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Wang W, Guan X, Wang S, Shi L, Zhu Y, Hua P, Guo Q, Wang J. Epirubicin and gait apraxia: a real-world data analysis of the FDA Adverse Event Reporting System database. Front Pharmacol 2023; 14:1249845. [PMID: 37781696 PMCID: PMC10536159 DOI: 10.3389/fphar.2023.1249845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/24/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction: Epirubicin is widely used in many malignancies with good efficacy and tolerability. However, investigations about adverse events (AEs) using real-world information are still insufficient. Methods: We extracted Epirubicin-related reports submitted between the first quarter of 2014 and first quarter of 2023 from FAERS database. Four algorithms were utilized to evaluate whether there was a significant correlation between Epirubicin and AEs. Results: After de-duplicating, a total of 3919 cases were extracted. Among the 3919 cases, we identified 1472 AEs, 253 of which were found to be adverse drug reactions (ADRs) associated with Epirubicin. We analysed the occurrence of Epirubicin-induced ADRs and found several unexpected significant ADRs, such as hepatic artery stenosis, hepatic artery occlusion, intestinal atresia and so on. Interestingly, we found gait apraxia, a neurological condition, was also significantly associated with Epirubicin. To our knowledge, there haven't studies that have reported an association between gait disorders and the usage of epirubicin. Discussion: Our study identified new unexpected significant ADRs related to Epirubicin, providing new perspectives to the clinical use of Epirubicin.
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Affiliation(s)
- Wei Wang
- Department of Urology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Xin Guan
- Department of Cardiology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Shuang Wang
- Department of Gastroenterology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Lipeng Shi
- Department of General Surgery, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Yanfei Zhu
- Department of General Surgery, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Pengbo Hua
- Department of Urology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Qiang Guo
- Department of Urology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Jingqi Wang
- Department of Urology, Second Hospital of Shanxi Medical University, Taiyuan, China
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Tan WS, Steinberg G, Witjes JA, Li R, Shariat SF, Roupret M, Babjuk M, Bivalacqua TJ, Psutka SP, Williams SB, Cookson MS, Palou J, Kamat AM. Intermediate-risk Non-muscle-invasive Bladder Cancer: Updated Consensus Definition and Management Recommendations from the International Bladder Cancer Group. Eur Urol Oncol 2022; 5:505-516. [PMID: 35718695 DOI: 10.1016/j.euo.2022.05.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/22/2022] [Accepted: 05/19/2022] [Indexed: 11/29/2022]
Abstract
CONTEXT Intermediate-risk (IR) non-muscle-invasive bladder cancer (NMIBC) is a heterogeneous disease. OBJECTIVE To update the International Bladder Cancer Group (IBCG) guidance and provide practical recommendations on IR NMIBC management. EVIDENCE ACQUISITION A collaborative review of published randomized clinical trials, meta-analyses, systematic reviews, and clinical practice guidance on IR NMIBC published before January 2022 was undertaken using PubMed/Medline. EVIDENCE SYNTHESIS Variation exists between guidelines in defining IR NMIBC. The IBCG recommends defining IR NMIBC as any TaLG tumor that is either recurrent or multifocal or has size ≥3 cm, OR any T1LG tumor. If the 3 tier grading system is used, than any TaG2 tumor would also be considered IR diease regardless of whether new diagnosis or recurrent. Accurate grading and staging of tumor, particularly in ruling out HG/G3 disease and/or carcinoma in situ, are crucial. The IBCG recommends that management of IR NMIBC should be further based on the following risk factors: multifocal tumor (more than one), early recurrence (<1 yr), frequent recurrence (>1/yr), tumor size (≥3 cm), and failure of prior intravesical treatment. Patients with no risk factors are best managed by one dose of postoperative intravesical chemotherapy. Patients with one to two risk factors should be offered additional adjuvant induction intravesical chemotherapy (or bacillus Calmette-Guérin (BCG) if prior chemotherapy has been used). Patients with three or more risk factors should be offered induction plus 1-yr maintenance BCG. Where BCG is not available or recurrent disease following BCG is present, alternative intravesical treatments such as chemotherapy (single agent, combination, or chemohyperthermia) or a clinical trial are recommended. CONCLUSIONS Standardizing the definition of IR NMIBC is critical for appropriate management of patients and for allowing a comparison of outcomes across clinical trials. The IBCG recommends defining IR NMIBC as any TaLG tumor that is either recurrent or multifocal or ≥3 cm, OR any T1LG tumor. If the 3 tier grading system is used, than any TaG2 tumor would also be considered IR disease regardless of whether new diagnosis or recurrent. Adjunctive management should then be based on established risk factors. PATIENT SUMMARY Standardizing the definition of intermediate-risk (IR) non-muscle-invasive bladder cancer (NMIBC), which is a heterogeneous disease, is critical for appropriate management of patients. The International Bladder Cancer Group recommends classification of IR NMIBC tumors and personalized management based on the following risk factors: multifocal tumor (more than one), early recurrence (<1 yr), frequent recurrence (>1/yr), tumor size (≥3 cm), and previous intravesical treatment.
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Affiliation(s)
- Wei Shen Tan
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals, London, UK
| | - Gary Steinberg
- Department of Urology, New York University, New York City, NY, USA
| | - J Alfred Witjes
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Roger Li
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria; Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
| | - Morgan Roupret
- Urology, GRC n°5, Predictive ONCO-URO, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France
| | - Marko Babjuk
- Department of Urology, Hospital Motol, Second Faculty of Medicine, Charles University, Praha, Czech Republic
| | - Trinity J Bivalacqua
- Department of Urology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sarah P Psutka
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Stephen B Williams
- Department of Surgery, Division of Urology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Michael S Cookson
- Department of Urology, The University of Oklahoma Health Sciences Center & The Stephenson Cancer Center, Oklahoma City, OK, USA
| | - Juan Palou
- Department of Urology, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Ashish M Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Rollin P, Xylinas E, Lanz C, Audenet F, Brunelle S, Compérat E, Houédé N, Larré S, Masson-Lecomte A, Pignot G, Roumiguié M, Méjean A, Rouprêt M, Neuzillet Y. Instauration du traitement adjuvant endovésical par épirubicine des tumeurs de vessie n’infiltrant pas le muscle : premier retour national d’expérience du CC-AFU vessie. Prog Urol 2022; 32:326-331. [DOI: 10.1016/j.purol.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/02/2021] [Accepted: 12/14/2021] [Indexed: 11/16/2022]
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Eilender BM, Katims AB, Pfail JL, Sfakianos J. Evolving Treatment in Non-muscle-Invasive Bladder Cancer. Urol Oncol 2022. [DOI: 10.1007/978-3-030-89891-5_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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5
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Lu J, Xue Y, Shen F, Gu H, Liu H, Hou J, Miao H. Transurethral holmium laser resection and transurethral electrocision combined with intravesical epirubicin within 24 hours postoperatively for treatment of bladder cancer. J Int Med Res 2020; 48:300060519887267. [PMID: 31885339 PMCID: PMC7309393 DOI: 10.1177/0300060519887267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/17/2019] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To investigate the efficacy and safety of transurethral holmium laser resection (THOLR) and transurethral electrocision (TUR) combined with intravesical epirubicin within 24 hours postoperatively for treatment of non-muscular invasive bladder cancer. METHODS A total of 218 consecutive patients who were newly diagnosed with bladder cancer were enrolled in this prospective study from July 2014 to December 2017. The patients were randomly divided into THOLR and TUR groups. All patients received intravesical epirubicin (30 mg dissolved in 5% glucose solution) within 24 hours postoperatively. The operation time, blood loss, rate of obturator reflex, hospitalization time, catheterization time, complications, and recurrence were analyzed. RESULTS Operation, hospitalization, and catheterization times were significantly greater in the TUR group than in the THOLR group. The rates of blood loss and intraoperative obturator reflex were also significantly greater in the TUR group. There were no significant differences in complications, recurrence rate survival, or recurrence-free survival between the two groups, with the exception of bladder perforation rate. CONCLUSIONS THOLR and TUR combined with intravesical epirubicin within 24 hours postoperatively were both safe and effective for treatment of bladder tumor; however, patients who undergo THOLR might experience more rapid recovery.
