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Gontero P, Longo F, Montanari E, Roupret M, Stockley J, Kennedy A, Dudderidge T, Witjes J, McCracken S, Colombel M, Palou J, Sylvester R. Reducing the frequency of surveillance cystoscopies through the use of ADXBLADDER in the follow up of patients with non-muscle invasive bladder cancer. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00704-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Montanari E, Longo F, Gontero P, Roupret M, Stockley J, Kennedy A, Witjes J, McCracken S, Dudderidge T, Columbel M, Sylvester R, Palou J. Adxbladder exhibits anticipatory effects in the follow up of non-muscle invasive bladder cancer in a large multicentric european cohort. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00939-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Pisano F, Gontero P, Sylvester R, Joniau S, Serretta V, Larré S, Di Stasi S, van Rhijn B, Witjes A, Grotenhuis A, Colombo R, Briganti A, Babjuk M, Soukup V, Malmstrom PU, Irani J, Malats N, Baniel J, Mano R, Cai T, Cha E, Ardelt P, Varkarakis J, Bartoletti R, Dalbagni G, Shariat SF, Xylinas E, Karnes RJ, Palou J. Risk factors for residual disease at re-TUR in a large cohort of T1G3 patients. Actas Urol Esp 2021; 45:473-478. [PMID: 34147426 DOI: 10.1016/j.acuroe.2020.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/22/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES The goals of transurethral resection of a bladder tumor (TUR) are to completely resect the lesions and to make a correct diagnosis in order to adequately stage the patient. It is well known that the presence of detrusor muscle in the specimen is a prerequisite to minimize the risk of under staging. Persistent disease after resection of bladder tumors is not uncommon and is the reason why the European Guidelines recommended a re-TUR for all T1 tumors. It was recently published that when there is muscle in the specimen, re-TUR does not influence progression or cancer specific survival. We present here the patient and tumor factors that may influence the presence of residual disease at re-TUR. MATERIAL AND METHODS In our retrospective cohort of 2451 primary T1G3 patients initially treated with BCG, pathology results for 934 patients (38.1%) who underwent re-TUR are available. 74% had multifocal tumors, 20% of tumors were more than 3 cm in diameter and 26% had concomitant CIS. In this subgroup of patients who underwent re-TUR, there was no residual disease in 267 patients (29%) and residual disease in 667 patients (71%): Ta in 378 (40%) and T1 in 289 (31%) patients. Age, gender, tumor status (primary/recurrent), previous intravesical therapy, tumor size, tumor multi-focality, presence of concomitant CIS, and muscle in the specimen were analyzed in order to evaluate risk factors of residual disease at re-TUR, both in univariate analyses and multivariate logistic regressions. RESULTS The following were not risk factors for residual disease: age, gender, tumor status and previous intravesical chemotherapy. The following were univariate risk factors for presence of residual disease: no muscle in TUR, multiple tumors, tumors > 3 cm, and presence of concomitant CIS. Due to the correlation between tumor multi-focality and tumor size, the multivariate model retained either the number of tumors or the tumor diameter (but not both), p < 0.001. The presence of muscle in the specimen was no longer significant, while the presence of CIS only remained significant in the model with tumor size, p < 0.001. CONCLUSIONS The most significant factors for a higher risk of residual disease at re-TUR in T1G3 patients are multifocal tumors and tumors more than 3 cm. Patients with concomitant CIS and those without muscle in the specimen also have a higher risk of residual disease.
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Affiliation(s)
- F Pisano
- Città della Salute e della Scienza di Torino, University of Studies of Turin; Department of Urology, Fundacio Puigvert, University of Barcelona, Barcelona, Spain.
| | - P Gontero
- Città della Salute e della Scienza di Torino, University of Studies of Turin
| | - R Sylvester
- Formerly Department of Biostatistics, EORTC Headquarters
| | - S Joniau
- Oncologic and Reconstructive Urology, Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - V Serretta
- Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
| | - S Larré
- Department of Surgical Science, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - S Di Stasi
- Policlinico Tor Vergata-University of Rome, Rome, Italy
| | - B van Rhijn
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - A Witjes
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - A Grotenhuis
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - R Colombo
- Dipartimento di Urologia, Università Vita-Salute, Ospedale S. Raffaele, Milan, Italy
| | - A Briganti
- Dipartimento di Urologia, Università Vita-Salute, Ospedale S. Raffaele, Milan, Italy
| | - M Babjuk
- Department of Urology, Motol Hospital, University of Praha, Praha, Czech Republic
| | - V Soukup
- Department of Urology, Motol Hospital, University of Praha, Praha, Czech Republic
| | - P U Malmstrom
- Department of Urology, Academic Hospital, Uppsala University, Uppsala, Sweden
| | - J Irani
- Department of Urology, Hospital Bicetre, France
| | - N Malats
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO)
| | - J Baniel
- Department of Urology, Rabin Medical Centre, Tel Aviv, Israel
| | - R Mano
- Department of Urology, Rabin Medical Centre, Tel Aviv, Israel
| | - T Cai
- Department of Urology, Santa Chiara Hospital, Trento, Italy
| | - E Cha
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - P Ardelt
- University Hospital Basel, Urological University Clinic Basel-Liestal, Basel, Switzerland
| | - J Varkarakis
- Department of Urology, Sismanoglio Hospital, University of Athens, Athens, Greece
| | - R Bartoletti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - G Dalbagni
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - S F Shariat
- Department of Urology, Medical University of Vienna, Vienna, 1190, Austria; Department of Urology, Cochin Hospital, Paris, France
| | - E Xylinas
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - R J Karnes
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - J Palou
- Department of Urology, Fundacio Puigvert, University of Barcelona, Barcelona, Spain
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Rouprêt M, Gontero P, Montanari E, Longo F, Witjes J, Dudderidge T, Stockley J, Kennedy A, Vanie F, Rodriguez O, Allasia M, Mccracken S, Sylvester R, Palou J. Anticipatory effects of ADXBLADDER test results in the follow up of cystoscopy negative non muscle invasive bladder cancer patients in a large multicentric European cohort. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01100-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gontero P, Longo F, Allasia M, Roupret M, Stockley J, Kennedy A, Rodriguez O, Sieverink C, Vanie F, Witjes J, Colombel M, McCracken S, Dudderidge T, Sylvester R, Palou J, Montanari E. Comparison of performance of ADXBLADDER with urine cytology in NMIBC follow up: a blinded prospective multicentric study. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35622-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Veskimäe E, Linares Espinos E, Bruins H, Yuan Y, Sylvester R, Kamat A, Shariat S, Witjes J, Compérat E. What is the prognostic importance of urothelial and non-urothelial histological variants of bladder cancer in predicting oncological outcomes in patients with muscle-invasive and metastatic bladder cancer? Systematic review. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33799-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Gontero P, Montanari E, Roupret M, Longo F, Stockley J, Kennedy A, Rodríguez Ó, Sieverink C, Vanié F, Allasia M, Witjes J, Colombel M, Sylvester R, McCracken S, Dudderidge T, Palou J. Evaluation of ADXBLADDER and cytology performance in the follow up of NMIBC: A blinded prospective multicentric study. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33499-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Boormans J, Mayor De Castro J, Fankhauser C, Algaba F, Bokemeyer C, Fizzazi K, Gremmels H, Nicolai N, Nicol D, Oldenburg J, Sylvester R, Laguna M. An individual patient data (IPD) prognostic factor study on the value of pathological factors in clinical stage I seminoma testis patients under active surveillance from the EAU Testicular Cancer Guidelines panel. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33812-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Rouprêt M, Gontero P, McCracken S, Dudderidge T, Stockley J, Kennedy A, Rodríguez Ó, Sieverink C, Vanié F, Allasia M, Witjes J, Colombel M, Sylvester R, Longo F, Montanari E, Palou J. Diagnostic performance of MCM5 testing in the diagnosis of recurrent bladder cancer: Results from a large prospective, blinded, multicentric European study. