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Rajala P, Liukkonen T, Raitanen M, Rintala E, Kaasinen E, Helle M, Lukkarinen O. Transurethral resection with perioperative instilation on interferon-alpha or epirubicin for the prophylaxis of recurrent primary superficial bladder cancer: a prospective randomized multicenter study--Finnbladder III. J Urol 1999; 161:1133-5; discussion 1135-6. [PMID: 10081854 DOI: 10.1016/s0022-5347(01)61609-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE We evaluated the efficacy of single dose of interferon or epirubicin administered immediately after transurethral resection compared with transurethral resection only on the recurrence of primary (not recurrent) superficial bladder cancer. MATERIALS AND METHODS A total of 283 patients with stages Ta to T1 primary superficial, grades 1 to 3 bladder cancer was randomized into study groups 1-transurethral resection only, 2-transurethral resection plus 50 million units interferon-a2b and 3-transurethral resection plus 100 mg. epirubicin. Eligible for final analysis were 200 patients, including 66 in group 1, 66 in group 2 and 68 in group 3. Patients were followed with cystoscopy every 3 months for 2 years or until the initial recurrence. RESULTS Group 3 had the most favorable outcome, since 45 of the 68 patients (66%) were without recurrence after 2 years compared to 24 of the 66 (37%) in group 2 and 26 of the 66 (40%) in group 1 (log rank test p <0.001). Side effects were mostly mild and transient, and no differences were found among the groups. CONCLUSIONS A single 100 mg. dose of epirubicin given intravesically immediately after transurethral resection is safe, and significantly decreases the recurrence of primary superficial bladder cancer. A 50 million unit dose of interferon-alpha2b is well tolerated but it has no effect on recurrence as a single dose. The long-term effect of this treatment remains to be studied.
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Affiliation(s)
- P Rajala
- Division of Urology, Turku University Hospital, Finland
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202
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Schellhammer PF. INTRAVESICAL CHEMOTHERAPY WITH GAMMA LINOLENIC ACID BECOMES A REALITY. J Urol 1998. [DOI: 10.1016/s0022-5347(01)62212-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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203
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Affiliation(s)
- C Lee
- Department of Urology, Seoul National University College of Medicine, Korea
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204
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Schellhammer PF. Immediate adjuvant intravesical chemotherapy after transurethral resection of bladder tumor. Curr Opin Urol 1998; 8:407-9. [PMID: 17039020 DOI: 10.1097/00042307-199809000-00008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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205
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Solomon LZ, Jennings AM, Foley SJ, Birch BR, Cooper AJ. Bladder cancer recurrence by implantation of exfoliated cells: is gamma-linolenic acid an effective tumoricidal agent? BRITISH JOURNAL OF UROLOGY 1998; 82:122-6. [PMID: 9698674 DOI: 10.1046/j.1464-410x.1998.00677.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare the tumoricidal efficacy of meglumine gamma-linolenic acid (MeGLA), mitomycin C, epirubicin and water on two urothelial cell lines, and to establish the effect of serum protein levels derived from bladder cancer resection craters on the action of these agents. MATERIALS AND METHODS The human urothelial cell lines MGHU-1 and RT112 and their drug-resistant variants were exposed to short pulses of aqueous MeGLA, mitomycin, epirubicin and water. Both adherent and suspended cells were exposed to these agents. The MTT viable biomass assay and a clonogenic assay were used to establish tumoricidal efficacy. These experiments were then repeated to assess the effect of added serum proteins on the test results. Estimates of protein in the waste irrigation fluid from 10 patients undergoing transurethral resection of bladder tumour (TURBT) were used to select the quantity of protein used in the study, to establish the clinical relevance. RESULTS MeGLA caused > 95% reduction in the residual viable biomass of adherent cells, compared with < 50% reduction with any other agent. Both epirubicin and mitomycin were as effective as MeGLA in preventing colony formation from suspended drug-sensitive (parental) cells. However, using multidrug-resistant (MDR) cell lines, only MeGLA prevented any colony formation, although counts were greatly reduced by mitomycin and epirubicin. Water was least effective as a tumoricidal agent on both adherent and suspended cells. On the latter, water was markedly inactivated by adding 5% serum. TURBT waste irrigation fluid was found frequently to contain such quantities of serous fluid contamination, as shown by albumin estimates in waste fluid from 10 consecutive patients undergoing this procedure. CONCLUSION MeGLA is an effective tumoricidal agent against both parental and MDR cell lines. Its efficacy is maintained in the presence of clinically relevant serum contamination.
