a total of 439 patients, 221 randomised to surgery and 218 to radical radiotherapy. Peto odds ratio analysis consistently favoured surgery in terms of survival. It was significant at 3 (OR = 2.11, 95% CI 1.10,4.07) and 5 years (OR = 2.40, 95% CI 1.35, 4.29) for overall survival and at 3 years (OR = 1.96, 95% CI 1.06,3.65) for disease-specific survival for patients that actually received the protocol treatment. On an intention-to-treat analysis for disease-specific survival, the results were significantly in favour of surgery at 3 years (OR = 1.96, 95% CI 1.06,3.65) but not at 5 years. REVIEWER'S CONCLUSIONS: The evidence from this review suggests that there is no overall statistically significant benefit to radiotherapy or surgery ( with pre-operative radiotherapy) in muscle invasive bladder cancer in terms of survival, but the trends consistently favour surgery.
UI - 11869621
AU - Shelley MD; Barber J; Wilt T; Mason MD
TI - Surgery versus radiotherapy for muscle invasive bladder cancer.
SO - Cochrane Database Syst Rev 2002;(1):CD002079
AD - Research Laboratories, Velindre NHS Trust, Velindre Road, Whitchurch, Cardiff, Wales, UK, CF14 2TL. firstname.lastname@example.org
BACKGROUND: Muscle invasive bladder cancer is a serious clinical problem and is fatal for the majority of patients. Alternative treatments for this condition are radical cystectomy or radical radiotherapy. The choice of treatment varies according to the resident country. The ideal treatment would be a bladder preserving therapy with total eradication of the tumour without compromising survival. OBJECTIVES: The objective of this review was to compare the overall survival after radical surgery (cystectomy) versus radical radiotherapy in patients with muscle invasive cancer. SEARCH STRATEGY: We searched the Cochrane Controlled authors of unpublished data were undertaken. SELECTION CRITERIA: Randomised trials comparing surgery versus radiotherapy were eligible for assessment. DATA COLLECTION AND ANALYSIS: Three reviewers assessed trial quality based on the Cochrane Guidelines. Data were extracted from the text of the article or extrapolated from the Kaplan-Meier plot. The Peto odds ratio was determined to compare the overall survival and disease-specific survival. Analysis was performed on an intention-to-treat basis and treatment actually received. MAIN RESULTS: Three randomised trials comparing pre-operative radiotherapy followed by radical cystectomy (surgery) versus radical radiotherapy with salvage cystectomy (radical radiotherapy) were eligible for assessment. These trials represented a total of 439 patients, 221 randomised to surgery and 218 to radical radiotherapy. Three trials were combined for the overall survival results and one for the disease-specific analysis [Bloom 1982]. The mean overall survival (intention-to-treat analysis) at 3 and 5 years were 45% and 36% for surgery, and 28% and 20% for radiotherapy, respectively. Peto odds ratio (95% Confidence Interval) analysis consistently favoured surgery in terms of overall survival. The results were significantly in favour of surgery at 3 years (OR = 1.91, 95% CI 1.30 -2.82) and at 5 years (OR = 1.85 95% CI 1.22 - 2.82). On a 'treatment received' basis, the results were significantly in favour of surgery at 3 (OR = 1.84, 95% CI 1.17 - 2.90) and 5 years (OR = 2.17, 95% CI 1.39 - 3.38) for overall survival and at 3 years (OR = 1.96, 95% CI 1.06,3.65) for disease-specific survival. REVIEWER'S CONCLUSIONS: The analysis of this review suggests that there is an overall survival benefit with radical surgery compared to radical radiotherapy in patients with muscle-invasive bladder cancer. However, it must be considered that only three trials were included for analysis, the patients numbers were small and that many patients did not receive the treatment they were randomised to. It must also be noted that many improvements in both radiotherapy and surgery have taken place since the initiation of these trials.
UI - 11893883
AU - Albers P; Siener R; Hartlein M; Fallahi M; Haeutle D; Perabo FG; Steiner
TI - G; Blatter J; Muller SC; German TCC Study Group of the German Association of Urologic Oncology Gemcitabine monotherapy as second-line treatment in cisplatin-refractory transitional cell carcinoma - prognostic factors for response and improvement of quality of life.