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33491-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Soria F, Pisano F, Gontero P, Palou J, Joniau S, Serretta V, Larré S, Di Stasi S, van Rhijn B, Witjes JA, Grotenhuis A, Colombo R, Briganti A, Babjuk M, Soukup V, Malmstrom PU, Irani J, Malats N, Baniel J, Mano R, Cai T, Cha E, Ardelt P, Varkarakis J, Bartoletti R, Dalbagni G, Shariat SF, Xylinas E, Karnes RJ, Sylvester R. Predictors of oncological outcomes in T1G3 patients treated with BCG who undergo radical cystectomy. World J Urol 2018; 36:1775-1781. [PMID: 30171454 DOI: 10.1007/s00345-018-2450-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 08/13/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE To evaluate the oncological impact of postponing radical cystectomy (RC) to allow further conservative therapies prior to progression in a large multicentre retrospective cohort of T1-HG/G3 patients initially treated with BCG. METHODS According to the time of RC, the population was divided into 3 groups: patients who did not progress to muscle-invasive disease, patients who progressed before radical cystectomy and patients who experienced progression at the time of radical cystectomy. Clinical and pathological outcomes were compared across the three groups. RESULTS Of 2451 patients, 509 (20.8%) underwent RC. Patients with tumors > 3 cm or with CIS had earlier cystectomies (HR = 1.79, p = 0.001 and HR = 1.53, p = 0.02, respectively). Patients with tumors > 3 cm, multiple tumors or CIS had earlier T3/T4 or N + cystectomies. In patients who progressed, the timing of cystectomy did not affect the risk of T3/T4 or N + disease at RC. Patients with T3/T4 or N + disease at RC had a shorter disease-specific survival (HR = 4.38, p < 0.001), as did patients with CIS at cystectomy (HR = 2.39, p < 0.001). Patients who progressed prior to cystectomy had a shorter disease-specific survival than patients for whom progression was only detected at cystectomy (HR = 0.58, p = 0.024) CONCLUSIONS: Patients treated with RC before experiencing progression to muscle-invasive disease harbor better oncological and survival outcomes compared to those who progressed before RC and to those upstaged at surgery. Tumor size and concomitant CIS at diagnosis are the main predictors of surgical treatment while tumor size, CIS and tumor multiplicity are associated with extravesical disease at surgery.
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Affiliation(s)
- Francesco Soria
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Francesca Pisano
- Città della Salute e della Scienza di Torino, University of Studies of Turin, Turin, Italy. .,Department of Urology, Fundacio Puigvert, University of Barcelona, Barcelona, Spain.
| | - Paolo Gontero
- Città della Salute e della Scienza di Torino, University of Studies of Turin, Turin, Italy
| | - J Palou
- Department of Urology, Fundacio Puigvert, University of Barcelona, Barcelona, Spain
| | - S Joniau
- Oncologic and Reconstructive Urology, Department of Urology, University Hospitals Leuven, Louvain, Belgium
| | - V Serretta
- Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
| | - S Larré
- Department of Surgical Science, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - S Di Stasi
- Policlinico Tor Vergata-University of Rome, Rome, Italy
| | - B van Rhijn
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - J A Witjes
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - A Grotenhuis
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - R Colombo
- Dipartimento di Urologia, Università Vita-Salute. Ospedale S. Raffaele, Milan, Italy
| | - A Briganti
- Dipartimento di Urologia, Università Vita-Salute. Ospedale S. Raffaele, Milan, Italy
| | - M Babjuk
- Department of Urology, Motol Hospital, University of Praha, Prague, Czech Republic
| | - V Soukup
- Department of Urology, Motol Hospital, University of Praha, Prague, Czech Republic
| | - P U Malmstrom
- Department of Urology, Academic Hospital, Uppsala University, Uppsala, Sweden
| | - J Irani
- Department of Urology, CHU de Bicêtre, 78, rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - N Malats
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - J Baniel
- Department of Urology, Rabin Medical Centre, Tel Aviv, Israel
| | - R Mano
- Department of Urology, Rabin Medical Centre, Tel Aviv, Israel
| | - T Cai
- Department of Urology, Santa Chiara Hospital, Trento, Italy
| | - E Cha
- Department of Urology, Weill Medical College of Cornell University in New York City, New York, NY, USA
| | - P Ardelt
- Facharzt fur Urologie, Abteilung fur Urologie, Chirurgische Universitats klinik, Freiburg, Germany
| | - J Varkarakis
- Department of Urology, Sismanoglio Hospital, University of Athens, Athens, Greece
| | - R Bartoletti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - G Dalbagni
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - S F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - E Xylinas
- Department of Urology, Cochin Hospital, Paris, France
| | - R J Karnes
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - R Sylvester
- Formerly Department of Biostatistics, EORTC Headquarters, Brussels, Belgium
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11
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Robinson M, Smith P, Richards B, Newling D, de Pauw M, Sylvester R. The Final Analysis of the EORTC
Genito-Urinary T ract Cancer
Co-Operative Group Phase III
Clinical Trial (Protocol 30805)
Comparing Orchidectomy,
Orchidectomy plus Cyproterone
Acetate and Low Dose Stilboestrol
in the Management of Metastatic
Carcinoma of the Prostate. Eur Urol 2017. [DOI: 10.1159/000475067] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Kramar A, Negrier S, Sylvester R, Joniau S, Mulders P, Powles T, Bex A, Bonnetain F, Bossi A, Bracarda S, Bukowski R, Catto J, Choueiri T, Crabb S, Eisen T, El Demery M, Fitzpatrick J, Flamand V, Goebell P, Gravis G, Houédé N, Jacqmin D, Kaplan R, Malavaud B, Massard C, Melichar B, Mourey L, Nathan P, Pasquier D, Porta C, Pouessel D, Quinn D, Ravaud A, Rolland F, Schmidinger M, Tombal B, Tosi D, Vauleon E, Volpe A, Wolter P, Escudier B, Filleron T, Kramar A, Sylvester R, Filleron T, Negrier S, Joniau S, Mulders P, Powles T, Escudier B, Bex A, Bonnetain F, Bossi A, Braccarda S, Bukowski R, Catto J, Choueiri T, Crabb S, Eisen T, El Demery M, Fitzpatrick J, Flamand V, Goebell PJ, Gravis G, Houédé N, Jacqmin D, Kaplan R, Malavaud B, Massard C, Melichar B, Mourey L, Nathan P, Pasquier D, Porta C, Pouessel D, Quinn D, Ravaud A, Rolland F, Schmidinger M, Tombal B, Tosi D, Vauleon E, Volpe A, Wolter P. Guidelines for the definition of time-to-event end points in renal cell cancer clinical trials: results of the DATECAN project. Ann Oncol 2015; 26:2392-8. [DOI: 10.1093/annonc/mdv380] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 07/24/2015] [Indexed: 12/19/2022] Open
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Pisano F, Witjes J, Dalbagni G, Shariat S, Joniau S, Serretta V, Palou J, Di Stasi S, Larré S, Colombo R, Babjuk M, Malmstrom P, Irani J, Malats N, Baniel J, Cai T, Cha E, Ardelt P, Varkarakis J, Bartoletti R, Spahn M, Pisano F, Gontero P, Sylvester R. 948 The impact of different BCG strains on outcome in a large cohort of T1G3 patients treated with BCG. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/s1569-9056(15)60936-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kramar A, Filleron T, Sylvester R, Escudier B, Joniau S, Mulders P, Negrier S, Powles T. International Guidelines for the Definition of Time to Event Endpoints (Tee) in Renal Cell Cancer (Rcc) Randomised Clinical Trials (Rct): Results of the Datecan Project. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu337.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Aitchison M, Bray CA, Van Poppel H, Sylvester R, Graham J, Innes C, McMahon L, Vasey PA. Adjuvant 5-flurouracil, alpha-interferon and interleukin-2 versus observation in patients at high risk of recurrence after nephrectomy for renal cell carcinoma: results of a phase III randomised European Organisation for Research and Treatment of Cancer (Genito-Urinary Cancers Group)/National Cancer Research Institute trial. Eur J Cancer 2013; 50:70-7. [PMID: 24074763 DOI: 10.1016/j.ejca.2013.08.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 07/15/2013] [Accepted: 08/22/2013] [Indexed: 01/22/2023]
Abstract