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Affiliation(s)
- Jiawei Lu
- Department of Urology, The Affiliated Zhangjiagang Hospital of Soochow University, Zhangjiagang, jiangsu, China
| | - Yagang Xue
- Department of Urology, The Affiliated Zhangjiagang Hospital of Soochow University, Zhangjiagang, jiangsu, China
| | - Feng Shen
- Department of Urology, The Affiliated Zhangjiagang Hospital of Soochow University, Zhangjiagang, jiangsu, China
| | - Hongxing Gu
- Department of Urology, The Affiliated Zhangjiagang Hospital of Soochow University, Zhangjiagang, jiangsu, China
| | - Haiyong Liu
- Department of Urology, The Affiliated Zhangjiagang Hospital of Soochow University, Zhangjiagang, jiangsu, China
| | - Jianhua Hou
- Department of Urology, The Affiliated Zhangjiagang Hospital of Soochow University, Zhangjiagang, jiangsu, China
| | - Huidong Miao
- Department of Urology, The Affiliated Zhangjiagang Hospital of Soochow University, Zhangjiagang, jiangsu, China
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Fujita N, Hatakeyama S, Momota M, Kido K, Narita T, Tobisawa Y, Yoneyama T, Yamamoto H, Imai A, Ito H, Yoneyama T, Hashimoto Y, Yoshikawa K, Ohyama C. Safety and efficacy of intensive instillation of low-dose pirarubicin vs. bacillus Calmette-Guérin in patients with high-risk non-muscle-invasive bladder cancer. Urol Oncol 2020; 38:684.e17-684.e24. [PMID: 32278732 DOI: 10.1016/j.urolonc.2020.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/21/2020] [Accepted: 03/14/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the safety and efficacy of intensive intravesical instillation of low-dose pirarubicin (THP) for 6 times vs. bacillus Calmette-Guérin (BCG) without maintenance therapy after transurethral resection of bladder tumor (TURBT) in patients with primary high-risk non-muscle-invasive bladder cancer (NMIBC). MATERIALS AND METHODS We retrospectively evaluated 370 patients with primary high-risk NMIBC who underwent TURBT from November 1993 to April 2019. The patients were divided into 2 groups: patients treated with intravesical instillation of BCG without maintenance therapy (BCG group) and intensive intravesical instillation of low-dose (20 mg) THP for 6 times within 10 days after TURBT (THP group). Safety was assessed using the Common Terminology Criteria for Adverse Events version 5.0. Background-adjusted multivariate analyses were performed to evaluate the effect of intensive intravesical instillation of low-dose THP on oncological outcomes, including intravesical recurrence-free survival (RFS), upper urinary tract RFS, muscle-invasive bladder cancer-free survival, metastasis-free survival, cancer-specific survival, and overall survival. RESULTS Of the 370 patients with primary high-risk NMIBC, 180 (49%) and 190 (51%) were stratified into the BCG and THP groups, respectively. The incidence rate of adverse events of any grade in the BCG group was significantly higher than that in the THP group (P < 0.001). In the background-adjusted multivariate analyses, no significant differences were observed in oncological outcomes between the BCG and THP groups. CONCLUSIONS Intensive intravesical instillation of low-dose THP for 6 times may be one of the treatment options in view of safety and efficacy after TURBT in patients with primary high-risk NMIBC.
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Affiliation(s)
- Naoki Fujita
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
| | - Masaki Momota
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Koichi Kido
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takuma Narita
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuki Tobisawa
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tohru Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hayato Yamamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Atsushi Imai
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hiroyuki Ito
- Department of Urology, Aomori Rosai Hospital, Hachinohe, Japan
| | - Takahiro Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuhiro Hashimoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | | | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Elevated release of inflammatory but not sensory mediators from the urothelium is maintained following epirubicin treatment. Eur J Pharmacol 2019; 863:172703. [DOI: 10.1016/j.ejphar.2019.172703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 11/20/2022]
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Murakami K, Hamada A, Teramoto Y, Matsumoto K, Kita Y, Saito R, Yamasaki T, Matsui Y, Inoue T, Ogawa O, Kobayashi T. Efficacy of Immediate Postoperative Instillation of Chemotherapy for Primary Non–Muscle-Invasive Bladder Cancer in Real-World Clinical Practice. Clin Genitourin Cancer 2019; 17:e1003-e1010. [DOI: 10.1016/j.clgc.2019.05.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 05/20/2019] [Accepted: 05/26/2019] [Indexed: 11/24/2022]
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9
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Zamboni S, Baumeister P, Mattei A, Mordasini L, Antonelli A, Simeone C, Moschini M. Single postoperative instillation for non-muscle invasive bladder cancer: are there still any indication? Transl Androl Urol 2019; 8:76-84. [PMID: 30976571 PMCID: PMC6414349 DOI: 10.21037/tau.2018.08.20] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/09/2018] [Indexed: 11/22/2022] Open
Abstract
Intravesical chemotherapeutical agents after transurethral resection have shown to be effective in reducing the risk of recurrence and progression during the follow up. Specifically, an early single chemotherapeutical instillation (SI) might play an important role but the efficacy of this treatment has been questioned. For these reasons, we sought to review and summarize the current evidence with a non-systematic Medline/PubMed literature search. Level 1a evidence strongly supports the utility of SI in reducing recurrence in low-intermediate risk non-muscle invasive bladder cancer (NMIBC) patients, with about 35% of relative reduction rates in patients with single, <3 cm and low-intermediate stage and grade tumors. The efficacy of this procedure is particularly evident when epirubicin or mitomycin C is administered. However, no randomized controlled trials compared the effect of the different types of drugs for SI. Only few trials have analyzed the effect of timing in SI, therefore, the optimal delivery timeframe is not yet completely clear with some series suggesting that a delivery within the first 2 hours after surgery might have an impact on recurrence rates and others that show no differences with those treated within 24 hours. None of the patients included in the randomized controlled trials analyzed in this review suffered from systemic toxicity. On the other hand, other side effects were recorded, including: chemical cystitis and skin reaction. Although it is a safe procedure, rare severe complications have been reported in the literature, mostly due to extravasation of drugs in patients who underwent extended resection or bladder perforation. To avoid potential deadly complications, SI should not be administered in these patients.