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Affiliation(s)
- L Z Solomon
- Department of Urology, Southampton University Hospitals NHS Trust, UK
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206
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New treatment approaches for superficial and invasive bladder cancer. Urol Oncol 1998; 4:183-7. [DOI: 10.1016/s1078-1439(99)00011-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/1999] [Indexed: 11/18/2022]
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207
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Petrovich Z, Baert L, Boyd SD, Brady LW, D'Hallewin M, Heilmann HP, Jakse G, Jones PA, Van Der Meijden AP, Oyen RH, Van Poppel H, Rotman M, Sauer R, Shipley WU, Skinner EC. Management of carcinoma of the bladder. Am J Clin Oncol 1998; 21:217-22. [PMID: 9626784 DOI: 10.1097/00000421-199806000-00001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Carcinoma of the bladder (CaB) is a common tumor of the genitourinary tract. In the United States in 1997, CaB was second in frequency of occurrence and third in mortality among genitourinary tumors. This tumor has a well-documented history of environmental and industrial causative factors. The strongest etiologic risk factors include the use of tobacco, which is thought to be responsible for half of the CaB diagnosed in men in the United States, and some arylamines. In the past 30 years, there has been major improvement in the survival of patients with this disease. Multiple factors were responsible for this accomplishment and they include: 1) better understanding of the natural history of CaB, 2) development of immunohistochemical analysis helpful in defining prognostic factors, 3) improved imaging and nonimaging diagnostic modalities helpful in making earlier diagnosis and better defining the true anatomical extent of the tumor, 4) development of more effective therapy for carcinoma in situ, 5) major improvement in surgical techniques resulting in better treatment outcomes, and 6) the wide use of adjuvant chemotherapy. Major stress has been placed on the quality of life of patients treated for CaB. Quality of life was improved by optimizing surgical, radiation, and medical treatment techniques. The two most important factors producing this quality-of-life improvement include: 1) the use of organ-preserving therapy in properly selected patients that involves the use of a multimodality therapeutic approach with transurethral resection, radiation therapy, and chemotherapy; and 2) the ability to treat selected men and women with radical cystectomy followed by orthotopic reconstruction that allows patients nearly physiologic voiding. Current research efforts are directed toward better patient selection for appropriate therapy which is expected to increase patient survival and improve quality of life. Of particular importance in the selection of this optimal therapy in patients with CaB is a wide application in the clinical practice of important recent advances in molecular genetics.
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Affiliation(s)
- Z Petrovich
- Department of Radiation Oncology, University of Southern California School of Medicine, Los Angeles 90033, USA
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208
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Schellhammer PF. What is the available evidence to support immediate adjuvant intravesical chemotherapy after transurethral resection of superficial transitional cell carcinoma of the bladder? Urol Oncol 1998; 4:73-9. [DOI: 10.1016/s1078-1439(98)00035-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/1998] [Indexed: 10/17/2022]
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209
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DEN OTTER WILLEM, DOBROWOLSKI ZYGMUNT, BUGAJSKI ANDREJ, PAPLA BOLESLAW, VAN DER MEIJDEN A, KOTEN JANW, BOON TOMA, SIEDLAR MACIEJ, ZEMBALA MAREK. INTRAVESICAL INTERLEUKIN-2 IN T1 PAPILLARY BLADDER CARCINOMA: REGRESSION OF MARKER LESION IN 8 OF 10 PATIENTS. J Urol 1998. [DOI: 10.1016/s0022-5347(01)63548-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- WILLEM DEN OTTER
- Department of Functional Morphology, Utrecht University and Departments of Urology, University Hospital Utrecht, Utrecht and Groot Ziekengasthuis, 's-Hertogenbosch, The Netherlands, and Departments of Urology (Clinic of Urology), Pathology and Clinical Immunology, Jagiellonian University Medical College, Cracow, Poland
| | - ZYGMUNT DOBROWOLSKI
- Department of Functional Morphology, Utrecht University and Departments of Urology, University Hospital Utrecht, Utrecht and Groot Ziekengasthuis, 's-Hertogenbosch, The Netherlands, and Departments of Urology (Clinic of Urology), Pathology and Clinical Immunology, Jagiellonian University Medical College, Cracow, Poland
| | - ANDREJ BUGAJSKI
- Department of Functional Morphology, Utrecht University and Departments of Urology, University Hospital Utrecht, Utrecht and Groot Ziekengasthuis, 's-Hertogenbosch, The Netherlands, and Departments of Urology (Clinic of Urology), Pathology and Clinical Immunology, Jagiellonian University Medical College, Cracow, Poland
| | - BOLESLAW PAPLA
- Department of Functional Morphology, Utrecht University and Departments of Urology, University Hospital Utrecht, Utrecht and Groot Ziekengasthuis, 's-Hertogenbosch, The Netherlands, and Departments of Urology (Clinic of Urology), Pathology and Clinical Immunology, Jagiellonian University Medical College, Cracow, Poland
| | - A.P.M. VAN DER MEIJDEN
- Department of Functional Morphology, Utrecht University and Departments of Urology, University Hospital Utrecht, Utrecht and Groot Ziekengasthuis, 's-Hertogenbosch, The Netherlands, and Departments of Urology (Clinic of Urology), Pathology and Clinical Immunology, Jagiellonian University Medical College, Cracow, Poland
| | - JAN W. KOTEN
- Department of Functional Morphology, Utrecht University and Departments of Urology, University Hospital Utrecht, Utrecht and Groot Ziekengasthuis, 's-Hertogenbosch, The Netherlands, and Departments of Urology (Clinic of Urology), Pathology and Clinical Immunology, Jagiellonian University Medical College, Cracow, Poland
| | - TOM A. BOON
- Department of Functional Morphology, Utrecht University and Departments of Urology, University Hospital Utrecht, Utrecht and Groot Ziekengasthuis, 's-Hertogenbosch, The Netherlands, and Departments of Urology (Clinic of Urology), Pathology and Clinical Immunology, Jagiellonian University Medical College, Cracow, Poland
| | - MACIEJ SIEDLAR
- Department of Functional Morphology, Utrecht University and Departments of Urology, University Hospital Utrecht, Utrecht and Groot Ziekengasthuis, 's-Hertogenbosch, The Netherlands, and Departments of Urology (Clinic of Urology), Pathology and Clinical Immunology, Jagiellonian University Medical College, Cracow, Poland
| | - MAREK ZEMBALA
- Department of Functional Morphology, Utrecht University and Departments of Urology, University Hospital Utrecht, Utrecht and Groot Ziekengasthuis, 's-Hertogenbosch, The Netherlands, and Departments of Urology (Clinic of Urology), Pathology and Clinical Immunology, Jagiellonian University Medical College, Cracow, Poland
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210
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EDITORIAL COMMENT. J Urol 1997. [DOI: 10.1016/s0022-5347(01)68158-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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211
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Montie JE, Wojno K, Klein E, Pearsall C, Levin H. Transitional cell carcinoma in situ of the seminal vesicles: 8 cases with discussion of pathogenesis, and clinical and biological implications. J Urol 1997; 158:1895-8. [PMID: 9334625 DOI: 10.1016/s0022-5347(01)64162-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE Mucosal migration of transitional cell carcinoma in situ is a potential mechanism for multifocal lower tract disease. MATERIALS AND METHODS The clinical course and pathological studies of 8 cases of carcinoma in situ are reviewed in detail. RESULTS The pattern of disease of carcinoma in situ of seminal vesicle provides circumstantial evidence for mucosal migration of cancer from a bladder or prostatic urethral origin. CONCLUSIONS A monoclonal origin of bladder cancer combined with mucosal spread of carcinoma in situ suggests that incomplete destruction of carcinoma in situ may adversely affect long-term results by permitting extension into the distal ureters, prostatic duct or seminal vesicles. Protracted intravesical treatment of carcinoma in situ without complete elimination of the disease allows the natural history of mucosal spread to become evident.
