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Alcorn J, Burton R, Topping A. Patterns of patient withdrawal from BCG treatment for bladder cancer: A retrospective time interval analysis. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2019. [DOI: 10.1111/ijun.12191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jason Alcorn
- Department of Urology, Mid Yorkshire Hospitals NHS Trust, Pinderfields Hospital, Wakefield West Yorkshire UK
| | - Rob Burton
- School of Nursing and MidwiferyGriffith University Brisbane Queensland Australia
| | - Annie Topping
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham & University Birmingham Hospitals NHS Foundation Trust Birmingham UK
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Immunotherapy. Bladder Cancer 2018. [DOI: 10.1016/b978-0-12-809939-1.00020-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Andreu Z, Otta Oshiro R, Redruello A, López-Martín S, Gutiérrez-Vázquez C, Morato E, Marina AI, Olivier Gómez C, Yáñez-Mó M. Extracellular vesicles as a source for non-invasive biomarkers in bladder cancer progression. Eur J Pharm Sci 2016; 98:70-79. [PMID: 27751843 DOI: 10.1016/j.ejps.2016.10.008] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 09/15/2016] [Accepted: 10/04/2016] [Indexed: 12/18/2022]
Abstract
Bladder cancer is the second most frequent malignancy of the urinary tract after prostate cancer. Current diagnostic techniques, such as cystoscopy and biopsies are highly invasive and accompanied of undesirable side effects. Moreover, there are no suitable biomarkers for relapse or progression prognosis. We analysed whether the specific composition of microRNAs (miRNAs) and proteins of extracellular vesicles (EVs) that urothelial tumour cells of bladder mucosa release into the urine, could reflect their pathologic condition. For this purpose, urinary EVs were isolated and their protein and miRNA composition evaluated in healthy donors and low or high-grade bladder cancer patients. Using a microarray platform containing probes for 851 human miRNAs we found 26 deregulated miRNAs in high-grade bladder cancer urine EVs, from which 23 were downregulated and 3 upregulated. Real-time PCR analysis pointed to miR-375 as a biomarker for high-grade bladder cancer while miR-146a could identify low-grade patients. Finally, several protein markers were also deregulated in EVs from tumour patients. Our data suggest that the presence of ApoB in the 100,000 pellet is a clear marker for malignancy.
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Affiliation(s)
- Zoraida Andreu
- Unidad de Investigación, Hospital Santa Cristina, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Renan Otta Oshiro
- Servicio de Urología, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Spain
| | - Alberto Redruello
- Unidad de Investigación, Hospital Santa Cristina, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Soraya López-Martín
- Unidad de Investigación, Hospital Santa Cristina, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Cristina Gutiérrez-Vázquez
- Servicio de Inmunología, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP); Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Unidad de Proteómica, CBM-SO, Madrid, Spain; Departamento de Biología Molecular, UAM/CBM-SO, Madrid, Spain
| | | | | | - Carlos Olivier Gómez
- Servicio de Urología, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Spain
| | - María Yáñez-Mó
- Unidad de Investigación, Hospital Santa Cristina, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain; Departamento de Biología Molecular, UAM/CBM-SO, Madrid, Spain.