BACKGROUND The purpose of this trial was to compare adjuvant 5-flurouracil, alpha-interferon and interleukin-2 to observation in patients at high risk of recurrence after nephrectomy for renal cell carcinoma (RCC) in terms of disease free survival, overall survival and quality of life (QoL). PATIENTS AND METHODS Patients 8weeks post nephrectomy for RCC, without macroscopic residual disease, with stage T3b-c,T4 or any pT and pN1 or pN2 or positive microscopic margins or microscopic vascular invasion, and no metastases were randomised to receive adjuvant treatment or observation. QoL was assessed by European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-30 (QLQC-30). Treatment delivery and toxicity were monitored. The trial was designed to detect an increase in 3year disease free survival (DFS) from 50% on observation to 65% on treatment (hazard ratio (HR)=0.63) with 90% power and two-sided alpha=0.05. RESULTS From 1998 to 2007, 309 patients were randomised (155 to observation; 154 to treatment). 35% did not complete the treatment, primarily due to toxicity (92% of patients experienced ⩾grade 2, 41% ⩾grade 3). Statistically significant differences between the arms in QoL parameters at 2months disappeared by 6months although there was suggestion of a persistent deficit in fatigue and physical function. Median follow-up was 7years (maximum 12.1years). 182 patients relapsed or died. DFS at 3years was 50% with observation and 61% with treatment (HR 0.84, 95% confidence interval (CI) 0.63-1.12, p=0.233). 124 patients died. Overall survival (OS) at 5years was 63% with observation and 70% with treatment (HR 0.87, 95% CI 0.61-1.23, p=0.428). CONCLUSIONS The treatment is associated with significant toxicity. There is no statistically significant benefit for the regimen in terms of disease free or overall survival.
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Affiliation(s)
- M Aitchison
- The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom.
| | - C A Bray
- The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | | | | | - J Graham
- Musgrove Park Hospital, Taunton, United Kingdom
| | - C Innes
- The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - L McMahon
- The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - P A Vasey
- School of Medicine, University of Queensland, Brisbane, Australia
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Morrison KE, Dhariwal S, Hornabrook R, Savage L, Burn DJ, Khoo TK, Kelly J, Murphy CL, Al-Chalabi A, Dougherty A, Leigh PN, Wijesekera L, Thornhill M, Ellis CM, O'Hanlon K, Panicker J, Pate L, Ray P, Wyatt L, Young CA, Copeland L, Ealing J, Hamdalla H, Leroi I, Murphy C, O'Keeffe F, Oughton E, Partington L, Paterson P, Rog D, Sathish A, Sexton D, Smith J, Vanek H, Dodds S, Williams TL, Steen IN, Clarke J, Eziefula C, Howard R, Orrell R, Sidle K, Sylvester R, Barrett W, Merritt C, Talbot K, Turner MR, Whatley C, Williams C, Williams J, Cosby C, Hanemann CO, Iman I, Philips C, Timings L, Crawford SE, Hewamadduma C, Hibberd R, Hollinger H, McDermott C, Mils G, Rafiq M, Shaw PJ, Taylor A, Waines E, Walsh T, Addison-Jones R, Birt J, Hare M, Majid T. Lithium in patients with amyotrophic lateral sclerosis (LiCALS): a phase 3 multicentre, randomised, double-blind, placebo-controlled trial. Lancet Neurol 2013; 12:339-45. [PMID: 23453347 PMCID: PMC3610091 DOI: 10.1016/s1474-4422(13)70037-1] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Lithium has neuroprotective effects in cell and animal models of amyotrophic lateral sclerosis (ALS), and a small pilot study in patients with ALS showed a significant effect of lithium on survival. We aimed to assess whether lithium improves survival in patients with ALS. Methods The lithium carbonate in amyotrophic lateral sclerosis (LiCALS) trial is a randomised, double-blind, placebo-controlled trial of oral lithium taken daily for 18 months in patients with ALS. Patients aged at least 18 years who had ALS according to the revised El Escorial criteria, had disease duration between 6 and 36 months, and were taking riluzole were recruited from ten centres in the UK. Patients were randomly assigned (1:1) to receive either lithium or matched placebo tablets. Randomisation was via an online system done at the level of the individual by block randomisation with randomly varying block sizes, stratified by study centre and site of disease onset (limb or bulbar). All patients and assessing study personnel were masked to treatment assignment. The primary endpoint was the rate of survival at 18 months and was analysed by intention to treat. This study is registered with Eudract, number 2008-006891-31. Findings Between May 26, 2009, and Nov 10, 2011, 243 patients were screened, 214 of whom were randomly assigned to receive lithium (107 patients) or placebo (107 patients). Two patients discontinued treatment and one died before the target therapeutic lithium concentration could be achieved. 63 (59%) of 107 patients in the placebo group and 54 (50%) of 107 patients in the lithium group were alive at 18 months. The survival functions did not differ significantly between groups (Mantel-Cox log-rank χ2 on 1 df=1·64; p=0·20). After adjusting for study centre and site of onset using logistic regression, the relative odds of survival at 18 months (lithium vs placebo) was 0·71 (95% CI 0·40–1·24). 56 patients in the placebo group and 61 in the lithium group had at least one serious adverse event. Interpretation We found no evidence of benefit of lithium on survival in patients with ALS, but nor were there safety concerns, which had been identified in previous studies with less conventional designs. This finding emphasises the importance of pursuing adequately powered trials with clear endpoints when testing new treatments. Funding The Motor Neurone Disease Association of Great Britain and Northern Ireland.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Collette L, Bogaerts J, Suciu S, Fortpied C, Gorlia T, Coens C, Mauer M, Hasan B, Collette S, Ouali M, Litière S, Rapion J, Sylvester R. Statistical methodology for personalized medicine: New developments at EORTC Headquarters since the turn of the 21st Century. EJC Suppl 2012. [DOI: 10.1016/s1359-6349(12)70005-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Rouprêt M, Zigeuner R, Palou J, Boehle A, Kaasinen E, Sylvester R, Babjuk M, Oosterlinck W. European guidelines for the diagnosis and management of upper urinary tract urothelial cell carcinomas: 2011 update. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.acuroe.2011.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rouprêt M, Zigeuner R, Palou J, Boehle A, Kaasinen E, Sylvester R, Babjuk M, Oosterlinck W. [European guidelines for the diagnosis and management of upper urinary tract urothelial cell carcinomas: 2011 update. European Association of Urology Guideline Group for urothelial cell carcinoma of the upper urinary tract]. Actas Urol Esp 2012; 36:2-14. [PMID: 22036956 DOI: 10.1016/j.acuro.2011.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 09/12/2011] [Indexed: 10/26/2022]
Abstract
CONTEXT The European Association of Urology (EAU) Guideline Group for urothelial cell carcinoma of the upper urinary tract (UUT-UCC) has prepared new guidelines to aid clinicians in assessing the current evidence-based management of UUT-UCC and to incorporate present recommendations into daily clinical practice. OBJECTIVE This paper provides a brief overview of the EAU guidelines on UUT-UCC as an aid to clinicians in their daily practice. EVIDENCE ACQUISITION The recommendations provided in the current guidelines are based on a thorough review of available UUT-UCC guidelines and papers identified using a systematic search of Medline. Data on urothelial malignancies and UUT-UCCs in the literature were searched using Medline with the following keywords: urinary tract cancer, urothelial carcinomas, upper urinary tract, carcinoma, transitional cell, renal pelvis, ureter, bladder cancer, chemotherapy, nephroureterectomy, adjuvant treatment, neoadjuvant treatment, recurrence, risk factors, and survival. A panel of experts weighted the references. EVIDENCE SYNTHESIS There is a lack of data in the current literature to provide strong recommendations due to the rarity of the disease. A number of recent multicentre studies are now available, whereas earlier publications were based only on limited populations. However, most of these studies have been retrospective analyses. The TNM classification 2009 is recommended. Recommendations are given for diagnosis as well as for radical and conservative treatment; prognostic factors are also discussed. Recommendations are provided for patient follow-up after different therapeutic options. CONCLUSIONS These guidelines contain information for the diagnosis and treatment of individual patients according to a current standardised approach. When determining the optimal treatment regimen, physicians must take into account each individual patient's specific clinical characteristics with regard to renal function including medical comorbidities; tumour location, grade and stage; and molecular marker status.