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Affiliation(s)
- J E Montie
- Department of Surgery, University of Michigan, Ann Arbor 48109-0330, USA
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212
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Kurth K, Tunn U, Ay R, Schröder FH, Pavone-Macaluso M, Debruyne F, ten Kate F, de Pauw M, Sylvester R. Adjuvant chemotherapy for superficial transitional cell bladder carcinoma: long-term results of a European Organization for Research and Treatment of Cancer randomized trial comparing doxorubicin, ethoglucid and transurethral resection alone. J Urol 1997; 158:378-84. [PMID: 9224307 DOI: 10.1016/s0022-5347(01)64484-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE We compared the efficacy of transurethral resection alone or transurethral resection followed by bladder instillations of doxorubicin or ethoglucid for 1 year in patients with superficial bladder carcinoma, and followed them long term for the incidence of progression to muscle invasion. MATERIALS AND METHODS A total of 443 patients with superficial transitional cell carcinoma of the bladder was randomized. After randomization of 206 patients the control arm was closed to patient entry based on the results of an interim analysis showing a significant difference in favor of those receiving adjuvant chemotherapy. RESULTS Final analysis of treatment results for recurrence included 432 patients at a median followup of 3.4 years for time to first recurrence, 5 years for analysis of time to invasion (Category T2 disease or worse) and 10.7 years for duration of survival. Time to first recurrence was significantly prolonged by both drugs compared to transurethral resection alone (doxorubicin versus transurethral resection alone p < 0.001 and ethoglucid versus control p < 0.001). Recurrence rate per year was 0.30 for both adjuvant treatment arms and 0.68 for the resection only group. Progression to muscle invasion was rare (15.1% of cases) and not apparently different in the 3 treatment arms. Of the 423 patients death from any cause in 199 and from malignant disease in 59 was not correlated with treatment. However, there was a strong correlation between death from malignant disease, and T category and tumor grade. CONCLUSIONS In regard to time to first recurrence and recurrence rate per year this study indicates that adjuvant chemotherapy with doxorubicin and ethoglucid using the indicated schedule is superior to transurethral resection alone. However, progression in stage or survival was not influenced by the treatment regimen.
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Affiliation(s)
- K Kurth
- University of Amsterdam, The Netherlands
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213
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Ali-el-Dein B, el-Baz M, Aly AN, Shamaa S, Ashamallah A. Intravesical epirubicin versus doxorubicin for superficial bladder tumors (stages pTa and pT1): a randomized prospective study. J Urol 1997; 158:68-73; discussion 73-4. [PMID: 9186325 DOI: 10.1097/00005392-199707000-00018] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE We performed a prospective, randomized, controlled study to compare intravesical epirubicin and doxorubicin as adjuvant therapy after endoscopic resection of superficial bladder tumor. MATERIALS AND METHODS We randomly allocated 253 eligible patients to 4 study arms. Seven to 14 days after transurethral bladder tumor resection instillation of the intravesical agent was instituted, including 50 and 80 mg. epirubicin in study arms 1 and 2, respectively, and 50 mg. doxorubicin in arm 3. Control arm 4 included patients who underwent transurethral bladder tumor resection alone. Instillation was repeated weekly for 8 weeks and monthly thereafter to complete 1 year of treatment. All patients were followed every 3 months by cystourethroscopy, urine cytology and deoxyribonucleic acid flow cytometry for 12 to 48 months (mean 30.1). RESULTS Rates of recurrence were significantly lower in the chemotherapy groups than in controls (p < 0.001) and in the epirubicin groups than in the doxorubicin group (p = 0.02). In arms 1 to 4 recurrence rates were 25, 17.6, 36.7 and 65.6%, respectively. Recurrence rates per 100 patient months were 0.83, 0.60, 1.18 and 2.73, respectively, which were significant statistically, and lower after chemotherapy in general and epirubicin in particular (p < 0.05). Mean interval to first recurrence was 16, 15.4, 18.9 and 6.3 months, respectively, with a significant difference between the chemotherapy and control groups (p < 0.05). Progression to muscle invasive disease occurred in 7 (10.9%), 3 (4.4%), 6 (10%) and 5 patients (8.2%), respectively, in arms 1 to 4 (p > 0.05). We studied the relationships among different risk factors, and patterns of recurrence and progression. For pT1 tumors recurrence rates in arms 1 to 4 were 26.3, 17.8, 39.3 and 70.9%, respectively, which were significantly lower in the chemotherapy group than in controls (p < 0.001) and in the epirubicin groups than in the doxorubicin group (p = 0.01). Toxic and untoward side effects developed in 10 (15.6%), 16 (23.5%) and 25 (41.7%) patients in chemotherapy arms 1 to 3, respectively, with a marginal insignificant difference between low and high dose epirubicin (p = 0.3), and significantly lower toxicity rates in arms 1 and 2 than in 3 (p = 0.002). A contracted bladder developed in 2.1% of all patients who received chemotherapy. CONCLUSIONS This study demonstrates that epirubicin has better efficacy and lower toxicity than doxorubicin when used as an intravesical agent.