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Is it possible to stop follow-up of patients with primary T1G3 urothelial carcinoma of the bladder managed with intravesical bacille Calmette-Guérin immunotherapy? World J Urol 2016; 35:237-243. [PMID: 27277599 DOI: 10.1007/s00345-016-1856-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 05/17/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Recurrence and progression of T1 grade 3 (T1G3) urothelial bladder carcinomas (UBCs) treated with bacille Calmette-Guérin (BCG) are common events, but the long-term follow-up of the disease remains controversial. OBJECTIVE To evaluate the long-term outcomes of BCG intravesical therapy in relation to disease recurrence and progression in primary T1G3 UBCs and upper tract disease. PATIENTS AND METHODS A single-institution, retrospective, population-based analysis of 316 patients with primary T1G3 UBC treated with transurethral resection (TUR) and BCG induction intravesical instillations was performed. Response was determined and monitored by routine periodic urine cytology, cystoscopy, and upper tract imaging. RESULTS The median follow-up was 70 months (maximum 210 months). Among all of the tumours, 49.4 % did not relapse, 48.7 % recurred in the bladder during the first 5 years of surveillance, and only 6 patients (1.9 %) recurred after being free of disease during the first 5 years of follow-up. Nineteen percentage of the UBCs progressed to stage T2, and only 2 patients (1.2 %) progressed after the first 5 years of surveillance. An upper urinary tract recurrence was detected in 9.2 % of the patients; 65.5 % were diagnosed within the upper urinary tract during the first 5 years of follow-up. CONCLUSIONS Following a 5-year tumour-free period, there is minimal risk of recurrence and progression in T1G3 UBCs treated with TUR and BCG induction intravesical instillations. This finding supports a less intensive and potentially less invasive surveillance scheme of bladder follow-up and upper urinary tract imaging in patients without any recurrence.
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Alcorn J, Burton R, Topping A. BCG treatment for bladder cancer, from past to present use. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2014. [DOI: 10.1111/ijun.12064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jason Alcorn
- Mid Yorkshire Hospitals NHS Trust; Pinderfields Hospital; Aberford Road West Yorkshire WF1 4DG UK
| | - Rob Burton
- Head of International Business; School Of Human and Health Sciences, Ramsden R2/41; University Of Huddersfield; West Yorkshire HD1 3DH UK
| | - Annie Topping
- Assistant Executive Director of Nursing Hamad Medical Corporation; Department of Nursing Education; Qatar
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Alcorn J, Burton RL, Topping A. Non-muscle invasive bladder cancer and bacillus Calmette-Guerin treatment: a review of the literature. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2014. [DOI: 10.1111/ijun.12055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jason Alcorn
- Mid Yorkshire Hospitals NHS Trust; Pinderfields Hospital; Aberford Road Wakefield West Yorkshire, WF1 4DG UK
| | - Rob L Burton
- School Of Human and Health Sciences; University of Huddersfield; Ramsden R2/41 Huddersfield West Yorkshire, HD1 3DH UK
| | - Annie Topping
- Department of Nursing Education; Hamad Medical Corporation; Hamad Qatar
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Prasad SM, Eyre S, Loughlin KR. Salvage combination intravesical immunotherapy with Bacillus Calmette-Guérin and interferon-α2B: impact on recurrence, progression, and survival. Hosp Pract (1995) 2014; 41:31-9. [PMID: 24145587 DOI: 10.3810/hp.2013.10.1078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The population of patients with bladder cancer who have recurrence following an initial instillation of Bacillus Calmette-Guérin (BCG) is critical to study, as treatment delay with repeated courses of intravesical therapy may yield poor prognosis in patients with disease progression. OBJECTIVE To evaluate our institution's experience with use of BCG alone and in combination with interferon (INF)-α2B in regard to the rates of bladder cancer recurrence, disease progression, need for eventual cystectomy, and survival in patients with initial BCG failure. STUDY DESIGN We identified a combined series of 139 patients who had undergone intravesical instillations of BCG alone (n = 114) or in combination with INF-α2B (n = 25) performed at Brigham and Women's Hospital, Boston, between 2002 and 2007. All patients previously received an initial 6-week course of BCG therapy and subsequently had BCG failure on follow-up cystoscopy. Study outcome measures included: time to cancer recurrence in patients, progression of disease, eventual cystectomy, and patient mortality. RESULTS At a median follow-up of 64.7 months from initial BCG administration, 84% of patients treated with BCG + INF-α2B had disease recurrence. The average time to recurrence was < 1 year, and 63% of patients had recurrence on the first post-treatment biopsy. Among patients with a positive first biopsy, 52% had disease progression on initial surveillance. Overall, disease progression was seen in 48% of patients receiving BCG + INF-α2B therapy, and 28% of all patients eventually underwent radical cystectomy. All outcomes occurred more frequently in patients undergoing combination intravesical therapy compared with patients given BCG monotherapy. CONCLUSIONS Patients with bladder cancer undergoing salvage intravesical BCG + INF-α2B at our institution had a > 50% chance of disease recurrence and progression, and > 25% of patients eventually proceeded to radical cystectomy. Randomized trials are needed to clarify the issues present in our findings and to determine the appropriate role for concomitant INF therapy in patients when BCG monotherapy has failed.