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Affiliation(s)
- Stefania Zamboni
- Klinik für Urologie, Luzerner Kantonsspital, Spitalstrasse 2, Lucerne, Switzerland
- Department of Urology, Spedali Civili di Brescia, Piazzale Spedali Civili 1, Brescia, Italy
| | - Philipp Baumeister
- Klinik für Urologie, Luzerner Kantonsspital, Spitalstrasse 2, Lucerne, Switzerland
| | - Agostino Mattei
- Klinik für Urologie, Luzerner Kantonsspital, Spitalstrasse 2, Lucerne, Switzerland
| | - Livio Mordasini
- Klinik für Urologie, Luzerner Kantonsspital, Spitalstrasse 2, Lucerne, Switzerland
| | - Alessandro Antonelli
- Department of Urology, Spedali Civili di Brescia, Piazzale Spedali Civili 1, Brescia, Italy
| | - Claudio Simeone
- Department of Urology, Spedali Civili di Brescia, Piazzale Spedali Civili 1, Brescia, Italy
| | - Marco Moschini
- Klinik für Urologie, Luzerner Kantonsspital, Spitalstrasse 2, Lucerne, Switzerland
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Tabayoyong WB, Kamat AM, O'Donnell MA, McKiernan JM, Ray-Zack MD, Palou J, Brausi M, Black PC, Williams SB. Systematic Review on the Utilization of Maintenance Intravesical Chemotherapy in the Management of Non-muscle-invasive Bladder Cancer. Eur Urol Focus 2018; 4:512-521. [PMID: 30190111 DOI: 10.1016/j.euf.2018.08.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/02/2018] [Accepted: 08/23/2018] [Indexed: 11/28/2022]
Abstract
CONTEXT Current guidelines remain ill-defined regarding the optimal intravesical chemotherapy type and regimen for the treatment of non-muscle-invasive bladder cancer (NMIBC). Although maintenance therapy is a standard part of bacillus Calmette-Guerin (BCG) therapy, its role in the context of chemotherapy remains debatable. OBJECTIVE We reviewed the literature regarding the utilization of intravesical maintenance chemotherapy in the treatment of NMIBC to determine its impact on recurrence, progression, and survival. EVIDENCE ACQUISITION A systematic search was conducted using Ovid and Medline according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines to identify studies between 1970 and 2018 reporting on the utilization of maintenance intravesical chemotherapy. Only randomized controlled trials (RCTs) that included a comparison between an induction regimen and an induction plus maintenance regimen were included. EVIDENCE SYNTHESIS Sixteen RCTs were included in the final analysis. The most commonly studied intravesical chemotherapy agents used in maintenance regimens were epirubicin, doxorubicin, and mitomycin C. Several maintenance schedules were utilized, some as short as 3mo and others as long as 3 yr, while the most common maintenance regimen utilized was monthly instillation for 1 yr. Of the 16 trials, 13 reported no significant improvement in recurrence for patients receiving maintenance compared with no maintenance, and none of the trials demonstrated a significant impact on progression or survival. CONCLUSIONS Intermediate length maintenance regimens lasting 7-12mo were the most common maintenance regimens utilized. There was considerable heterogeneity between trial design and duration of follow-up, making direct comparisons for recurrence, progression, and survival outcomes between trials challenging. Although maintenance intravesical chemotherapy is suggested as a treatment option for patients with NMIBC by some guidelines, the majority of evidence suggested that it provided no significant advantage over induction therapy alone with respect to recurrence, progression, or survival. PATIENT SUMMARY In this review, we reviewed prior clinical trials to determine whether prolonged intravesical chemotherapy ("maintenance therapy") improved the rates of recurrence, progression, and survival. Where differences were found in favor of maintenance therapy, there was no statistical significance demonstrated, possibly due to the underpowered nature of the study design. While there was no consensus on an optimal agent or maintenance schedule, we found no evidence to suggest that maintenance therapy would improve recurrence, progression, or survival.
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Affiliation(s)
- William B Tabayoyong
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ashish M Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - James M McKiernan
- Department of Urology, Columbia University Medical Center, New York, NY, USA
| | - Mohamed D Ray-Zack
- Division of Urology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Joan Palou
- Department of Urology, Fundacio Puigvert, Barcelona, Spain
| | - Maurizio Brausi
- Department of Urology, Azienda Unita Sanitaria Locale Modena, Modena, Italy
| | - Peter C Black
- Department of Urologic Sciences, The University of British Columbia, Vancouver, Canada
| | - Stephen B Williams
- Division of Urology, The University of Texas Medical Branch, Galveston, TX, USA.
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Oosterlinck W, Decaestecker K. Editorial on the value of an immediate intravesical instillation of mitomycin C in patients with non-muscle-invasive bladder cancer. Transl Androl Urol 2018; 7:S135-S137. [PMID: 29644182 PMCID: PMC5881219 DOI: 10.21037/tau.2017.09.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Oosterlinck W, Decaestecker K. Update on early instillation of chemotherapy after transurethral resection of non-muscle-invasive bladder cancer. Expert Rev Anticancer Ther 2018. [PMID: 29528758 DOI: 10.1080/14737140.2018.1451748] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Non-muscle-invasive bladder cancer (NMIBC) is a highly recurrent disease. Early bladder chemotherapy instillation (EBCI) after transurethral resection (TURB) is an efficient way to diminish recurrence. However, this method is often challenged. Areas covered: There was a recent publication of a large meta-analysis with the original patient data and the largest study ever on EBCI. Both brought new evidence on EBCI. Also the results of the 2 trials of EBCI with apaziquone appeared. EBCI is discussed among other methods to decrease recurrence. Expert commentary: EBCI obtains a 35% relative reduction of recurrence with the best results in low risk tumors. However, tumors with an EORTC recurrence score of 5 or more do not respond. It should be given within a few hours after TURB. Mitomycin C and epirubicin have been most widely used with no difference in response. Intensive rinsing of the bladder is also able to reduce recurrence rates by about 21%. A rare, but major problem and reason for not using EBCI is the possible extravasation of the drug after TURB. Apaziquone is rapidly inactivated in tissue and blood and is therefore ideal for local use. Two phase III trials however obtained only a modest result.
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13
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Bosschieter J, van Moorselaar RJA, Vis AN, van Ginkel T, Lissenberg-Witte BI, Beckers GMA, Nieuwenhuijzen JA. The effect of timing of an immediate instillation of mitomycin C after transurethral resection in 941 patients with non-muscle-invasive bladder cancer. BJU Int 2018; 122:571-575. [PMID: 29319922 DOI: 10.1111/bju.14124] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate whether the timing of an immediate instillation of mitomycin C (on the day of transurethral resection of bladder tumour [TURBT] or 1 day later) has an impact on time to recurrence of non-muscle-invasive bladder cancer (NMIBC). PATIENTS AND METHODS All patients with NMIBC who were enrolled in a prospective trial between 1998 and 2003, and treated with an early mitomycin C instillation (on the day of TURBT or 1 day later), were selected. Statistical analysis was performed with Kaplan-Meier curves and multivariable Cox regression. RESULTS Administering an instillation of mitomycin C on the day of TURBT or 1 day later did not show a statistically significant difference in time to recurrence in a univariable model (log-rank P = 0.99). After correcting for the number of scheduled adjuvant instillations, no statistically significant difference could be detected either: hazard ratio 1.05 (95% confidence interval 0.81-1.35, P = 0.74). CONCLUSION These data do not support the hypothesis that a very early instillation (on the day of TURBT) of mitomycin C decreases the risk of recurrence as compared with an early instillation (1 day after TURBT).