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Greillier L, Hasan B, Baas P, Welch JJ, Van Meerbeeck JP, Gaafar RM, Sylvester R, Lacombe DA, O'Brien M. Does disease control rate (DCR) at 9 and 18 weeks predict overall survival (OS) in patients with malignant pleural mesothelioma (MPM)? An individual patient data combined analysis of 10 European Organisation for Research and Treatment of Cancer (EORTC) Lung Cancer Group (LCG) studies. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.7025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Aitchison M, Bray CA, Van Poppel H, Sylvester R, Graham J, Innes C, McMahon L, Vasey PA. Final results from an EORTC (GU Group)/NCRI randomized phase III trial of adjuvant interleukin-2, interferon alpha, and 5-fluorouracil in patients with a high risk of relapse after nephrectomy for renal cell carcinoma (RCC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4505] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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De Santis M, Bellmunt J, Mead G, Kerst JM, Leahy MG, Daugaard G, Gil T, Maroto JP, Marreaud S, Sylvester R. Randomized phase II/III trial comparing gemcitabine/carboplatin (GC) and methotrexate/carboplatin/vinblastine (M-CAVI) in patients (pts) with advanced urothelial cancer (UC) unfit for cisplatin-based chemotherapy (CHT): Phase III results of EORTC study 30986. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.18_suppl.lba4519] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA4519 Background: About 50% of pts with advanced UC are not eligible for cisplatin based CHT (“unfit”) due to impaired renal function, performance status (PS) or comorbidity. This is the first randomized phase II/III trial comparing two chemotherapy regimens in this pts group. Methods: The primary objective of the phase III part of this study was to compare the overall survival (OS) of CHT naïve pts with measurable disease and an impaired renal function (GFR<60 but >30 ml/min) and/or PS 2 who were randomized to receive either GC (G 1000 mg/m2 d1 and 8 and C AUC 4.5) q21 days or M-CAVI (M 30 mg/m2 d1 and 15 and 22, C AUC 4.5 d1 and VI 3 mg/m2 d1 and 15 and 22) q28 days. In order to detect an increase of 50% in median survival on GC compared to M-CAVI (13.5 versus 9 months) based on a two sided logrank test at error rates alpha=0.05 and beta=0.20, 225 pts were required. Secondary endpoints were overall response rate (ORR) and progression free survival (PFS). Results: 238 pts, 119 in each arm, were randomized between January 2001 and March 2008 by 29 institutions. The median follow-up is 4.5 years. Two pts were ineligible and two other pts never started treatment. Best ORRs (CR + PR) were 41.2% (36.1% confirmed response) on GC versus 30.3% (21.0% confirmed response) on M-CAVI (p = 0.08). Median OS was 9.3 months on GC and 8.1 months on M-CAVI (p = 0.64). There was no difference in PFS between the two arms (p = 0.78). OS, PFS and ORR were similar in each of the risk groups (reason unfit for cisplatin and Bajorin risk group). Severe acute toxicity (SAT) (death, grade 4 thrombocytopenia with bleeding, or grade 3/4 renal toxicity, neutropenic fever or mucositis) was observed in 9.3% of pts on GC (2 toxic deaths) and 21.2% on M-CAVI (4 toxic deaths). The most common grade 3/4 toxicities were leucopenia (44.9%, 46.6%), neutropenia (52.5%, 63.5%), febrile neutropenia (4.2%, 14.4%), thrombocytopenia (48.3%, 19.4%), and infection (11.8%, 12.7%) on GC and M-CAVI, respectively. Conclusions: There were no significant differences in efficacy between the two treatment groups. The incidence of SATs was slightly higher on M-CAVI. [Table: see text]
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Affiliation(s)
- M. De Santis
- ACR-ITR VIEnna/CEADDP, LBI-ACR VIEnna, and KFJ-Spital, Vienna, Austria; Hospital del Mar, IMIM, Barcelona, Spain; Royal South Hants Hospital, Southhampton, United Kingdom; The Netherlands Cancer Institute, Amsterdam, Netherlands; St. James Hospital, Leeds, United Kingdom; Rigshospitalet, Copenhagen, Denmark; Institut Jules Bordet, Brussels, Belgium; Hospital Santa Creu, Barcelona, Spain; EORTC Headquarters, Brussels, Belgium
| | - J. Bellmunt
- ACR-ITR VIEnna/CEADDP, LBI-ACR VIEnna, and KFJ-Spital, Vienna, Austria; Hospital del Mar, IMIM, Barcelona, Spain; Royal South Hants Hospital, Southhampton, United Kingdom; The Netherlands Cancer Institute, Amsterdam, Netherlands; St. James Hospital, Leeds, United Kingdom; Rigshospitalet, Copenhagen, Denmark; Institut Jules Bordet, Brussels, Belgium; Hospital Santa Creu, Barcelona, Spain; EORTC Headquarters, Brussels, Belgium
| | - G. Mead
- ACR-ITR VIEnna/CEADDP, LBI-ACR VIEnna, and KFJ-Spital, Vienna, Austria; Hospital del Mar, IMIM, Barcelona, Spain; Royal South Hants Hospital, Southhampton, United Kingdom; The Netherlands Cancer Institute, Amsterdam, Netherlands; St. James Hospital, Leeds, United Kingdom; Rigshospitalet, Copenhagen, Denmark; Institut Jules Bordet, Brussels, Belgium; Hospital Santa Creu, Barcelona, Spain; EORTC Headquarters, Brussels, Belgium
| | - J. M. Kerst
- ACR-ITR VIEnna/CEADDP, LBI-ACR VIEnna, and KFJ-Spital, Vienna, Austria; Hospital del Mar, IMIM, Barcelona, Spain; Royal South Hants Hospital, Southhampton, United Kingdom; The Netherlands Cancer Institute, Amsterdam, Netherlands; St. James Hospital, Leeds, United Kingdom; Rigshospitalet, Copenhagen, Denmark; Institut Jules Bordet, Brussels, Belgium; Hospital Santa Creu, Barcelona, Spain; EORTC Headquarters, Brussels, Belgium