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Affiliation(s)
- B Ali-el-Dein
- Department of Pathology, Faculty of Medicine, Mansoura University, Egypt
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214
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Abstract
BACKGROUND Radiation therapy (RT) to the pelvis has been associated with an increased risk of bladder carcinoma, as well as other malignancies. However, no controlled studies have previously explored the risk of second malignancies after RT for prostate carcinoma. METHODS A retrospective cohort study was conducted utilizing data from the Surveillance, Epidemiology, and End Results Program (SEER) of the U. S. National Cancer Institute from 1973-1990. The standardized incidence ratio (SIR), adjusted for age, was calculated as an estimate of the relative risk (RR) of developing a second malignancy after prostate carcinoma for radiated and nonradiated prostate carcinoma patients separately. RESULTS The cohort was comprised of 34,889 prostate carcinoma patients who had undergone RT, and 106,872 who had not. After 8 years, the risk of bladder carcinoma was elevated for the RT group (RR 1.5; 95% confidence interval [CI], 1.1-2.0) but not for the non-RT group (RR 1.0; 95% CI, 0.7-1.2). There was an elevated risk of bladder carcinoma for the RT group at 5-8 years as well (RR 1.3; 95% CI, 1.0-1.7). No elevations in risk were observed for rectal carcinoma, acute nonlymphocytic leukemia, or chronic lymphocytic leukemia for either RT patients or non-RT patients. CONCLUSIONS The risk of bladder carcinoma is elevated several years after RT for prostate carcinoma, but this elevation is not dramatic. There is no increased risk of rectal carcinoma or leukemia after this type of radiation exposure.
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Affiliation(s)
- A I Neugut
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York, USA
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215
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Abstract
Superficial transitional cell carcinoma of the bladder is a heterogeneous group of tumours, and prediction of disease outcome in an individual patient is still impossible. In low-risk patients the initial treatment [transurethral resection (TUR)] should be followed by no or only one immediate intravesical instillation with a chemotherapeutic drug to prevent a recurrence due to tumour cell implantation during TUR. Drug efficacy has been clearly demonstrated and adverse effects are very limited. Intermediate-risk patients should receive a course of additional intravesical instillations to reduce the recurrence rate with few adverse effects. All drugs seem to be equally effective, but the long term effects remain a question. In high-risk patients intravesical immunotherapy (BCG) should be given. Although toxicity is more pronounced, it is usually mild and adverse effects disappear after cessation of therapy. BCG (maintenance) therapy seems to be able to improve progression and ultimately tumour-related survival. It is important to know the advantages and disadvantages (adverse effects) of these treatment modalities to be able to individualise treatment as much as possible. The choice is difficult because several intravesical bladder cancer trials have not reached consensus on this. For patients with non-metastasised invasive bladder tumours chemotherapy can be given before (neoadjuvant) or immediately after (adjuvant) surgery or radiotherapy. Both strategies have some advantages and disadvantages. For both, however, efficacy still needs to be proven, and results of ongoing trials are needed. For metastasised or recurrent urothelial cell carcinoma MVAC (methotrexate, vinblastine, doxorubicin and cisplatin) chemotherapy remains the most effective treatment modality. Although initial response rates of between 40% and 70% can be achieved, most patients have a recurrence of their cancer. Moreover, toxicity of these drugs also is considerable and limiting. Leucopenia is responsible for the majority of grade III and IV toxicities and subsequent dose modifications. In case of toxic deaths, a leucopenic sepsis is usually the cause. Most other adverse effects are acceptable or can be treated.
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Affiliation(s)
- J A Witjes
- Department of Urology, University Hospital Nijmegen, The Netherlands
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216
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A Combined Analysis of European Organization for Research and Treatment of Cancer, and Medical Research Council Randomized Clinical Trials for the Prophylactic Treatment of Stage TaT1 Bladder Cancer. J Urol 1996. [DOI: 10.1016/s0022-5347(01)65396-5] [Citation(s) in RCA: 222] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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217
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Abstract
Bladder cancer is the fourth most common cancer in England and Wales. The most common presenting symptom is macroscopic haematuria. The management options for superficial and invasive bladder cancer depend on the stage at presentation. Most superficial bladder cancers are managed by transurethral resection and cytoscopic follow-up. The prognosis for patients with invasive bladder cancer is less good. The role of chemical, radiotherapeutic and surgical intervention are discussed.