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Affiliation(s)
- Sandip M Prasad
- Division of Urologic Surgery, Medical University of South Carolina, Charleston, SC
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Ellinger J, Bachmann A, Göke F, Behbahani TE, Baumann C, Heukamp LC, Rogenhofer S, Müller SC. Alterations of Global Histone H3K9 and H3K27 Methylation Levels in Bladder Cancer. Urol Int 2014; 93:113-8. [DOI: 10.1159/000355467] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 09/04/2013] [Indexed: 11/19/2022]
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Metwalli AR, Kamat AM. Controversial issues and optimal management of stage T1G3 bladder cancer. Expert Rev Anticancer Ther 2014; 6:1283-94. [PMID: 16925494 DOI: 10.1586/14737140.6.8.1283] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The management of T1G3 bladder cancer is controversial. Diagnostic methods, such as bladder mapping or second-look transurethral resection are recommended to assess risk. Bacillus Calmette-Guérin intravesical therapy with a maintenance regimen is recommended for solitary T1G3 tumors. The timing of radical cystectomy for these patients is controversial, but early recurrence during intravesical therapy is an indication for radical cystectomy. Multifocal disease, concomitant carcinoma in situ and disease in the prostatic urethra and bladder neck also suggest aggressive disease and cystectomy should be considered in these patients.
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Affiliation(s)
- Adam R Metwalli
- The University of Texas MD Anderson Cancer Center, Department of Urology, Unit 1373, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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Prognostic significance of tumor location in high-grade non-muscle-invasive bladder cancer. Med Oncol 2011; 29:1916-20. [DOI: 10.1007/s12032-011-9999-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 05/27/2011] [Indexed: 11/25/2022]
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Leliveld AM, Bastiaannet E, Doornweerd BH, Schaapveld M, Jong IJD. High risk bladder cancer: current management and survival. Int Braz J Urol 2011; 37:203-10; discussion 210-2. [DOI: 10.1590/s1677-55382011000200007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2010] [Indexed: 11/21/2022] Open
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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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Mengual L, Burset M, Ars E, Lozano JJ, Villavicencio H, Ribal MJ, Alcaraz A. DNA microarray expression profiling of bladder cancer allows identification of noninvasive diagnostic markers. J Urol 2009; 182:741-8. [PMID: 19539325 DOI: 10.1016/j.juro.2009.03.084] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2008] [Indexed: 11/26/2022]
Abstract
PURPOSE There is a need in urological practice to identify new bladder cancer molecular markers to further develop noninvasive diagnostic tests. We analyzed bladder cancer gene expression profiles to determine the relevant differentially expressed genes and whether this differential expression is maintained in urine samples. MATERIALS AND METHODS We collected 55 tissue specimens from a total of 43 patients with bladder cancer and 12 controls, and 49 urine samples from bladder washings from a total of 36 patients with bladder cancer and 13 controls between September 2003 and December 2004. DNA microarrays (GeneChip Human Genome U133 Plus 2.0 Array) were used to identify differentially expressed genes at 3 bladder cancer stages. Selected differentially expressed genes were validated in an independent set of bladder washings by quantitative reverse transcriptase-polymerase chain reaction. RESULTS Unsupervised cluster analysis of DNA microarray data showed a clear distinction in control vs tumor samples and low vs high grade tumors. Genes with at least 2-fold differential expression in controls vs tumors (2,937 probe sets or 2,295 genes) and in low vs high grade tumors (674 probe sets or 530 genes) were identified and ranked. Gene expression measurements in bladder washings of the 6 most differentially expressed genes in controls vs tumors were confirmed for the 2 over expressed genes tested by quantitative reverse transcriptase-polymerase chain reaction. All 8 selected differentially expressed genes in low vs high grade tumors were confirmed in bladder washing samples. CONCLUSIONS Bladder cancer analysis by DNA microarrays provides new putative mRNA markers for bladder cancer diagnosis and/or prognosis that can be extrapolated to bladder fluids.