| | - M. G. Leahy
- ACR-ITR VIEnna/CEADDP, LBI-ACR VIEnna, and KFJ-Spital, Vienna, Austria; Hospital del Mar, IMIM, Barcelona, Spain; Royal South Hants Hospital, Southhampton, United Kingdom; The Netherlands Cancer Institute, Amsterdam, Netherlands; St. James Hospital, Leeds, United Kingdom; Rigshospitalet, Copenhagen, Denmark; Institut Jules Bordet, Brussels, Belgium; Hospital Santa Creu, Barcelona, Spain; EORTC Headquarters, Brussels, Belgium
| | - G. Daugaard
- ACR-ITR VIEnna/CEADDP, LBI-ACR VIEnna, and KFJ-Spital, Vienna, Austria; Hospital del Mar, IMIM, Barcelona, Spain; Royal South Hants Hospital, Southhampton, United Kingdom; The Netherlands Cancer Institute, Amsterdam, Netherlands; St. James Hospital, Leeds, United Kingdom; Rigshospitalet, Copenhagen, Denmark; Institut Jules Bordet, Brussels, Belgium; Hospital Santa Creu, Barcelona, Spain; EORTC Headquarters, Brussels, Belgium
| | - T. Gil
- ACR-ITR VIEnna/CEADDP, LBI-ACR VIEnna, and KFJ-Spital, Vienna, Austria; Hospital del Mar, IMIM, Barcelona, Spain; Royal South Hants Hospital, Southhampton, United Kingdom; The Netherlands Cancer Institute, Amsterdam, Netherlands; St. James Hospital, Leeds, United Kingdom; Rigshospitalet, Copenhagen, Denmark; Institut Jules Bordet, Brussels, Belgium; Hospital Santa Creu, Barcelona, Spain; EORTC Headquarters, Brussels, Belgium
| | - J. P. Maroto
- ACR-ITR VIEnna/CEADDP, LBI-ACR VIEnna, and KFJ-Spital, Vienna, Austria; Hospital del Mar, IMIM, Barcelona, Spain; Royal South Hants Hospital, Southhampton, United Kingdom; The Netherlands Cancer Institute, Amsterdam, Netherlands; St. James Hospital, Leeds, United Kingdom; Rigshospitalet, Copenhagen, Denmark; Institut Jules Bordet, Brussels, Belgium; Hospital Santa Creu, Barcelona, Spain; EORTC Headquarters, Brussels, Belgium
| | - S. Marreaud
- ACR-ITR VIEnna/CEADDP, LBI-ACR VIEnna, and KFJ-Spital, Vienna, Austria; Hospital del Mar, IMIM, Barcelona, Spain; Royal South Hants Hospital, Southhampton, United Kingdom; The Netherlands Cancer Institute, Amsterdam, Netherlands; St. James Hospital, Leeds, United Kingdom; Rigshospitalet, Copenhagen, Denmark; Institut Jules Bordet, Brussels, Belgium; Hospital Santa Creu, Barcelona, Spain; EORTC Headquarters, Brussels, Belgium
| | - R. Sylvester
- ACR-ITR VIEnna/CEADDP, LBI-ACR VIEnna, and KFJ-Spital, Vienna, Austria; Hospital del Mar, IMIM, Barcelona, Spain; Royal South Hants Hospital, Southhampton, United Kingdom; The Netherlands Cancer Institute, Amsterdam, Netherlands; St. James Hospital, Leeds, United Kingdom; Rigshospitalet, Copenhagen, Denmark; Institut Jules Bordet, Brussels, Belgium; Hospital Santa Creu, Barcelona, Spain; EORTC Headquarters, Brussels, Belgium
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Sylvester R, Haynes JD, Driver J, Rees G. Asymmetric responses to temporal versus nasal hemifield stimulation in the human superior colliculus. J Vis 2010. [DOI: 10.1167/6.6.506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Sylvester R, Haynes JD, Rees G. Saccadic modulation of activity in human LGN and V1. J Vis 2010. [DOI: 10.1167/5.8.577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Palou J, Gaya J, Sylvester R, Rodríguez FO, Huguet J, Parada R, Pascual M, Algaba F, Villavicencio H. 658 PROGNOSTIC FACTORS FOR RECURRENCE AND PROGRESSION IN T1G3 BLADDER CANCER TREATED WITH BCG: CIS IN THE PROSTATIC URETHRA AND GENDER. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/s1569-9056(09)60653-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Legrand C, Duchateau L, Janssen P, Ducrocq V, Sylvester R. Validation of prognostic indices using the frailty model. Lifetime Data Anal 2009; 15:59-78. [PMID: 18618249 DOI: 10.1007/s10985-008-9092-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2007] [Accepted: 06/25/2008] [Indexed: 05/26/2023]
Abstract
A major issue when proposing a new prognostic index is its generalisibility to daily clinical practice. Validation is therefore required. Most validation techniques assess whether "on average" the results obtained by the prognostic index in classifying patients in a new sample of patients are similar to the results obtained in the construction set. We introduce a new important aspect of the generalisibility of a prognostic index: the heterogeneity of the prognostic index risk group hazard ratios over different centers. If substantial variability between centers exists, the prognostic index may have no discriminatory capability in some of the centers. To model such heterogeneity, we use a frailty model including a random center effect and a random prognostic index by center interaction. Statistical inference is based on a Bayesian approach using a Laplacian approximation for the marginal posterior distribution of the variances of the random effects. We investigate different ways to summarize the information available from this marginal posterior distribution. Our approach is applied to a real bladder cancer database for which we demonstrate how to investigate and interpret heterogeneity in prognostic index effect over centers.
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Affiliation(s)
- C Legrand
- European Organisation for Research and Treatment of Cancer, 1200, Brussels, Belgium.