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Affiliation(s)
- H Y Leung
- University Department of Surgery, Medical School, University of Newcastle upon Tyne, Newcastle, UK
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218
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Griffiths TR, Brotherick I, Bishop RI, White MD, McKenna DM, Horne CH, Shenton BK, Neal DE, Mellon JK. Cell adhesion molecules in bladder cancer: soluble serum E-cadherin correlates with predictors of recurrence. Br J Cancer 1996; 74:579-84. [PMID: 8761373 PMCID: PMC2074678 DOI: 10.1038/bjc.1996.404] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Sera from 40 patients with newly diagnosed bladder cancer (28 superficial tumours (pTa and pT1) and 12 muscle-invasive tumours) were assessed by enzyme-linked immunosorbent assay (ELISA) to determine the concentrations of soluble E-cadherin (sE-cadherin), soluble E-selectin (sE-selectin), soluble vascular cell adhesion molecule-1 (sVCAM-1) and soluble intercellular adhesion molecule-1 (sICAM-1). Corresponding frozen sections of primary tumour were analysed for E-cadherin expression using the monoclonal antibody, HECD-1 and standard immunohistochemistry. Patients with bladder cancer had significantly higher concentrations of sE-cadherin compared with a control group (P = 0.017). No difference was found between the two groups with regard to sE-selection (P = 0.403), sVCAM-1 (P = 0.942) and sICAM-1 (P = 0.092). High levels of sE-cadherin were related to poor histological grade (P = 0.009), number of superficial tumours at presentation (P = 0.008) and a positive 3 month check cytoscopy in superficial disease (P = 0.036). Abnormal E-cadherin expression was associated with increasing tumour stage (P = 0.009) and grade (P = 0.03). There was no correlation between high levels of soluble E-cadherin in sera and abnormal E-cadherin expression by the tumour (P = 0.077). Elevated levels of sE-cadherin are found in sera of patients with bladder cancer and correlate with known prognostic factors.
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Affiliation(s)
- T R Griffiths
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK
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219
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Rintala E, Jauhiainen K, Kaasinen E, Nurmi M, Alfthan O. Alternating Mitomycin C and Bacillus Calmette-Guerin Instillation Prophylaxis For Recurrent Papillary (Stages Ta to T1) Superficial Bladder Cancer. J Urol 1996. [DOI: 10.1016/s0022-5347(01)65936-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Erkki Rintala
- Department of Urology, Helsinki University Central Hospital, Helsinki, Finland
| | - Kari Jauhiainen
- Department of Urology, Helsinki University Central Hospital, Helsinki, Finland
| | - Eero Kaasinen
- Department of Urology, Helsinki University Central Hospital, Helsinki, Finland
| | - Martti Nurmi
- Department of Urology, Helsinki University Central Hospital, Helsinki, Finland
| | - Olof Alfthan
- Department of Urology, Helsinki University Central Hospital, Helsinki, Finland
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220
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Tolley D, Parmar M, Grigor K, Lallemand G. The Effect of Intravesical Mitomycin C on Recurrence of Newly Diagnosed Superficial Bladder Cancer: A Further Report with 7 Years of Followup. J Urol 1996. [DOI: 10.1016/s0022-5347(01)66226-8] [Citation(s) in RCA: 220] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- D.A. Tolley
- Medical Research Council Cancer Trials Office, Cambridge, United Kingdom
| | - M.K.B. Parmar
- Medical Research Council Cancer Trials Office, Cambridge, United Kingdom
| | - K.M. Grigor
- Medical Research Council Cancer Trials Office, Cambridge, United Kingdom
| | - G. Lallemand
- Medical Research Council Cancer Trials Office, Cambridge, United Kingdom
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221
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Melekos MD, Zarakovitis I, Dandinis K, Fokaefs E, Chionis H, Dauaher H, Barbalias G. BCG versus epirubicin in the prophylaxis of multiple superficial bladder tumours: results of a prospective randomized study using modified treatment schemes. Int Urol Nephrol 1996; 28:499-509. [PMID: 9119635 DOI: 10.1007/bf02550957] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A prospective randomized trial on 94 eligible patients evaluated and compared the efficacy of adjuvant intravesical epirubicin and bacillus Calmette-Guérin (BCG) after complete resection of multifocal superficial bladder cancer. BCG treatment schedule consisted of an induction 6-week course of instillations (150 mg Pasteur BCG per instillation) and single maintenance doses to patients who remained free of recurrences at follow-up examinations for a total treatment period of 2 years. These initial responders received additionally a separate 4-week course of therapy 6 months after the start of treatment. Chemoprophylaxis included an early (on the second postoperative day) instillation followed by 4 weekly treatments with epirubicin (50 mg per instillation) and then by 10 monthly treatments for the initial responders during the first year of follow-up and at every follow-up examination for a total treatment period of 2 years. The overall treatment results did not differ significantly between the 2 arms (54% of patients of the epirubicin group remained free of recurrences compared to 65% of those treated with BCG) for an identical mean follow-up of 35.1 months. However, a significant benefit in favour of BCG when compared with epirubicin was shown in patients who had stage T1 and grade 3 tumours and in terms of relative risk of recurrences, disease-free interval and recurrence rate per 100 patient-months. Both drugs were proved to be safe with manageable toxicity.