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Affiliation(s)
- Lourdes Mengual
- Laboratory of Urology, Urology Department, Hospital Clínic, Barcelona, Spain.
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Okamura T, Akita H, Imura M, Kaneko T, Mizuno K, Tozawa K, Kohri K. Efficacy of bacillus Calmette-Guérin in the treatment of superficial bladder cancer: The impact of previous intravesical treatment. Int J Urol 2008; 15:976-80. [DOI: 10.1111/j.1442-2042.2008.02146.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Inoue M, Ishioka JI, Fukuda H, Kageyama Y, Saito Y, Higashi Y. Clinical outcome of chemoradiotherapy for T1G3 bladder cancer. Int J Urol 2008; 15:747-50. [DOI: 10.1111/j.1442-2042.2008.02077.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gofrit ON, Pode D, Shapiro A, Zorn KC, Pizov G. Significance of inflammatory pseudotumors in patients with a history of bladder cancer. Urology 2007; 69:1064-7. [PMID: 17572187 DOI: 10.1016/j.urology.2007.01.101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Revised: 12/19/2006] [Accepted: 01/30/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To study the significance of inflammatory pseudotumor (IPT) in patients with a history of bladder cancer. METHODS We surveyed our hospital database for patients who developed IPT during follow-up of bladder cancer. The original histologic blocks were reviewed and immunostained for vimentin, anaplastic large cell lymphoma (ALK), and pancytokeratin. RESULTS Between the years 1988 and 2005, a total of 809 patients were registered in the database, and 16 patients (2%) developed IPT during follow-up. All patients had initial high-grade tumor. Immunostaining for vimentin was positive in all patients, ALK was negative in all patients, and pancytokeratin positive in only 2 patients. During follow-up, 12 patients (75%) developed tumor recurrence, 9 patients (56%) tumor progression, and 6 patients (37.5%) died of bladder cancer. Median period from the finding of IPT to tumor recurrence was 16 months, to progression 7 months, and to mortality 26 months. CONCLUSIONS The finding of IPT in a patient with a history of bladder cancer is associated with a high risk of tumor recurrence, progression, and cancer-related mortality. Second- and possibly third-look bladder biopsies should be considered. The unique characteristics of IPT in patients with a history of bladder cancer suggest that this is a separate disease entity.
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Affiliation(s)
- Ofer N Gofrit
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
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Erdemir F, Ozcan F, Kilicaslan I, Parlaktas BS, Uluocak N, Gokce O. The relationship between the expression of E-cadherin and tumor recurrence and progression in high-grade stage T1 bladder urothelial carcinoma. Int Urol Nephrol 2007; 39:1031-7. [PMID: 17340210 DOI: 10.1007/s11255-006-9159-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2006] [Accepted: 11/21/2006] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To evaluate the relationship between the expression of E-cadherin (E-CD) and tumor recurrence and progression in patients with high-grade stage T1 urothelial carcinoma of bladder. METHODS Fifty-two patients who had primary high-grade stage T1 urothelial carcinoma were enrolled to the study. The pathologic specimens of patients were evaluated and staged as T1a and T1b according to muscularis mucosae involvement by the tumor. The immunohistochemical demonstration of E-CD was accomplished by using immunoperoxidase method and all the specimens were examined under light microscope for E-CD level. RESULTS The mean age of the patients was 64.0 +/- 7.7 (range 36-81) years. The mean follow-up period was 56.4 +/- 19.4 (range 14-84) months. Among 52 patients, 27 (52%) of them were stage T1b and 25 (48%) were T1a tumors. The recurrence rates for T1a and T1b groups were 52% (n = 13) and 92.6% (n = 25), respectively (P < 0.05). The expression of E-CD was homogenous