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Malmström P, Sylvester R. POD-7.08: Intravesical Mitomycin C Versus Bacillus Calmette-Guérin for Non-muscle Invasive Bladder Cancer: An Individual Patient Data Meta-analysis of Randomized Studies. Urology 2008. [DOI: 10.1016/j.urology.2008.08.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Aitchison M, Bray C, Van Poppel H, Sylvester R, Graham J, Innes C, McMahon L, Vasey PA. Preliminary results from a randomized phase III trial of adjuvant interleukin-2, interferon alpha and 5-fluorouracil in patients with a high risk of relapse after nephrectomy for renal cell carcinoma (RCC). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.5040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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30
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Bellmunt J, von der Maase H, Mead GM, Heyer J, Houede N, Paz-Ares LG, Winquist E, Laufman LR, de Wit R, Sylvester R. Randomized phase III study comparing paclitaxel/cisplatin/gemcitabine (PCG) and gemcitabine/cisplatin (GC) in patients with locally advanced (LA) or metastatic (M) urothelial cancer without prior systemic therapy; EORTC30987/Intergroup Study. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.lba5030] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA5030 Background: GC is a standard alternative to M-VAC for LA/M urothelial cancer (UC) based on comparable efficacy and a more favorable toxicity profile. Based on a phaseII trial, it has been suggested that the PCG triplet might provide improved response and survival. To evaluate the role of paclitaxel when added to GC, a randomized, international study (EORTC30987/Intergroup Study) comparing GC with PCG in LA/M UC was initiated in 2001, with the main endpoint being overall survival (OS). Methods: Chemo naive patients with histologic evidence of LA or M transitional UC, with GFR>60ml/min were eligible. After stratification for institution, PS(WHO 0–1) and presence/absence of metastatic disease, patients were randomized to receive PCG(armA) or GC(armB). PCG treatment included: paclitaxel(P) 80mg/m2 d1&8, cisplatin(C) 70mg/m2 d1 and gemcitabine(G) 1000mg/m2 d1&8, every 21d. GC: C70mg/m2 d1 or 2, G1000mg/m2 d1,8,15 every 28d. To detect an increase in median survival from 14 to 18m(HR=0.778) based on a two sided logrank test at error rates a=0.05 and β=0.20, 498 deaths were required. The planned sample size was of 610 pts. Results: From June 01 to May 04, 627pts (82% primary bladder) were included, (312 PCG, 315 GC). Median age was 61y with 81% males and similar baseline prognostic characteristics on both arms. PS 1 in 47%PCG and 46%GC pts. On PCG 47% had visceral and 83% M; on CG 49%-83% respectively. Overall response rate (RR): 57,1% for PCG (CR15%) and 46,4% for GC (CR10%), p=0.02. Median PFS: 8.4m and 7.7m for PCG and GC, p=0.10. 478 pts have died; the EORTC IDMC has released the study because the required number of events will occur prior to presentation. Median survival is 15.7m for PCG and 12.8m for CG, with no significant difference in OS (p=0.10, HR0.86, CI95% 0.72–1.03, p=0.12 adjusted for risk factors). Both treatments were overall well tolerated, with more thrombopenia and bleeding on GC (12%vs7%) and more febrile neutropenia on PCG (13%vs4%). Conclusions: This large, multicenter, Phase III study shows that PCG provided a better RR when compared with GC in LA/M UC; however the predefined endpoint for PFS and OS improvement was not reached. [Table: see text]
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Affiliation(s)
- J. Bellmunt
- Vall d’Hebron University Hospital, Barcelona, Spain; Aarhus University Hospital, Aarhus, Denmark; Southhampton General Hospital, Southampton, United Kingdom; Universitätsklinikum S-H, Campus Lübeck, Lübeck, Germany; Institut Bergonié, Bordeaux, France; Hospital Doce de Octubre, Madrid, Spain; London Health Sciences Center, London, ON, Canada; Hematology Oncology Consultants, Inc., Columbus, OH; Rotterdam Cancer Institute, Rotterdam, The Netherlands; EORTC Data Center, Brussels, Belgium
| | - H. von der Maase
- Vall d’Hebron University Hospital, Barcelona, Spain; Aarhus University Hospital, Aarhus, Denmark; Southhampton General Hospital, Southampton, United Kingdom; Universitätsklinikum S-H, Campus Lübeck, Lübeck, Germany; Institut Bergonié, Bordeaux, France; Hospital Doce de Octubre, Madrid, Spain; London Health Sciences Center, London, ON, Canada; Hematology Oncology Consultants, Inc., Columbus, OH; Rotterdam Cancer Institute, Rotterdam, The Netherlands; EORTC Data Center, Brussels, Belgium
| | - G. M. Mead
- Vall d’Hebron University Hospital, Barcelona, Spain; Aarhus University Hospital, Aarhus, Denmark; Southhampton General Hospital, Southampton, United Kingdom; Universitätsklinikum S-H, Campus Lübeck, Lübeck, Germany; Institut Bergonié, Bordeaux, France; Hospital Doce de Octubre, Madrid, Spain; London Health Sciences Center, London, ON, Canada; Hematology Oncology Consultants, Inc., Columbus, OH; Rotterdam Cancer Institute, Rotterdam, The Netherlands; EORTC Data Center, Brussels, Belgium
| | - J. Heyer
- Vall d’Hebron University Hospital, Barcelona, Spain; Aarhus University Hospital, Aarhus, Denmark; Southhampton General Hospital, Southampton, United Kingdom; Universitätsklinikum S-H, Campus Lübeck, Lübeck, Germany; Institut Bergonié, Bordeaux, France; Hospital Doce de Octubre, Madrid, Spain; London Health Sciences Center, London, ON, Canada; Hematology Oncology Consultants, Inc., Columbus, OH; Rotterdam Cancer Institute, Rotterdam, The Netherlands; EORTC Data Center, Brussels, Belgium
| | - N. Houede
- Vall d’Hebron University Hospital, Barcelona, Spain; Aarhus University Hospital, Aarhus, Denmark; Southhampton General Hospital, Southampton, United Kingdom; Universitätsklinikum S-H, Campus Lübeck, Lübeck, Germany; Institut Bergonié, Bordeaux, France; Hospital Doce de Octubre, Madrid, Spain; London Health Sciences Center, London, ON, Canada; Hematology Oncology Consultants, Inc., Columbus, OH; Rotterdam Cancer Institute, Rotterdam, The Netherlands; EORTC Data Center, Brussels, Belgium
| | - L. G. Paz-Ares
- Vall d’Hebron University Hospital, Barcelona, Spain; Aarhus University Hospital, Aarhus, Denmark; Southhampton General Hospital, Southampton, United Kingdom; Universitätsklinikum S-H, Campus Lübeck, Lübeck, Germany; Institut Bergonié, Bordeaux, France; Hospital Doce de Octubre, Madrid, Spain; London Health Sciences Center, London, ON, Canada; Hematology Oncology Consultants, Inc., Columbus, OH; Rotterdam Cancer Institute, Rotterdam, The Netherlands; EORTC Data Center, Brussels, Belgium
| | - E. Winquist
- Vall d’Hebron University Hospital, Barcelona, Spain; Aarhus University Hospital, Aarhus, Denmark; Southhampton General Hospital, Southampton, United Kingdom; Universitätsklinikum S-H, Campus Lübeck, Lübeck, Germany; Institut Bergonié, Bordeaux, France; Hospital Doce de Octubre, Madrid, Spain; London Health Sciences Center, London, ON, Canada; Hematology Oncology Consultants, Inc., Columbus, OH; Rotterdam Cancer Institute, Rotterdam, The Netherlands; EORTC Data Center, Brussels, Belgium
| | - L. R. Laufman
- Vall d’Hebron University Hospital, Barcelona, Spain; Aarhus University Hospital, Aarhus, Denmark; Southhampton General Hospital, Southampton, United Kingdom; Universitätsklinikum S-H, Campus Lübeck, Lübeck, Germany; Institut Bergonié, Bordeaux, France; Hospital Doce de Octubre, Madrid, Spain; London Health Sciences Center, London, ON, Canada; Hematology Oncology Consultants, Inc., Columbus, OH; Rotterdam Cancer Institute, Rotterdam, The Netherlands; EORTC Data Center, Brussels, Belgium
| | - R. de Wit
- Vall d’Hebron University Hospital, Barcelona, Spain; Aarhus University Hospital, Aarhus, Denmark; Southhampton General Hospital, Southampton, United Kingdom; Universitätsklinikum S-H, Campus Lübeck, Lübeck, Germany; Institut Bergonié, Bordeaux, France; Hospital Doce de Octubre, Madrid, Spain; London Health Sciences Center, London, ON, Canada; Hematology Oncology Consultants, Inc., Columbus, OH; Rotterdam Cancer Institute, Rotterdam, The Netherlands; EORTC Data Center, Brussels, Belgium
| | - R. Sylvester
- Vall d’Hebron University Hospital, Barcelona, Spain; Aarhus University Hospital, Aarhus, Denmark; Southhampton General Hospital, Southampton, United Kingdom; Universitätsklinikum S-H, Campus Lübeck, Lübeck, Germany; Institut Bergonié, Bordeaux, France; Hospital Doce de Octubre, Madrid, Spain; London Health Sciences Center, London, ON, Canada; Hematology Oncology Consultants, Inc., Columbus, OH; Rotterdam Cancer Institute, Rotterdam, The Netherlands; EORTC Data Center, Brussels, Belgium
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Bogaerts J, Sylvester R, Therasse P. Analysis of breast cancer survival by clinical response to neoadjuvant chemoendocrine therapy. Ann Oncol 2006; 17:352-3; author reply 353-4. [PMID: 16113059 DOI: 10.1093/annonc/mdj010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
BACKGROUND There is increasing interest in the management of stroke in ethnic minorities but few studies have considered this issue. This study investigated if differences in acute stroke management exist between a white European and Bangladeshi populations living in London, England. METHODS All stroke surviving patients discharged over a five year period in a major London teaching hospital based in an ethnically diverse area of inner city London were recruited. Cerebrovascular risk factors, their management, and investigation for acute stroke syndromes were recorded and comparison between white and Bangladeshi cohorts was made. Categorical data were analysed using Fisher's exact test. RESULTS Measurement of cholesterol concentrations are undertaken less often in those from a Bangladeshi background (25%) compared with white Europeans (76%) (p<0.0001). Statin therapy tends to be given less often to Bangladeshis. However, neuroimaging (p<0.05) and echocardiography (p<0.0001) is performed more often in Bangladeshis compared with white Europeans. CONCLUSION There are variations in the management of acute stroke because of ethnicity and these variations could have substantial consequences on secondary rates of cerebrovascular and cardiovascular disease. Whether the reasons for this disparity are attributable to inequity or iniquity of care need to be further investigated perhaps along with the development of ethnicity specific protocols. Overall the management of stroke and its risk factors in either racial group remains lamentable.