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Affiliation(s)
- M D Melekos
- Department of Urology, University of Patras School of Medicine, Greece
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222
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Raitanen MP, Lukkarinen O. A controlled study of intravesical epirubicin with or without alpha 2b-interferon as prophylaxis for recurrent superficial transitional cell carcinoma of the bladder. Finnish Multicentre Study Group. BRITISH JOURNAL OF UROLOGY 1995; 76:697-701. [PMID: 8535711 DOI: 10.1111/j.1464-410x.1995.tb00759.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES To evaluate the efficacy of intravesical epirubicin with or without alpha 2b-interferon (alpha 2b-IFN) as a prophylactic treatment for recurrent superficial transitional cell carcinoma (TCC) of the urinary bladder. PATIENTS AND METHODS A total of 81 patients with superficial (stage Ta and T1), well or moderately differentiated (grades 1 and 2) TCC were treated between June 1988 and December 1993. The patients were randomized into three groups: Group 1 was treated by transurethral resection (TUR) alone; Group 2 received 50 mg epirubicin and Group 3 received 50 mg epirubicin combined with 10 MU alpha 2b-IFN, intravesically in 50 mL sterile buffer solution. The instillations were started 1 week after TUR and were performed weekly during the first month and then once a month for one year. The patients were followed for a total of 2 years. Recurrence rate and tumour rate were calculated to assess the behaviour of the disease. RESULTS The patients were followed for a mean of 20 months. Patients receiving intravesical chemoimmunotherapy (Group 3) had the most favourable outcome; they had comparatively lower recurrence and tumour rates, fewer patients with recurrences and, most importantly, the longest disease-free interval. Side-effects were mostly mild and transient, and no differences were found among the groups. CONCLUSIONS In reducing the number of patients having recurrences and extending the recurrence-free interval, intravesical chemoimmunotherapy with epirubicin and alpha 2b-IFN had a promising effect on the natural course of superficial bladder cancer, particularly in patients with a history of prior recurrences.
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223
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Kurth KH, Denis L, Bouffioux C, Sylvester R, Debruyne FM, Pavone-Macaluso M, Oosterlinck W. Factors affecting recurrence and progression in superficial bladder tumours. Eur J Cancer 1995; 31A:1840-6. [PMID: 8541110 DOI: 10.1016/0959-8049(95)00287-s] [Citation(s) in RCA: 188] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Prognostic factors in superficial bladder tumours are highly correlated with each other. In this study, their relative importance is examined and grouping of patients in three different prognostic groups suggested. 576 patients (from EORTC protocols 30790 and 30782) were analysed. They have been followed from 3 months to 8.6 years with a median of 4 years. 76 patients developed an invasive tumour (> or = T2); the shortest time to invasion was 12 weeks, the longest was 6.6 years. Time from invasion to death ranged from 3 weeks to 4.4 years with a median of 2 years. Prognostic factors contributing to recurrence, invasion and survival were investigated: age, sex, size of largest tumour, number of tumours, T-category, G-grade, time from diagnosis (years), prior recurrence rate/year, site of involvement. The relative importance of these factors was measured by performing a multivariate analysis based on Cox's proportional hazards regression model. Based on the most important prognostic factors and their association with invasion and death, an index was computed reflecting the risk of both invasion and death due to malignant disease, respectively. The index was used to assign patients to one of three prognostic groups. Three main factors determined patient's prognosis: tumour size, G-grade and prior recurrence rate/year. The model coefficients for invasion were 0.51 (recurrence rate < 1/year, 1-3/year, > 3/year), 84 (grade 1, 2, 3), 0.48 (size < 1.5, 1.5-3, > 3 cm) and for death due to malignant disease 0.89 (recurrence rate), 0.73 (grade) and 0.44 (size), respectively. Risk groups are suggested based on the index. Additional treatment in patients with superficial transitional cell carcinoma of the bladder may be decided depending on the risk group to which the patient belongs.
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Affiliation(s)
- K H Kurth
- Department of Urology, Academic Hospital University Amsterdam, The Netherlands
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224
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Messing EM, Young TB, Hunt VB, Newton MA, Bram LL, Vaillancourt A, Hisgen WJ, Greenberg EB, Kuglitsch ME, Wegenke JD. Hematuria home screening: repeat testing results. J Urol 1995; 154:57-61. [PMID: 7776456 DOI: 10.1016/s0022-5347(01)67224-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
To determine at what interval screening should be repeated to detect bladder cancer before it becomes muscle invasive 856 men who had 14 negative daily home tests for hematuria with a chemical reagent strip 9 months previously performed repeat tests. Of these men 50 (5.8%) had at least 1 positive test during the second 14-day screening period and 38 were evaluated, 15 of whom (39.5%) had significant urological pathological conditions, including 8 with malignancies. Bladder cancer was noted in 7 men, with no tumor invading the muscularis propria. The finding of 7 bladder cancers in 856 men (0.82%) who had a negative test 9 months previously indicates that bladder cancer has a brief preclinical duration and that testing must be repeated at least annually for screening to detect bladder cancer consistently before invasion occurs.