SO - Onkologie 2002 Feb;25(1):47-52
AD - Klinik und Poliklinik fur Urologie, Universitatsklinikum Bonn, Germany. email@example.com
OBJECTIVES: i) To evaluate objective response, toxicity, and quality of life (QoL) of gemcitabine monotherapy as second-line treatment in patients with cisplatin-refractory, metastatic transitional cell carcinoma (TCC). ii) To assess prognostic parameters for response to treatment and for improvement of QoL parameters. PATIENTS AND METHODS: 30 patients were prospectively enrolled in this open-label, nonrandomized multicenter phase II trial. Patients received up to 6 courses of gemcitabine monotherapy (1,250 mg/m(2) on day 1 and 8 of a 21-day course). 28 of 30 patients were available for response evaluation. RESULTS: Objective response (OR) was seen in 3/28 (11%) of patients (2 complete remissions, 1 partial remission). The mean time to progression (TTP) was 4.9 +/- 3.5 months and mean disease-specific survival time was 8.7 +/- 4.7 months. 13 of 28 patients did not progress (OR + 10 stable diseases), and TTP (8.0 +/- 2.7 months, p < 0.001) as well as survival time (10.2 +/- 3.8 months, p < 0.05) differed significantly from those who showed progressive disease within 18 weeks of treatment. Pain values significantly improved in the group of responders from 4.3 +/- 1.9 to 5.8 +/- 1.3 points (p < 0.05). Response to cisplatin pretreatment was the best prognosticator for the response to gemcitabine. CONCLUSIONS: Gemcitabine monotherapy as second-line treatment is justified in patients with metastatic TCC who are refractory to cisplatin treatment. Patients with initially OR to cisplatin benefit most from second-line treatment. QoL remains stable during treatment, and pain improves especially in patients with bone metastases. Copyright 2002 S. Karger GmbH, Freiburg
UI - 11872337
AU - Sternberg CN
TI - Current perspectives in muscle invasive bladder cancer.
SO - Eur J Cancer 2002 Mar;38(4):460-7
AD - Vincenzo Pansadoro Foundation, Clinic Pio XI, Via Aurelia 559, 00165, Rome, Italy. firstname.lastname@example.org
Muscle-infiltrating bladder cancer should be dealt with in a multimodality approach with collaboration between the urologist, medical oncologist and radiotherapist. Neo-adjuvant chemotherapy has not been proven to improve survival, but may be useful in programs of bladder preservation. Response to M-VAC neo-adjuvant chemotherapy is an important prognostic factor, but may represent patient selection factors. It is not known whether it is better to administer chemotherapy in the neo-adjuvant or in the adjuvant setting, that may spare some patients unnecessary chemotherapy. The international adjuvant chemotherapy trial coordinated by the EORTC (protocol 30994) will hopefully clarify some of the unanswered questions concerning whether or not adjuvant chemotherapy immediately following cystectomy improves survival.
UI - 11912367
AU - Soloway MS; Sofer M; Vaidya A
TI - Contemporary management of stage T1 transitional cell carcinoma of the bladder.
SO - J Urol 2002 Apr;167(4):1573-83
AD - Department of Urology, University of Miami, Miami, Florida, USA.
PURPOSE: Transitional cell carcinoma involving the lamina propria (stage T1) is associated with a high recurrence and progression rate with implications for patient survival and quality of life. A better understanding of the natural history of and treatment alternatives for this tumor may improve the outcome in patients with this stage of bladder cancer. MATERIALS AND METHODS: Literature of the last decade was comprehensively reviewed in regard to clinical and pathological diagnosis, adjuvant treatments, prognosis, and the role and timing of cystectomy. The information was gathered from MEDLINE, current urology journals, abstracts from recent urological meetings and personal experience. RESULTS: High grade and the depth of lamina propria invasion are important prognostic factors. Early diagnosis and accurate pathological assessment are essential for determining the most adequate treatment pathway. Initial treatment consists of complete transurethral resection and adjuvant treatment with intravesical instillation of bacillus Calmette-Guerin (BCG). Immediate postoperative instillation of mitomycin C decreases the risk of recurrence possibly related to tumor implantation. Intravesical treatment does not substantially decrease the chance of progression. Lack of a complete response to BCG at 3 to 6 months, high grade, the depth of lamina propria invasion, the association of carcinoma in situ and prostate mucosa or duct involvement represent significant predictors for progression. Cystectomy should be suggested for recurrent stage T1 tumor after BCG, new onset or persistent carcinoma in situ, tumor located at a difficult site for resection, prostatic duct or stromal involvement and muscle invasion. CONCLUSIONS: High grade stage T1 transitional cell carcinoma is a highly malignant tumor. Complete resection followed by immediate mitomycin C instillation and 6 weekly BCG instillations results in an acceptably low recurrence and progression rate. Rigorous long-term surveillance and continuous reconsideration of radical cystectomy in concordance with the evolution of the disease are essential.
UI - 11912378
AU - Holmang S; Johansson SL
TI - Stage Ta-T1 bladder cancer: the relationship between findings at first followup cystoscopy and subsequent recurrence and progression.
SO - J Urol 2002 Apr;167(4):1634-7
AD - Department of Urology, Sahlgrenska University Hospital, Goteborg, Sweden.