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Affiliation(s)
- Judith Bosschieter
- Department of Urology, VU university Medical Center, Amsterdam, The Netherlands
| | | | - André N Vis
- Department of Urology, VU university Medical Center, Amsterdam, The Netherlands
| | - Tessa van Ginkel
- Department of Urology, VU university Medical Center, Amsterdam, The Netherlands
| | - Birgit I Lissenberg-Witte
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Goedele M A Beckers
- Department of Urology, VU university Medical Center, Amsterdam, The Netherlands
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Impact of age on outcomes of patients with non-muscle-invasive bladder cancer treated with immediate postoperative instillation of mitomycin C. Urol Oncol 2017; 36:89.e1-89.e5. [PMID: 29221642 DOI: 10.1016/j.urolonc.2017.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 11/06/2017] [Accepted: 11/12/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To evaluate whether age affects the clinical benefit afforded by immediate postoperative intravesical instillation of mitomycin C in a contemporary cohort of patients with NMIBC. PATIENTS AND METHODS A total of 4,258 patients with NMIBC treated with transurethral resection of the bladder with (n = 2,605, 61%) or without (n = 1,652, 39%) one immediate instillation of mitomycin C from 5 institutions (study period: 2000-2007) were included. No patients received adjuvant instillations. A multivariable Cox proportional hazards regression model adjusting for standard clinical and pathological features tested the potential interaction term between age and administration of mitomycin C with regard to disease recurrence. RESULTS A total of 2,063 patients experienced disease recurrence with a median follow-up of 48 months for those who did not recur. In multivariable Cox regression analysis, immediate postoperative instillation of mitomycin C (HR: 0.62; 95% CI: 0.56-0.68; P<0.0001) and age (HR: 1.04; 95% CI: 1.00-1.09; P = 0.036) were associated with disease recurrence. We observed only slight decreases in recurrence-free survival with age irrespective of treatment administration of mitomycin C or not. CONCLUSION We confirmed reduced disease recurrence rates associated with 1 immediate postoperative intravesical instillation of mitomycin C in NMIBC patients. The benefit on recurrence-free survival of a postoperative intravesical instillation was preserved across all ages and therefore age by itself should not be taken into consideration when deciding to use it.
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Management of non-muscle invasive bladder cancer: A comprehensive analysis of guidelines from the United States, Europe and Asia. Cancer Treat Rev 2016; 47:22-31. [PMID: 27231966 DOI: 10.1016/j.ctrv.2016.05.002] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/03/2016] [Accepted: 05/04/2016] [Indexed: 11/21/2022]
Abstract
Bladder cancer is the 8th most common cancer with 74,000 new cases in the United States in 2015. Non-muscle invasive bladder cancer (NMIBC) accounts for 75% of all bladder cancer cases. Transurethral resection and intravesical treatments remain the main treatment modality. Up to 31-78% of cases recur, hence the need for intensive treatment and surveillance protocols which makes bladder cancer one of the most expensive cancers to manage. The purpose of this review is to compare contemporary guidelines from Europe, (European Association of Urology), the United States (National Comprehensive Cancer Network), the United Kingdom (National Institute for Health and Care Excellence), Japan (Japanese Urological Association) and the International Consultation on Bladder Cancer (ICUD). We compare and contrast the different guidelines and the evidence on which their recommendations are based.
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Prediction model for recurrence probabilities after intravesical chemotherapy in patients with intermediate-risk non-muscle-invasive bladder cancer, including external validation. World J Urol 2015; 34:173-80. [PMID: 26025189 PMCID: PMC4729802 DOI: 10.1007/s00345-015-1598-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 05/18/2015] [Indexed: 11/03/2022] Open
Abstract
PURPOSE To develop a model to predict recurrence for patients with intermediate-risk (IR) non-muscle-invasive bladder cancer (NMIBC) treated with intravesical chemotherapy which can be challenging because of the heterogeneous characteristics of these patients. METHODS Data from three Dutch trials were combined. Patients treated with intravesical chemotherapy with characteristics according to the IR definition of the EAU guideline 2013 were included. Uni- and multivariable Cox regression with selection methods were used to identify predictors of recurrence at 1, 2, and 5 years. An easy-readable table for recurrence probabilities was developed. An external validation was done using data from Spanish patients. RESULTS A total of 724 patients were available for analyses, of which 305 were primary patients. Recurrences occurred in 413 patients (57%). History of recurrences, history of intravesical treatment, grade 2, multiple tumors, and adjuvant treatment with epirubicin were relevant predictors for recurrence-free survival with hazard ratios of 1.48, 1.38, 1.22, 1.56, and 1.27, respectively. A table for recurrence probabilities was developed using these five predictors. Based on the probability of recurrence, three risk groups were identified. Patients in each of the separate risk groups should be scheduled for less or more aggressive treatment. The model showed sufficient discrimination and good predictive accuracy. External validation showed good validity. CONCLUSION In our model, we identified five relevant predictors for recurrence-free survival in IR-NMIBC patients treated with intravesical chemotherapy. These recurrence predictors allow the urologists to stratify patients in risk groups for recurrence that could help in deciding for an individualized treatment approach.
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Li T, Xing Y, Liu SC, Han XM, Li WC, Chen M. Long-term versus short-term introvesical chemotherapy in patients with non-muscle-invasive bladder cancer: a systematic review and meta-analysis of the published results of randomized clinical trials. ACTA ACUST UNITED AC 2014; 34:706-715. [PMID: 25318881 DOI: 10.1007/s11596-014-1340-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 07/25/2014] [Indexed: 12/01/2022]
Abstract
In order to assess the effect of long-term versus short-term intravesical chemotherapy in preventing the recurrence of patients with non-muscle-invasive bladder cancer, we searched several databases with words as mesh terms and free text words to find all eligible randomized clinical trials (RCTs) for the comparison of the two strategies of instillation durations. "Observed-Expected events research (O-E)" and "Variance (V)" for calculating hazard ratio (HR) were used in Revman 5.2 software recommended by Cochrane Collabration for data analysis. Sensitivity and subgroup analysis were selected to minish heterogeneity. GRADEpro 3.6 profile recommended by Cochrane Collabration was employed for quality assessment of analyses. Finally, 13 eligible RCTs with 4216 patients were included in this review and 16 comparisons from 13 trials were involved for analysis. The pooled analysis revealed no significant difference between long-term and short-term duration [HR=0.99, 95% CI (0.89, 1.11), P=0.89]. Within the subgroup analysis, patients benefited from long-term instillations with a start regimen of one immediate instillation [HR=0.83, 95% CI (0.69, 1.00), P=0.05]. But patients were not suitable to receive long-term instillations with epirubicin (EPI) [HR=1.01, 95% CI (0.91, 1.13), P=0.78]. The progression rate was not reduced after long-term instillations [HR=0.96, 95% CI (0.66, 1.39), P=0.82]. From our results, patients should not receive introvesical chemotherapy more than half a year. In contrast, patients with one immediate instillation are preferred to have a long-term duration at least one year. Long-term instillations can not reduce the progression rate.
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Affiliation(s)
- Teng Li
- Department of Urology, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yi Xing
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Shu-Cheng Liu
- Department of Urology, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiao-Min Han
- Department of Urology, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Wen-Cheng Li
- Department of Urology, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Min Chen
- Department of Urology, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Lammers RJM, Palou J, Witjes WPJ, Janzing-Pastors MHD, Caris CTM, Witjes JA. Comparison of expected treatment outcomes, obtained using risk models and international guidelines, with observed treatment outcomes in a Dutch cohort of patients with non-muscle-invasive bladder cancer treated with intravesical chemotherapy. BJU Int 2014; 114:193-201. [PMID: 24304638 DOI: 10.1111/bju.12495] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the risks according to the American Urological Association (AUA), EAU, European Organization for Research and Treatment of Cancer (EORTC) and Club Urológico Español de Tratamiento Oncologico (CUETO) classifications with real outcomes in a cohort of patients in the Netherlands, and to confirm that patients who were undertreated according to these risk models have worse outcomes than adequately treated patients. PATIENTS AND METHODS Patients treated with complete transurethral resection of bladder tumour and intravesical chemotherapy were included. Not all patients would have received intravesical chemotherapy had they been treated to current standards, and thus comparison of the observed outcomes in our Dutch cohort vs expected outcomes based on the EORTC risk tables and CUETO scoring model was possible. The cohort was reclassified according to the definitions of five index patients (IPs), as defined by the AUA guidelines, and three risk groups, defined according to the EAU guidelines, to compare the outcomes of undertreated patients with those of adequately treated patients. RESULTS A total of 1001 patients were available for comparison with the AUA definitions and 728 patients were available for comparison with the EORTC and CUETO models. There was a large overlap between the observed outcomes and expected recurrence and progression probabilities when comparison was made using the EORTC risk tables. The observed recurrence outcomes were in general higher than the expected probabilities according to the CUETO risk classification, especially in the long term. No differences in progression were found when comparing these two models to the Dutch cohort. Patients who were undertreated according to the guidelines showed, in general, a higher risk of developing recurrence and progression. Limitations are i.a. its retrospective nature and the differences in grading system. CONCLUSION Comparisons between the observed outcomes in our Dutch cohort and the expected outcomes based on EAU and CUETO risk models and the EORTC and AUA guidelines showed that lack of adherence to existing guidelines translates into worse outcomes.