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Affiliation(s)
- E M Messing
- Department of Surgery, University of Wisconsin, Madison, USA
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225
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Lamm DL, Meijden APM, Akaza H, Brendler C, Hedlund PO, Mizutani Y, Ratliff TL, Robinson MRG, Shinka T. INTRAVESICAL CHEMOTHERAPY AND IMMUNOTHERAPY: HOW DO WE ASSESS THEIR EFFECTIVENESS AND WHAT ARE THEIR LIMITATIONS AND USES? Int J Urol 1995. [DOI: 10.1111/j.1442-2042.1995.tb00476.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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226
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Apparent Failure of Current Intravesical Chemotherapy Prophylaxis to Influence the Long-Term Course of Superficial Transitional Cell Carcinoma of the Bladder. J Urol 1995. [DOI: 10.1016/s0022-5347(01)67427-5] [Citation(s) in RCA: 135] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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227
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c DLL, cc APMVDM, cc HA, Brendler C, Hedlund PO, Mizutani Y, Ratliff TL, Robinson MRG, Shinka T. INTRAVESICAL CHEMOTHERAPY AND IMMUNOTHERAPY: HOW DO WE ASSESS THEIR EFFECTIVENESS AND WHAT ARE THEIR LIMITATIONS AND USES? Int J Urol 1995. [DOI: 10.1111/j.1442-2042.1995.tb00069.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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228
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Messing EM, Young TB, Hunt VB, Gilchrist KW, Newton MA, Bram LL, Hisgen WJ, Greenberg EB, Kuglitsch ME, Wegenke JD. Comparison of bladder cancer outcome in men undergoing hematuria home screening versus those with standard clinical presentations. Urology 1995; 45:387-96; discussion 396-7. [PMID: 7879333 DOI: 10.1016/s0090-4295(99)80006-5] [Citation(s) in RCA: 159] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Because repetitive hematuria home screening with a chemical reagent strip can detect early stage bladder cancer (BC) in asymptomatic middle-aged and elderly men, the ability of this screening to effect earlier detection and reduce BC mortality was investigated. METHODS Grades, stages, and outcomes of BCs detected by hematuria screening in 1575 men were compared with those of all newly diagnosed BCs in men age 50 years or older reported to the Wisconsin cancer registry in 1988. BC grades and stages were assigned by review of all pathology slides/blocks, and causes of deaths were determined from cancer registry records. As an additional control group, outcomes of BC cases diagnosed in men solicited to take part in screening, who declined, were also determined. RESULTS The proportions of low-grade (grades 1 and 2) superficial (Stages Ta and T1) versus high-grade (grade 3) or invasive (Stage T2 or higher) cancers in cases detected by hematuria screening (screened cases) and those reported to the tumor registry (unscreened cases) were not significantly different (52.4% versus 47.7% in 21 screened and 56.8% versus 43.3% in 511 unscreened cases) (P > 0.20). Of the high-grade or invasive cases, however, the proportion of late stage (T2 or higher) tumors was significantly lower in the screening-detected BCs compared to unscreened ones (P = 0.007). No screened case has died of BC (3- to 9-year follow-up), whereas 16.4% of unscreened cases have within 2 years of diagnosis (P = 0.025). Twenty-three of 1940 (1.2%) men who were solicited but chose not to participate in screening were diagnosed with BC within 18 months after what would have been their last home screening date, compared with 1.3% of participants having BC detected by screening. Thus, screening participants and those who were solicited and declined had similar likelihoods of developing BC. CONCLUSIONS Hematuria home screening detects high-grade cancers before they become muscle invading and significantly reduces BC mortality.
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Affiliation(s)
- E M Messing
- Department of Surgery, University of Wisconsin, Madison
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229
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Popert RJ, Goodall J, Coptcoat MJ, Thompson PM, Parmar MK, Masters JR. Superficial bladder cancer: the response of a marker tumour to a single intravesical instillation of epirubicin. BRITISH JOURNAL OF UROLOGY 1994; 74:195-9. [PMID: 7921938 DOI: 10.1111/j.1464-410x.1994.tb16585.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To determine the response of a marker tumour to a single instillation of intravesical epirubicin. PATIENTS AND METHODS Eighty-one patients (54 men, 27 women) with a mean age of 69.3 years (range 36-92) with superficial bladder cancer were randomized to receive a single instillation of intravesical epirubicin. At the initial cystoscopy all but one papillary marker tumour was resected. Subsequently the patients were randomized to receive either intravesical epirubicin at a concentration of 1 mg/ml (n = 40) or 2 mg/ml (n = 41) in 50 ml of saline for 1 h. The response of the marker tumour was determined at 3 months (first check cystoscopy). The toxicity associated with both treatments was also recorded. RESULTS A complete response (no visible or microscopic bladder carcinoma) was observed in 46% (95% confidence interval (CI) 35-57%) of patients. No patient experienced systemic side-effects. Chemical cystitis and bladder irritability were the most frequent local side-effects, occurring in 15% (95% CI 8-24%) of the patients. CONCLUSIONS A single instillation of intravesical epirubicin has a demonstrable effect in superficial bladder cancer. The results compare favourably with more onerous regimes. Side-effects were minimal at 1 mg/ml and acceptable at 2 mg/ml.
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Affiliation(s)
- R J Popert
- Department of Urology, King's College Hospital, London, UK
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230
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Abstract
Bladder cancer is almost certainly a product of the industrial revolution and the cigarette smoking that has accompanied it. Exposure to a chemical bladder carcinogen such as beta naphthylamine, benzidine, or 4-diphenylaniline can be proved in only a small proportion of patients and only a handful obtain industrial diseases benefit after developing "Prescribed Industrial Disease C23." None the less, the continued use of known carcinogenic substances in British industry for many years after their identification, the wide range of industries with a known or suspected increased risk of bladder cancer, and our ignorance of the carcinogenic potential of many materials used in current manufacturing should be a cause for continuing concern.