PURPOSE: We studied the relationship of first cystoscopy findings with recurrence and progression rates in a large, population based series of patients with bladder cancer. MATERIALS AND METHODS: All 463 patients with an initial diagnosis of stage Ta-T1 bladder cancer in western Sweden in 1987 to 1988 were followed at least 5 years. The 355 patients who were treated with transurethral resection only until repeat cystoscopy or longer were selected for this report. RESULTS: Negative first cystoscopy findings were associated with significantly decreased recurrence and progression rates for all grades, and for stage Ta and T1 tumors. However, some patients with initial high grade carcinoma (WHO 2 to 3) had stage progression despite negative first cystoscopy. On multivariate analyses first cystoscopy findings and papillary urothelial neoplasm of low malignant potential versus grades 1 to 3 but not stage and the number of tumors had prognostic significance for time to recurrence. Only first cystoscopy findings and grade had prognostic significance for time to stage progression. CONCLUSIONS: Our data support other groups who recommend a less intense cystoscopy followup schedule in patients with negative cystoscopy findings 3 months after initial transurethral bladder resection. We recommend that patients with initial papillary urothelial neoplasm of low malignant potential and low grade carcinoma (WHO 1) with negative first cystoscopy findings undergo repeat cystoscopy at month 12. In our opinion followup should not be less intense in patients with high grade carcinoma (WHO 2-3), even in those with stage pTa disease.
UI - 11942977
AU - Kolaczyk W; Dembowski J; Lorenz J; Dudek K
TI - Evaluation of the influence of systemic neoadjuvant chemotherapy on the survival of patients treated for invasive bladder cancer.
SO - BJU Int 2002 Apr;89(6):616-9
AD - Urology Department, District Hospital, Legnica, Poland.
OBJECTIVE: To assess the influence of neoadjuvant systemic chemotherapy using a modified methotrexate, vinblastine, doxorubicin and cisplatin (MVAC) scheme in patients with invasive bladder cancer. PATIENTS AND METHODS: Two groups of patients were reviewed retrospectively; group 1 included 51 who received chemotherapy before cystectomy and group 2 included 62 who were treated only with surgery. The mean (range) duration of follow-up was 3.2 (0.25-10.25) years. The patients in group 1 were divided into two subgroups: those with tumour confined to the bladder (T1, T2 and T3a) and the remaining patients with tumour beyond the bladder (T3b, T4a,b). The chemotherapy was administered as routine MVAC, except vinblastine and methotrexate were given at 15 and 22 days during the cycle. A mean of three cycles were administered. RESULTS: The 5-year survival rate in group 1 and 2 was 66% and 58%, respectively (P > 0.3); after 8 years of follow-up the survival rates were 58% and 33%, respectively, and significantly different (P < 0.01). CONCLUSION: Systemic chemotherapy using the modified MVAC scheme in patients subsequently undergoing radical cystectomy improved the survival rate after 8 years of follow-up.
UI - 11942978
AU - Kolodziej A; Dembowski J; Zdrojowy R; Wozniak P; Lorenz J
TI - Treatment of high-risk superficial bladder cancer with maintenance bacille Calmette-Guerin therapy: preliminary results.
SO - BJU Int 2002 Apr;89(6):620-2
AD - Department of Urology, University School of Medicine, Wroclaw, Poland. email@example.com
OBJECTIVE: To evaluate, in a prospective study, the effects and results of maintenance therapy with bacille Calmette-Guerin (BCG) in treating patients with high-risk superficial bladder cancer. PATIENTS AND METHODS: In all, 155 patients were enrolled in a randomized study of transurethral resection alone (53) or combined with intravesical BCG (102) as a treatment for superficial bladder cancer. BCG was administered for six consecutive weeks followed by three weekly instillations in months 3, 6, 12, 18, 24, 30 and 36 after resection. Recurrence, progression, prognostic factors and side-effects were assessed and analysed. RESULTS: After a median (range) follow-up of 23 (6-42) months, 83 of the 102 patients treated with BCG (81%) were disease-free, compared with 24 of the 53 treated with resection alone (45%). There was also a significant difference in tumour progression and time to progression between the trial arms. The disease progressed in eight patients (8%) treated with BCG and in 12 (23%) of those treated by resection alone. Independent risk factors for progression were DNA ploidy status and stage. Only the completion of treatment was predictive of outcome (risk of recurrence) for patients treated with BCG. CONCLUSION: Maintenance BCG therapy was better than resection alone in reducing the incidence of recurrence and progression in patients with high-risk superficial bladder cancer.
UI - 11942979
AU - Borkowski A
TI - Superficial bladder cancer T1G3: the choice of treatment.
SO - BJU Int 2002 Apr;89(6):623-7
AD - Department of Urology, Medical University, Warsaw, Poland. firstname.lastname@example.org
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