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Zhang Z, Cao Z, Xu C, Wang H, Zhang C, Pan A, Wei R, Peng S, Guo F, Wang L, Sun Y. Solifenacin Is Able to Improve the Irritative Symptoms After Transurethral Resection of Bladder Tumors. Urology 2014; 84:117-21. [DOI: 10.1016/j.urology.2014.02.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 02/24/2014] [Accepted: 02/28/2014] [Indexed: 10/25/2022]
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Mertens LS, Neuzillet Y, Horenblas S, van Rhijn BWG. Landmarks in non-muscle-invasive bladder cancer. Nat Rev Urol 2014; 11:476-80. [PMID: 24980189 DOI: 10.1038/nrurol.2014.130] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Bladder cancer is divided into two entities: non-muscle-invasive (NMIBC) and muscle invasive bladder cancer. NMIBC represents 75% of primary diagnoses and is characterized by frequent recurrence but a low risk of mortality. Throughout urological history, significant progress in detection, diagnosis, and treatment of NMIBC has been made. However, bladder cancer remains a heterogeneous disease with varying pathology, molecular background, diagnostic options, and subsequent therapies for the individual patient. Although significant progress has been made over the years, the improvement of bladder cancer outcomes remains the goal of future research.
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Affiliation(s)
- Laura S Mertens
- Department of Urology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, Netherlands
| | - Yann Neuzillet
- Department of Urology, Foch Hospital, University of Versailles, Saint-Quentin-en-Yveline, 92150 Suresnes, France
| | - Simon Horenblas
- Department of Urology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, Netherlands
| | - Bas W G van Rhijn
- Department of Urology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, Netherlands
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Kamat AM, Witjes JA, Brausi M, Soloway M, Lamm D, Persad R, Buckley R, Böhle A, Colombel M, Palou J. Defining and treating the spectrum of intermediate risk nonmuscle invasive bladder cancer. J Urol 2014; 192:305-15. [PMID: 24681333 DOI: 10.1016/j.juro.2014.02.2573] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE Low, intermediate and high risk categories have been defined to help guide the treatment of patients with nonmuscle invasive bladder cancer (Ta, T1, CIS). However, while low and high risk disease has been well classified, the intermediate risk category has traditionally comprised a heterogeneous group that does not fit into either of these categories. As a result, many urologists remain uncertain about the categorization of patients as intermediate risk as well as the selection of the most appropriate therapeutic option for this patient population. We review the current literature and clinical practice guidelines on intermediate risk nonmuscle invasive bladder cancer and, based on our findings, provide urologists with a better understanding of this heterogeneous risk group as well as practical recommendations for the treatment of intermediate risk patients. MATERIALS AND METHODS The IBCG analyzed published clinical trials, meta-analyses and current clinical practice guidelines on intermediate risk nonmuscle invasive bladder cancer available as of September 2013. The definitions of intermediate risk, patient outcomes and guideline recommendations were considered, as were the limitations of the available literature and additional parameters that may be useful in guiding treatment decisions in intermediate risk patients. RESULTS Current definitions and management recommendations for intermediate risk nonmuscle invasive bladder cancer vary. The most simple and practical definition is that proposed by the IBCG and the AUA of multiple and/or recurrent low grade Ta tumors. The IBCG suggests that several factors should be considered in clinical decisions in intermediate risk disease, including number (greater than 1) and size (greater than 3 cm) of tumors, timing (recurrence within 1 year) and frequency (more than 1 per year) of recurrence, and previous treatment. In patients without these risk factors a single, immediate instillation of chemotherapy is advised. In those with 1 to 2 risk factors adjuvant intravesical therapy (intravesical chemotherapy or maintenance bacillus Calmette-Guérin) is recommended, and previous intravesical therapy should be considered when choosing between these adjuvant therapies. For those patients with 3 to 4 risk factors, maintenance bacillus Calmette-Guérin is recommended. It is also important that all intermediate risk patients are accurately risk stratified at initial diagnosis and during subsequent followup. This requires appropriate transurethral resection of the bladder tumor, vigilance to rule out carcinoma in situ or other potential high risk tumors, and review of histological material directly with the pathologist. CONCLUSIONS Intermediate risk disease is a heterogeneous category, and there is a paucity of independent studies comparing therapies and outcomes in subgroups of intermediate risk patients. The IBCG has proposed a management algorithm that considers tumor characteristics, timing and frequency of recurrence, and previous treatment. Subgroup analyses of intermediate risk subjects in pivotal EORTC trials and meta-analyses will be important to validate the proposed algorithm and support clear evidence-based recommendations for subgroups of intermediate risk patients.
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Affiliation(s)
- Ashish M Kamat
- Department of Urology, MD Anderson Cancer Center, Houston, Texas.
| | - J Alfred Witjes
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | - Mark Soloway
- Department of Urology, University of Miami School of Medicine, Miami, Florida
| | - Donald Lamm
- Department of Surgery, University of Arizona, and BCG Oncology, Phoenix, Arizona
| | - Raj Persad
- Department of Urology/Surgery, Bristol Royal Infirmary & Bristol Urological Institute, Bristol, United Kingdom
| | - Roger Buckley
- Department of Urology, North York General Hospital, Toronto, Ontario, Canada
| | - Andreas Böhle
- Department of Urology, HELIOS Agnes Karll Hospital, Bad Schwartau, Germany
| | - Marc Colombel
- Department of Urology, Claude Bernard University, Hôpital Edouard Herriot, Lyon, France
| | - Joan Palou
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
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Lammers RJM, Witjes JA. Developments in intravesical therapy for non-muscle-invasive bladder cancer. Expert Rev Anticancer Ther 2014; 10:1903-16. [DOI: 10.1586/era.10.155] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Oosterlinck W, Decaestecker K. Current strategies in the treatment of non-muscle-invasive bladder cancer. Expert Rev Anticancer Ther 2014; 12:1097-106. [DOI: 10.1586/era.12.87] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder, the 2011 update. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.acuroe.2011.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Babjuk M, Oosterlinck W, Sylvester R, Kaasinen E, Böhle A, Palou-Redorta J, Rouprêt M. [EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder, the 2011 update]. Actas Urol Esp 2012; 36:389-402. [PMID: 22386115 DOI: 10.1016/j.acuro.2011.12.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 12/12/2011] [Indexed: 11/15/2022]
Abstract
CONTEXT AND OBJECTIVE To present the 2011 European Association of Urology (EAU) guidelines on non-muscle-invasive bladder cancer (NMIBC). EVIDENCE ACQUISITION Literature published between 2004 and 2010 on the diagnosis and treatment of NMIBC was systematically reviewed. Previous guidelines were updated, and the level of evidence and grade of recommendation were assigned. EVIDENCE SYNTHESIS Tumours staged as Ta, T1, or carcinoma in situ (CIS) are grouped as NMIBC. Diagnosis depends on cystoscopy and histologic evaluation of the tissue obtained by transurethral resection (TUR) in papillary tumours or by multiple bladder biopsies in CIS. In papillary lesions, a complete TUR is essential for the patient's prognosis. Where the initial resection is incomplete or where a high-grade or T1 tumour is detected, a second TUR should be performed within 2-6 wk. In papillary tumours, the risks of both recurrence and progression may be estimated for individual patients using the scoring system and risk tables. The stratification of patients into low-, intermediate-, and high-risk groups (separately for recurrence and progression) is pivotal to recommending adjuvant treatment. For patients with a low risk of tumour recurrence and progression, one immediate instillation of chemotherapy is recommended. Patients with an intermediate or high risk of recurrence and an intermediate risk of progression should receive one immediate instillation of chemotherapy followed by a minimum of 1 yr of bacillus Calmette-Guérin (BCG) intravesical immunotherapy or further instillations of chemotherapy. Papillary tumours with a high risk of progression and CIS should receive intravesical BCG for 1 yr. Cystectomy may be offered to the highest risk patients, and it is at least recommended in BCG failure patients. CONCLUSIONS These abridged EAU guidelines present updated information on the diagnosis and treatment of NMIBC for incorporation into clinical practice.