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Affiliation(s)
- R R Hall
- Freeman Hospital, High Heaton, Newcastle upon Tyne
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231
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Hall RR, Parmar MK, Richards AB, Smith PH. Proposal for changes in cystoscopic follow up of patients with bladder cancer and adjuvant intravesical chemotherapy. BMJ (CLINICAL RESEARCH ED.) 1994; 308:257-60. [PMID: 8179678 PMCID: PMC2539314 DOI: 10.1136/bmj.308.6923.257] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A famous surgeon observed that the most important instrument for the management of superficial bladder cancer was a typewriter because it facilitated the organisation of the regular follow up examinations that are so important in controlling this disease. Cystoscopic follow up must be lifelong, and the cost, in the broadest sense, to both patient and health service is considerable. A recent study has suggested that the conventional frequency of bladder examinations may not be necessary and that most patients could be spared many cystoscopies. Instillation of cytotoxic drugs in the bladder has been shown to reduce the recurrence of tumours destroyed endoscopically and the development of new tumours elsewhere in the bladder. Because intravesical instillations are inconvenient, expensive, and may be toxic they have been reserved for patients thought to be at greatest risk of recurrence. However, two clinical trials have shown that a single cytotoxic instillation may be beneficial for low risk patients. If this is verified in everyday practice, the routine use of intravesical chemotherapy for all patients at the time of initial treatment could reduce the need for cystoscopies even further. Such changes should improve the quality of life of the 7000 new patients with superficial bladder cancer each year in England and Wales and allow savings to be made in the NHS.
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Affiliation(s)
- R R Hall
- Freeman Hospital, Newcastle upon Tyne
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232
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Eto H, Oka Y, Ueno K, Nakamura I, Yoshimura K, Arakawa S, Kamidono S, Obe S, Ogawa T, Hamami G. Comparison of the prophylactic usefulness of epirubicin and doxorubicin in the treatment of superficial bladder cancer by intravesical instillation: a multicenter randomized trial. Kobe University Urological Oncology Group. Cancer Chemother Pharmacol 1994; 35 Suppl:S46-51. [PMID: 7994786 DOI: 10.1007/bf00686919] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A multicentric randomized trial was conducted for the purpose of investigating the prophylactic efficacy of intravesical epirubicin instillation following transurethral resection of superficial bladder cancer in comparison with the efficacy of doxorubicin. The patients were centrally randomized into 2 groups and received 19 intravesical instillations of epirubicin or doxorubicin at 30 mg/30 ml physiological saline twice a week for 4 weeks and then once monthly for 11 months. A total of 150 patients with Ta and T1 superficial bladder cancer were entered in the trial, and 114 were evaluable. The nonrecurrence rates determined for each group at 1 and 2 years by the Kaplan-Meier method were 92.8% and 88.6%, respectively, for the epirubicin group and 86.4% and 81.7%, respectively, for the doxorubicin group. The differences between the two groups were not statistically significant. The main side effects encountered in this study were symptoms of bladder irritation such as micturitional pain, pollakisuria, and hematuria. The respective frequencies of those symptoms were 10%, 15.0%, and 5.0% in the epirubicin group and 14.8%, 14.8%, and 0 in the doxorubicin group. These results suggest that epirubicin is a useful drug, comparable with doxorubicin, for intravesical instillation chemotherapy in the prophylactic treatment of superficial bladder cancer.
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Affiliation(s)
- H Eto
- Department of Urology, Kobe University, School of Medicine, Japan
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233
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Pavone-Macaluso M, Tripi M, Ingargiola GB, Corselli G, Pavone C, Serretta V. Current views on intravesical treatment and chemoprophylaxis of superficial bladder cancer. The present role of epirubicin and doxorubicin. J Chemother 1993; 5:207-11. [PMID: 8371131 DOI: 10.1080/1120009x.1993.11739234] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Since 1972, a large number of studies have shown that intravesical treatment with doxorubicin (adriamycin) is effective against carcinoma in situ and multiple papillary tumors. Furthermore, it significantly reduces the recurrence rate after transurethral resection. Its efficacy has been compared with that of Bacillus Calmette-Guerin (BCG), which is the only treatment accepted by the US Food and Drug Administration for therapy of carcinoma in situ (Tis). In more recent years, a few studies have been performed using intravesical epirubicin in the hope that different properties of the molecule might enhance the activity of the anthracyclines, but produce fewer and milder side-effects. After weekly instillations of epirubicin (50 mg in 50 ml of sterile water) a complete response is achieved in 47% of patients with a histologically proven papillary marker lesion. The prophylactic efficacy of even a single instillation of epirubicin within 6 hours after transurethral resection (TUR) was proved in a randomized study (30863) of the EORTC (European Organization for Research on Therapy of Cancer) Urological Group. A randomized Italian trial (Blinst 4) of chemoprophylaxis after TUR investigated the efficacy of different intravesical administration schedules of epirubicin (50 mg in 50 ml of sterile water). All treatment regimens were more effective than no treatment. The sequential intravesical combination of epirubicin and interferon-alpha-2b has shown, in our personal experience, encouraging clinical results and our laboratory data suggest the synergic activation of the local immune response.
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Affiliation(s)
- M Pavone-Macaluso
- Interdepartment Center for Research in Clinical Oncology, University of Palermo, Italy
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