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Flanigan R, Mickisch G, Sylvester R, Tangen C, Van Poppel H, Crawford E. RE: CYTOREDUCTIVE NEPHRECTOMY IN PATIENTS WITH METASTATIC RENAL CANCER: A COMBINED ANALYSIS. J Urol 2005. [DOI: 10.1016/s0022-5347(05)60142-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Oddens JR, van der Meijden APM, Sylvester R. One Immediate Postoperative Instillation of Chemotherapy in Low Risk Ta, T1 Bladder Cancer Patients. Is it Always Safe? Eur Urol 2004; 46:336-8. [PMID: 15306104 DOI: 10.1016/j.eururo.2004.05.003] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2004] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The optimal treatment for solitary low grade, low stage papillary bladder tumours consists of transurethral resection (TUR) followed by one immediate postoperative instillation with a chemotherapeutic drug. However, when during TUR a bladder perforation or a near-perforation occurs, instillation of a chemotherapeutic drug may lead to leakage outside the bladder, possibly causing severe morbidity. So far, few case reports dealing with complications using mitomycin C have been published, but severe complications of leakage after an early adjuvant instillation with epirubicin have not been reported. METHODS We describe 3 patients in whom we observed serious complications of one immediate postoperative instillation of epirubicin. RESULTS Two of the patients recovered after conservative therapy, one patient died due to multi organ failure after explorative laparotomy. CONCLUSION In order to prevent such complications, an immediate postoperative instillation has to be avoided when there is overt or even suspicion of bladder wall perforation.
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Affiliation(s)
- J R Oddens
- Department of Urology, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands.
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Oude Lashof AML, De Bock R, Herbrecht R, de Pauw BE, Krcmery V, Aoun M, Akova M, Cohen J, Siffnerová H, Egyed M, Ellis M, Marinus A, Sylvester R, Kullberg BJ. An open multicentre comparative study of the efficacy, safety and tolerance of fluconazole and itraconazole in the treatment of cancer patients with oropharyngeal candidiasis. Eur J Cancer 2004; 40:1314-9. [PMID: 15177489 DOI: 10.1016/j.ejca.2004.03.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2004] [Accepted: 03/01/2004] [Indexed: 11/30/2022]
Abstract
Oropharyngeal candidiasis is a frequent infection in cancer patients who receive cytotoxic drugs. In this study, the efficacy, safety and tolerance of fluconazole and itraconazole were compared in non-neutropenic cancer patients with oropharyngeal candidiasis. Of 279 patients who were randomised between the two treatment groups, 252 patients were considered to be eligible (126 in each group). The clinical cure rate was 74% for fluconazole and 62% for itraconazole (P=0.04, 95% Confidence Interval (CI): 0.5-23.3%). The mycological cure rate was 80% for fluconazole and 68% for itraconazole (P=0.03, 95% CI: 1.2-22.6%). The safety and tolerance profile of both drugs were comparable. This study has shown that in patients with cancer and oropharyngeal candidiasis, fluconazole has a significantly better clinical and mycological cure rate compared with itraconazole.
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Affiliation(s)
- A M L Oude Lashof
- Nijmegen University Medical Center, St Radboud and Nijmegen University, Center for Infectious Diseases, Nijmegen, The Netherlands
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Oosterlinck W, Solsona E, van der Meijden APM, Sylvester R, Böhle A, Rintala E, Lobel B. EAU Guidelines on Diagnosis and Treatment of Upper Urinary Tract Transitional Cell Carcinoma. Eur Urol 2004; 46:147-54. [PMID: 15245806 DOI: 10.1016/j.eururo.2004.04.011] [Citation(s) in RCA: 187] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2004] [Indexed: 11/17/2022]
Abstract
OBJECTIVES On behalf of the European Association of Urology (EAU) guidelines for diagnosis, therapy and follow-up of upper urinary tract transitional cell carcinoma (UUTT) patients were established. Criteria for recommendations are based of level 2 only, as large randomised clinical trials have not been performed in this type of disease. METHOD A systematic literature research using Medline Services was conducted. References were weighted by a panel of experts. RESULTS TNM classification 2002 is recommended. Recommendations are developed for diagnosis, radical and conservative treatment and for local chemo-immunotherapy. Prognostic factors are defined. Recommendations for follow-up after different types of treatment are given.
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Affiliation(s)
- W Oosterlinck
- Department of Urology, University Hospital Ghent, De Pintelaan 185, 9000 Ghent, Belgium.
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Albrecht W, Van Poppel H, Horenblas S, Mickisch G, Horwich A, Serretta V, Casetta G, Maréchal JM, Jones WG, Kalman S, Sylvester R. Randomized Phase II trial assessing estramustine and vinblastine combination chemotherapy vs estramustine alone in patients with progressive hormone-escaped metastatic prostate cancer. Br J Cancer 2004; 90:100-5. [PMID: 14710214 PMCID: PMC2395315 DOI: 10.1038/sj.bjc.6601468] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Based on the results of combined data from three North American Phase II studies, a randomised Phase II study in the same patient population was performed, using combination chemotherapy with estramustine phosphate (EMP) and vinblastine (VBL) in hormone refractory prostate cancer patients. In all, 92 patients were randomised into a Phase II study of oral EMP (10 mg kg day continuously) or oral EMP in combination with intravenous VBL (4 mg m2 week for 6 weeks, followed by 2 weeks rest). The end points were toxicity and PSA response in both groups, with the option to continue the trial as a Phase III study with time to progression and survival as end points, if sufficient responses were observed. Toxicity was unexpectedly high in both treatment arms and led to treatment withdrawal or refusal in 49% of all patients, predominantly already during the first treatment cycle. The mean treatment duration was 10 and 14 weeks, median time to PSA progression was 27.2 and 30.8 weeks, median survival time was 44 and 50.9 weeks, and PSA response rate was only 24.6 and 28.9% in the EMP/VBL and EMP arms, respectively. There was no correlation between PSA response and survival. While the PSA response in the patients tested was less than half that recorded in the North American studies, the toxicity of EMP monotherapy or in combination with VBL was much higher than expected. Further research on more effective and less toxic treatment strategies for hormone refractory prostate cancer is mandatory.