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Affiliation(s)
- M Babjuk
- Servicio de Urología, Hospital Motol, Segunda Facultad de Medicina, Universidad Carolina, Praga, República Checa.
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Phase 2 Study of Adjuvant Intravesical Instillations of Apaziquone for High Risk Nonmuscle Invasive Bladder Cancer. J Urol 2012; 187:1195-9. [DOI: 10.1016/j.juro.2011.11.101] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2011] [Indexed: 11/21/2022]
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An epirubicin-conjugated nanocarrier with MRI function to overcome lethal multidrug-resistant bladder cancer. Biomaterials 2012; 33:3919-30. [PMID: 22374456 DOI: 10.1016/j.biomaterials.2012.02.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 02/07/2012] [Indexed: 11/21/2022]
Abstract
Multidrug resistance (MDR) presents a major obstacle to curing cancer. Chemotherapy failure can occur through both cell membrane drug resistance (CMDR) and nuclear drug resistance (NDR), and anticancer effectiveness of chemotherapeutic agents is especially reduced by their nuclear export. Here we report an exciting magnetically-targeted nanomedicine formed by conjugation of epirubicin (EPI) to non-toxic and high-magnetization nanocarrier (HMNC). Strikingly, HMNC-EPI overcomes both CMDR and NDR in human bladder cancer cell models, without using P-glycoprotein (P-gp) and nuclear pore inhibitors. Besides, the half-life of drug is prolonged ~1.8-fold (from 45 h to 81 h) at 37 °C, with a ~10-fold increase in concentration at the tumor site through magnetic targeting (MT). Moreover, malignant NDR bladder cancer can be effectively inhibited after 14 days in mice by just two injections and MT. We are the first to demonstrate the nanomedical strategy that can overcome the CMDR and NDR bladder cancers simultaneously, and proceed to the excellent MT therapy, significantly reducing the dosage and cardiotoxicity and holding great promise for incurable human MDR bladder cancer.
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Mertens LS, Meinhardt W, Rier WB, Nooter RI, Horenblas S. Extravasation of Intravesical Chemotherapy for Non-Muscle-Invasive Bladder Cancer. Urol Int 2012; 89:332-6. [DOI: 10.1159/000341900] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 07/14/2012] [Indexed: 11/19/2022]
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Lotan Y, Amiel G, Boorjian SA, Clark PE, Droller M, Gingrich JR, Guzzo TJ, Inman BA, Kamat AM, Karsh L, Nielsen ME, Smith ND, Shariat SF, Svatek RS, Taylor JM. Comprehensive handbook for developing a bladder cancer cystectomy database. Urol Oncol 2011; 31:812-26. [PMID: 22056403 DOI: 10.1016/j.urolonc.2011.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 09/11/2011] [Accepted: 09/14/2011] [Indexed: 12/01/2022]
Abstract
OBJECTIVE In an effort to standardize data collection for research regarding bladder cancer, the Bladder Cancer Working Group sought to provide a handbook that can be used as a guide for prospective or retrospective data collection. METHODS Expert opinions for various data groups were compiled through a team of researchers at the BCAN. Peer review of each data group was performed from within the group. RESULTS Essential and comprehensive data elements are provided for 9 groups of data elements, including demographics, comorbidities, staging, laboratory data, operative details, pathology, complications, outcomes, and quality of life measurements. CONCLUSIONS Establishment of a comprehensive bladder cancer database is important in initiating multicenter collaborations. While not every data point is critical, this review may be useful in serving as a reference in initiating projects and providing a framework for collaborations.
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Affiliation(s)
- Yair Lotan
- The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
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Brausi M, Witjes JA, Lamm D, Persad R, Palou J, Colombel M, Buckley R, Soloway M, Akaza H, Böhle A. A review of current guidelines and best practice recommendations for the management of nonmuscle invasive bladder cancer by the International Bladder Cancer Group. J Urol 2011; 186:2158-67. [PMID: 22014799 DOI: 10.1016/j.juro.2011.07.076] [Citation(s) in RCA: 196] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Indexed: 11/26/2022]
Abstract
PURPOSE Although the European Association of Urology, First International Consultation on Bladder Tumors, National Comprehensive Cancer Network and American Urological Association guidelines all provide an excellent evidence-based framework for the management of nonmuscle invasive bladder cancer, these guidelines vary with respect to important issues such as risk level definitions and management strategies for these risk categories. Therefore, we built on the existing framework provided by current guidelines, and provide consensus on the definitions of low, intermediate and high risk nonmuscle invasive bladder cancer, as well as practical recommendations for the treatment of patients in each of these risk categories. MATERIALS AND METHODS An international committee of experts on bladder cancer management identified and analyzed the European Association of Urology, First International Consultation on Bladder Tumors, National Comprehensive Cancer Network and American Urological Association guidelines as well as the published English language literature related to the treatment and management of nonmuscle invasive bladder cancer available as of April 2010. RESULTS Based on review of the current guidelines and literature, the International Bladder Cancer Group developed practical recommendations for the management of nonmuscle invasive bladder cancer. CONCLUSIONS Complete transurethral bladder tumor resection is recommended for all patients with nonmuscle invasive bladder cancer. For low risk disease a single, immediate chemotherapeutic instillation after transurethral bladder tumor resection is recommended. For intermediate or high risk disease there is no significant benefit from an immediate, postoperative chemotherapeutic instillation. For intermediate risk disease intravesical bacillus Calmette-Guérin with maintenance or intravesical chemotherapy is recommended. For high risk disease bacillus Calmette-Guérin induction plus maintenance is recommended. The appropriate management of recurrence depends on the patient level of risk as well as previous treatment, while the management of treatment failure depends on the type of failure as well as the level of risk for recurrence and disease progression.