in 52% of pT1a and 14.8% of T1b tumors (P < 0.05). In T1a group with recurrence, homogeneous E-CD staining ratio was 30.7% (n = 4/13), but it was 75% (n = 9/12) in T1a patients without recurrence (P < 0.05). In T1b group with recurrence, the homogenous expression of E-CD was 12% (n = 3/25) and the expression of E-CD was heterogenous in 88% (n = 22/25) of them (P < 0.05). In T1a group, progression of the disease was detected in 28% (n = 7/25) of the patients, but disease progression was seen in 55.5% (n = 15/27) of T1b group patients (P < 0.05). In T1a group with progression, heterogeneous E-CD staining ratio was 85.7% (n = 6/7), but it was 80% (n = 12/15) in T1b patients with progression. The effects of tumor number, tumor size and carcinoma in situ presence on recurrence were evaluated within each group. It was determined that parameters such as tumor number and tumor size had no significant effect on recurrence of the groups. The mean survival rates were statistically different between the groups. On multivariate analysis only E-cadherin expression (P = 0.012, odds ratio 6.291, 95% confidence interval for odds ratio 1.303-4.72) and tumor stage (P = 0.003, odds ratio 11.58, 95% confidence interval for odds ratio 2.446-8.542) remained independently significant as predictors of recurrence. CONCLUSION E-CD expression was decreased in pathologic specimens of bladder tumor patients with muscularis mucosae involvement and this condition correlated well with tumor recurrence.
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Affiliation(s)
- Fikret Erdemir
- Yeşilirmak M. Bosna C. 3. Sok., No:7, Mollaoğullari Apt. K:2, D;3, Merkez, Tokat, 60100, Turkey.
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Weiss C, Wolze C, Engehausen DG, Ott OJ, Krause FS, Schrott KM, Dunst J, Sauer R, Rödel C. Radiochemotherapy After Transurethral Resection for High-Risk T1 Bladder Cancer: An Alternative to Intravesical Therapy or Early Cystectomy? J Clin Oncol 2006; 24:2318-24. [PMID: 16710030 DOI: 10.1200/jco.2006.05.8149] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose For high-risk T1 bladder cancer, the most important issue is how to restrict radical cystectomy to selective patients with a high likelihood of tumor progression and to choose an initial bladder-sparing approach in others without affecting survival. Radiotherapy or radiochemotherapy (RT/RCT) may help to strike a balance between intravesical treatment and early cystectomy. Patients and Methods Between 1982 and 2004, 141 patients with high-risk T1 bladder cancer (84 patients with T1 grade 3 [T1G3]; others with T1G1/2 and associated carcinoma-in-situ, multifocality, tumor diameter > 5 cm, or multiple recurrences) were treated with RT (n = 28) or platinum-based RCT (n = 113) after transurethral resection of bladder tumor (TURBT). Six weeks after RT/RCT, response was evaluated by restaging TURBT. Salvage cystectomy was recommended for patients with persistent disease and for tumor progression after initial complete response (CR). Median follow-up was 62 months; 65 patients have been observed for 5 years or more. Results CR was achieved in 121 of 137 patients (88%; four patients without restaging TURBT). Tumor progression for the entire group of 141 patients was 19% and 30% at 5 and 10 years, respectively (for 121 patients with CR, 15% and 29%; for 84 patients with T1G3, 13% and 29%, respectively). Disease-specific survival rates were 82% and 73% at 5 and 10 years (CR, 89% and 79%; T1G3, 80% and 71%, respectively). More than 80% of survivors preserved their bladder; 70.4% were “delighted” or “pleased” with their urinary function. Conclusion RT/RCT after TURBT with selective bladder preservation is a reasonable alternative to intravesical treatment or early cystectomy for high-risk T1 bladder cancer.
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Affiliation(s)
- Christian Weiss
- Department of Radiation Therapy, University of Erlangen, Erlangen, Germany
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