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Lammers RJ, Witjes WP, Hendricksen K, Caris CT, Janzing-Pastors MH, Witjes JA. Smoking Status Is a Risk Factor for Recurrence After Transurethral Resection of Non–Muscle-Invasive Bladder Cancer. Eur Urol 2011; 60:713-20. [DOI: 10.1016/j.eururo.2011.07.010] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 07/04/2011] [Indexed: 11/25/2022]
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Liu H, Xue S, Ruan Y, Sun X, Han B, Xia S. 2-micrometer continuous wave laser treatment for multiple non-muscle-invasive bladder cancer with intravesical instillation of epirubicin. Lasers Surg Med 2011; 43:15-20. [PMID: 21254138 DOI: 10.1002/lsm.21014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES We have reported the efficacy and safety of 2-micrometer continuous wave laser resection of non-muscle-invasive bladder tumor (NMIVBC) (World J Urology 2010;28:157-161). In this study, we evaluated the use of 2-micrometer continuous wave laser resection in combination with intravesical instillation of epirubicin for the treatment of multiple NMIVBC. MATERIALS AND METHODS From September 2007 to April 2008, sixty patients with multiple NMIVBC were included in this study (44 cases of low grade papillary urothelial carcinoma, 10 cases of high grade papillary urothelial carcinoma, and six cases of papillary urothelial neoplasm with low malignant potential). Imaging examinations including pelvic computer tomography (CT) and intravenous urography showed no extravesical extension, lymphatic metastasis or any lesions of upper urinary tract. All patients received 2-micrometer continuous wave laser therapy under continuous epidural anesthesia, and intravesical chemotherapy with epirubicin 1 week later (intravesical instillation weekly for 8 weeks, followed by monthly maintenance to 12 months). RESULTS Totally 211 tumors in 60 patients were successfully removed with 2-micrometer continuous wave laser. The mean operation time was 48 minutes per patient (ranged 20-90 minutes) and 13.6 minutes per tumor (range 5-25 minutes). No obturator nerve reflection or bladder perforation occurred during the procedure. All patients finished 12 months of intravesical chemotherapy without severe complications. The mean followed-up time was 23 months. Tumor recurrences were found in 13 patients (22%). CONCLUSIONS The combination of 2-micrometer continuous wave laser and intravesical chemotherapy is feasible, safe, and efficacious for the treatment of multiple NMIVBC.
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Affiliation(s)
- Haitao Liu
- The First People's Hospital Affiliated to Shanghai Jiao Tong University, University Department of Urology, Shanghai, China
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Abstract
Bladder cancer comprises a heterogeneous group of tumors, the majority of which are non-muscle-invasive bladder cancer (NMIBC) at initial presentation. Low-risk bladder cancer--defined as pTa low-grade papillary tumors--is the type of NMIBC with the most favorable oncologic outcome. Although the risk of progression is less than 1% in 5 years, almost 15% will recur after 1 year, and 32% after 5 years. A complete transurethral resection, followed by an immediate single postoperative instillation of chemotherapy will reduce the risk of recurrence for the first 2 years. Follow-up cystoscopy is required to detect recurrence; in the vast majority of cases the recurrent tumor is of the same stage and grade as the primary tumor. The first follow-up visit, 3 months after surgery, is the most important in predicting risk of recurrence for the future. Recent developments in profiling urine and cancer tissue make it possible to better predict risk of progression and recurrence. In the future this profiling will play an important role in the timing and the choice of treatment, as well as guiding follow-up procedures.
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Affiliation(s)
- Johannes Falke
- Radboud University Nijmegen Medical Center, Department of Urology (659), PO Box 9101, 6500 HB Nijmegen, The Netherlands.
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Gudjónsson S. Re: Willem Oosterlinck,Richard Sylvester, Marco Babjuk, et al. Should all patients receive an immediate chemotherapeutic drug instillation after resection of papillary bladder tumors? Eur Urol 2011;59:374-6. Eur Urol 2011; 60:e2-3; author reply e4. [PMID: 21531071 DOI: 10.1016/j.eururo.2011.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Accepted: 04/13/2011] [Indexed: 11/18/2022]
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Babjuk M, Oosterlinck W, Sylvester R, Kaasinen E, Böhle A, Palou-Redorta J, Rouprêt M. EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder, the 2011 update. Eur Urol 2011; 59:997-1008. [PMID: 21458150 DOI: 10.1016/j.eururo.2011.03.017] [Citation(s) in RCA: 570] [Impact Index Per Article: 43.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 03/10/2011] [Indexed: 12/13/2022]
Abstract
CONTEXT AND OBJECTIVE To present the 2011 European Association of Urology (EAU) guidelines on non-muscle-invasive bladder cancer (NMIBC). EVIDENCE ACQUISITION Literature published between 2004 and 2010 on the diagnosis and treatment of NMIBC was systematically reviewed. Previous guidelines were updated, and the level of evidence (LE) and grade of recommendation (GR) were assigned. EVIDENCE SYNTHESIS Tumours staged as Ta, T1, or carcinoma in situ (CIS) are grouped as NMIBC. Diagnosis depends on cystoscopy and histologic evaluation of the tissue obtained by transurethral resection (TUR) in papillary tumours or by multiple bladder biopsies in CIS. In papillary lesions, a complete TUR is essential for the patient's prognosis. Where the initial resection is incomplete or where a high-grade or T1 tumour is detected, a second TUR should be performed within 2-6 wk. In papillary tumours, the risks of both recurrence and progression may be estimated for individual patients using the scoring system and risk tables. The stratification of patients into low-, intermediate-, and high-risk groups-separately for recurrence and progression-is pivotal to recommending adjuvant treatment. For patients with a low risk of tumour recurrence and progression, one immediate instillation of chemotherapy is recommended. Patients with an intermediate or high risk of recurrence and an intermediate risk of progression should receive one immediate instillation of chemotherapy followed by a minimum of 1 yr of bacillus Calmette-Guérin (BCG) intravesical immunotherapy or further instillations of chemotherapy. Papillary tumours with a high risk of progression and CIS should receive intravesical BCG for 1 yr. Cystectomy may be offered to the highest risk patients, and it is at least recommended in BCG failure patients. The long version of the guidelines is available from the EAU Web site (www.uroweb.org). CONCLUSIONS These abridged EAU guidelines present updated information on the diagnosis and treatment of NMIBC for incorporation into clinical practice.
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Affiliation(s)
- Marko Babjuk
- Department of Urology, Hospital Motol, Second Faculty of Medicine, Charles University, Praha, Czech Republic.
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Oosterlinck W, Sylvester R, Babjuk M, Kaasinen E, Böhle A, Palou-Redorta J, Rouprêt M. Should All Patients Receive an Immediate Chemotherapeutic Drug Instillation After Resection of Papillary Bladder Tumors? Eur Urol 2011; 59:374-6. [DOI: 10.1016/j.eururo.2010.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Accepted: 12/03/2010] [Indexed: 10/18/2022]
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Long-term outcomes of intravesical therapy for non-muscle invasive bladder cancer. World J Urol 2010; 29:59-71. [DOI: 10.1007/s00345-010-0617-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Accepted: 11/09/2010] [Indexed: 11/26/2022] Open
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[Management of non invasive bladder cancers. T1Ga urothelial cell carcinoma: benefit of immediate post operative instillation?]. Prog Urol 2010; 20 Suppl 1:S46-9. [PMID: 20493444 DOI: 10.1016/s1166-7087(10)70026-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Immediate intravesical chemotherapy after transurethral resection decrease recurrences in non-muscle-invasive bladder cancer. Guidelines recommend immediate, intravesical instillation for all patients with Ta/T1 tumours. Instillation has to be avoided when there is a bladder perforation, a large resection (>3cm) or gross haematuria. Tolerance is good and morbidity is low.
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Babjuk M. New Insights in Intravesical Treatment for Intermediate- and High-Risk Non–Muscle-Invasive Urothelial Bladder Carcinoma. Eur Urol 2010; 57:774-6; author reply 776-7. [DOI: 10.1016/j.eururo.2010.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Accepted: 01/04/2010] [Indexed: 10/20/2022]
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Puppo P, Conti G, Francesca F, Mandressi A, Naselli A. New Italian guidelines on bladder cancer, based on the World Health Organization 2004 classification. BJU Int 2010; 106:168-79. [PMID: 20346041 DOI: 10.1111/j.1464-410x.2010.09324.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To provide evidence-based recommendations on bladder cancer management METHODS A multidisciplinary guideline panel composed of urologists, medical oncologists, radiotherapists, general practitioners, radiologists, epidemiologists and methodologists conducted a structured review of previous reports, searching the Medline database from 1 January 2004 to 31 December 2008. The milestone papers published before January 2004 were accepted for analysis. The level of evidence and the grade of the recommendations were established using the GRADE system. RESULTS In all, 15 806 references were identified, 1940 retrieved, 1712 eliminated (specifying the reason for their elimination) and 971 included in the analysis, as well as 241 milestone reports. A consensus conference held to discuss the discrepancies between the scientific evidence and the clinical practice was then attended by 122 delegates of various specialities. CONCLUSION Recommendations on bladder cancer management are provided.
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Reply to Sigurdur Gudjónsson, Wiking Månsson, Sten Holmäng and Fredrik Liedberg's Letter to the Editor re: Richard J. Sylvester, Willem Oosterlinck. An Immediate Instillation after Transurethral Resection of Bladder Tumor in Non–Muscle-Invasive Bladder Cancer: Has the Evidence Changed? Eur Urol 2009;56:43–5. Eur Urol 2010. [DOI: 10.1016/j.eururo.2009.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Ayres BE, Crew JP. Is immediate postoperative intravesical chemotherapy beneficial in non-muscle- invasive bladder cancer? BJU Int 2010; 105 Suppl 2:14-7. [PMID: 20089093 DOI: 10.1111/j.1464-410x.2009.09152.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Serretta V, Morgia G, Altieri V, Di Lallo A, Ruggiero G, Salzano L, Battaglia M, Falsaperla M, Zito A, Sblendorio D, Melloni D, Allegro R. A 1-year maintenance after early adjuvant intravesical chemotherapy has a limited efficacy in preventing recurrence of intermediate risk non-muscle-invasive bladder cancer. BJU Int 2010; 106:212-7. [DOI: 10.1111/j.1464-410x.2009.09153.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Saika T, Tsushima T, Nasu Y, Miyaji Y, Saegusa M, Takeda K, Kumon H. Two instillations of epirubicin as prophylaxis for recurrence after transurethral resection of Ta and T1 transitional cell bladder cancer: a prospective, randomized controlled study. World J Urol 2010; 28:413-8. [DOI: 10.1007/s00345-009-0502-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Accepted: 12/23/2009] [Indexed: 10/20/2022] Open
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Novara G, Ficarra V, Artibani W. Evidence-based Medicine: The Supporting Pillar of Trial Registration. Eur Urol 2009; 56:956-8. [DOI: 10.1016/j.eururo.2009.09.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Accepted: 09/13/2009] [Indexed: 11/25/2022]
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Gudjónsson S, Månsson W, Holmäng S, Liedberg F. Re: Richard J. Sylvester, Willem Oosterlinck. An immediate instillation after transurethral resection of bladder tumor in non-muscle-invasive bladder cancer: has the evidence changed? Eur Urol 2009;56;43-5. Eur Urol 2009; 57:e28-9; author reply e30. [PMID: 19931978 DOI: 10.1016/j.eururo.2009.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Accepted: 11/07/2009] [Indexed: 11/15/2022]
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[Intravesical therapy in non-muscle-invasive bladder cancer: indications and practical considerations]. Urologe A 2009; 48:1263-4, 1266-8, 1270-2. [PMID: 19795104 DOI: 10.1007/s00120-009-2105-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Intravesical treatment with various agents is an accepted standard for treating patients with non-muscle-invasive bladder cancer; all guidelines recommend its use. Depending on the agent and the instillation schedule, a reduction in recurrence and a decrease in the progression rate can be achieved.However, many of the recommendations in the various guidelines are currently under debate. Early instillation with a chemotherapeutic agent is probably overtreatment in patients requiring further induction or maintenance therapy because it adds no further benefit. The economic aspects of early instillations are also being discussed. Recent studies question the ability of bacillus Calmette-Guérin (BCG) instillations to reduce the progression of non-muscle-invasive bladder cancer. Furthermore, the superiority of maintenance therapies compared with induction schedules is under debate.There is a great body of evidence that the effectiveness of intravesical chemotherapy can be increased by simple measures. Reduction of BCG side effects without compromising the oncological outcome is possible.
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Perioperative instillation therapy in superficial bladder cancer: is it effective regarding outcome and costs? Curr Opin Urol 2009; 19:511-5. [PMID: 19553821 DOI: 10.1097/mou.0b013e32832eb449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This article reviews the current knowledge concerning immediate intravesical instillation therapy in nonmuscle-invasive bladder cancer after transurethral resection of the bladder tumour, with emphasis on the literature of the last few years. RECENT FINDINGS A review was conducted on the recent literature available by PubMed database on the subject of immediate bladder chemotherapy after transurethral resection of the bladder tumour and its recent developments. SUMMARY A single immediate bladder instillation with chemotherapy will give 39% reduction of recurrence. Numbers needed to treat to prevent one recurrence are estimated at 8.5. In intermediate and high-risk bladder cancer, the immediate postoperative instillation does not give sufficient reduction in recurrence rate to leave out subsequent bladder instillations. The significant reduction of recurrences, the mild side-effects of the treatment and the clear cost-effectiveness make one immediate instillation a valuable addition to transurethral resection of the bladder tumour in the treatment of nonmuscle-invasive bladder cancer. Points of controversy are the true numbers needed to treat to prevent a recurrence and the type of recurrences that will be prevented. No new types of instillation are added recently to the ones available, but promising types are under investigation of which pharmacokinetic studies have shown acceptable rates of side-effects.
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Recurrence and progression of disease in non-muscle-invasive bladder cancer: from epidemiology to treatment strategy. Eur Urol 2009; 56:430-42. [PMID: 19576682 DOI: 10.1016/j.eururo.2009.06.028] [Citation(s) in RCA: 514] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2009] [Accepted: 06/17/2009] [Indexed: 01/01/2023]
Abstract
CONTEXT This review focuses on the prediction of recurrence and progression in non-muscle invasive bladder cancer (NMIBC) and the treatments advocated for this disease. OBJECTIVE To review the current status of epidemiology, recurrence, and progression of NMIBC and the state-of-the art treatment for this disease. EVIDENCE ACQUISITION A literature search in English was performed using PubMed and the guidelines of the European Association of Urology and the American Urological Association. Relevant papers on epidemiology, recurrence, progression, and management of NMIBC were selected. Special attention was given to fluorescent cystoscopy, the new World Health Organisation 2004 classification system for grade, and the role of substaging of T1 NMIBC. EVIDENCE SYNTHESIS In NMIBC, approximately 70% of patients present as pTa, 20% as pT1, and 10% with carcinoma in situ (CIS) lesions. Bladder cancer (BCa) is the fifth most frequent type of cancer in western society and the most expensive cancer per patient. Recurrence (in < or = 80% of patients) is the main problem for pTa NMIBC patients, whereas progression (in < or = 45% of patients) is the main threat in pT1 and CIS NMIBC. In a recent European Organisation for Research and Treatment of Cancer analysis, multiplicity, tumour size, and prior recurrence rate are the most important variables for recurrence. Tumour grade, stage, and CIS are the most important variables for progression. Treatment ranges from transurethral resection (TUR) followed by a single chemotherapy instillation in low-risk NMIBC to, sometimes, re-TUR and adjuvant intravesical therapy in intermediate- and high-risk patients to early cystectomy for treatment-refractory high-risk NMIBC. CONCLUSIONS NMIBC is a heterogeneous disease with varying therapies, follow-up strategies, and oncologic outcomes for an individual patient.
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