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Affiliation(s)
- W Albrecht
- Department of Urology, Rudolfstiftung, Juchgasse 25, Vienna A 1030, Austria.
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Van Poppel H, Rigatti P, Albrecht W, Matveev V, Bono A, De Prijk L, Klaessens I, Sylvester R. 280 Results of the randomized trial comparing radical and partial nephrectomy for small kidney neoplasms eortc protocol 30904. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/s1569-9056(04)90280-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sylvester R. Statistical Principles: Myths or Facts? Oncol Res Treat 2003; 26:520-1. [PMID: 14709923 DOI: 10.1159/000074143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Bourhis J, Syz N, Overgaard J, Ang K, Dische S, Horiot J, Hilniak A, Poulsen M, O’Sullivan B, Dobrowsky W, Fallai C, Pinto L, Skladowski K, Hay J, Fu K, Sylvester R, Pignon J. Conventional vs modified fractionated radiotherapy. meta-analysis of radiotherapy in head & neck squamous cell carcinoma : a meta-analysis based on individual patient data. Int J Radiat Oncol Biol Phys 2002. [DOI: 10.1016/s0360-3016(02)03180-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
The objective of a treatment outcome study is to investigate the heterogeneity in outcome between patients according to factors other than treatment, such as country, institution or physician. Results of treatment outcome studies have already been extensively presented in the medical literature. However, no clear methodology has emerged to perform treatment outcome studies and various methods have been used. This paper reviews the different types of questions addressed in treatment outcome studies, the different methodologies and the different endpoints used. Statistical techniques are mainly descriptive including tables, estimates of survival curves, but regression models have also been used. Most of the studies use registry data, while only a few use discharge data or data available from clinical trials.
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Affiliation(s)
- C Legrand
- European Organization for Research and Treatment of Cancer, Av. E. Mounier 83, Box 11, B-1200 Brussels, Belgium.
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Sylvester R, Van Glabbeke M, Collette L, Suciu S, Baron B, Legrand C, Gorlia T, Collins G, Coens C, Declerck L, Therasse P. Statistical methodology of phase III cancer clinical trials: advances and future perspectives. Eur J Cancer 2002; 38 Suppl 4:S162-8. [PMID: 11858987 DOI: 10.1016/s0959-8049(01)00442-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The methodology for conducting cancer clinical trials has undergone enormous changes over the past 25-30 years since the EORTC Data Center was created. The purpose of this paper is to highlight and to provide a historical perspective for the main methodological concepts, both practical and theoretical, which form the basis for the design and analysis of phase III cancer clinical trials within the EORTC Data Center. Some statistical aspects of other associated topics such as quality of life, health economics, meta-analysis and treatment outcome will also be briefly discussed. Finally, some future perspectives and topics for further statistical methodological research will be presented in order to spur statisticians to meet the challenge of efficiently designing and analysing the clinical trials of tomorrow.
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Affiliation(s)
- R Sylvester
- EORTC Data Center, 83 avenue E Mounier, Bte 11, 1200, Brussels, Belgium.
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Oosterlinck W, Bono AV, Mack D, Hall R, Sylvester R, de Balincourt C, Brausi M. Frequency of positive biopsies after visual disappearance of superficial bladder cancer marker lesions. Eur Urol 2001; 40:515-7. [PMID: 11752858 DOI: 10.1159/000049828] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES In phase II trials in superficial bladder cancer, marker lesions have been used to test the ablative activity of intravesical chemo- or immunotherapy. These studies provide important knowledge about drug activity and toxicity without exposing hundreds of patients in phase III trials to drugs which ultimately may not be successful in preventing tumour recurrence or progression. After treatment a deep biopsy was necessary at the site of the marker lesion even in the absence of any visual tumour. The question is if this biopsy, in the absence of any visual tumour, should be done. MATERIAL AND METHODS The ablative effect of MMC, epirubicin, and quarter dose BCG instillations was evaluated in three different studies on a papillary marker lesion. Patients with multiple, primary or recurrent superficial bladder tumours were included. All visible Ta-T1 lesions were resected except for one marker lesion not exceeding 1 cm. TIS was excluded. In the last study, patients with T1 G3 tumours or multiple tumours >10 were also excluded. If the marker lesion disappeared completely, a deep biopsy was performed at the scar in order to prove histological disappearance of the tumour. RESULTS 185 patients were evaluated. No visual tumours were seen in 110 patients and a TUR was performed in 101 of them. It revealed only 3 Ta lesions. In the 9 others no biopsy was performed but follow-up cystoscopy revealed no lesions. CONCLUSIONS In the absence of any visual tumors, TUR and deep biopsy at the site of the scar of the marker lesion only rarely revealed (3 out of 110) the histological presence of a tumour. Therefore, this biopsy can be omitted in new marker lesion protocols in patient with Ta-T1, G1 G2 papillary superficial bladder tumours at intermediate risk for recurrence and low risk for progression.
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Affiliation(s)
- W Oosterlinck
- Department of Urology, University Hospital, Gent, Belgium.
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Duchateau L, Pignon JP, Bijnens L, Bertin S, Bourhis J, Sylvester R. Individual patient-versus literature-based meta-analysis of survival data: time to event and event rate at a particular time can make a difference, an example based on head and neck cancer. Control Clin Trials 2001; 22:538-47. [PMID: 11578787 DOI: 10.1016/s0197-2456(01)00152-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The objective of this study is to compare the results of an individual patient-based and a literature-based meta-analysis in chemotherapy in head and neck cancer and to identify the sources of difference. For all head and neck cancer randomized controlled clinical trials comparing chemotherapy and loco-regional treatment with loco-regional treatment alone, both the literature data and the individual patient data are retrieved and meta-analyses performed and compared. Only survival data are used as outcome, although both time to death and mortality at specific time points are considered in different analyses. There are substantial differences between the individual patient-based and the literature-based meta-analyses. The most important reason for the differing results is that the individual patient-based meta-analysis is based on a time to event analysis, whereas the literature-based meta-analysis is based on mortality at a specific time point. Mortality can change substantially with follow-up time. The absolute survival differences in the case study, for instance, increase from 2.6% at 2 years to 5.6% at 5 years.
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Affiliation(s)
- L Duchateau
- European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium.
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Mickisch GH, Garin A, van Poppel H, de Prijck L, Sylvester R. Radical nephrectomy plus interferon-alfa-based immunotherapy compared with interferon alfa alone in metastatic renal-cell carcinoma: a randomised trial. Lancet 2001; 358:966-70. [PMID: 11583750 DOI: 10.1016/s0140-6736(01)06103-7] [Citation(s) in RCA: 1007] [Impact Index Per Article: 43.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Surgery is the main treatment for localised renal cell carcinoma, but use of radical nephrectomy for metastatic disease is highly controversial. We aimed to establish whether radical nephrectomy done before interferon-alfa-based immunotherapy improved time to progression and overall survival (primary endpoints) compared with interferon alfa alone. METHODS We included 85 patients from June, 1995, to July, 1998: two (one per group) were ineligible. 42 of the 83 participants were randomly assigned combined treatment (study group) and 43 immunotherapy alone (controls). All patients had metastatic renal-cell carcinoma that had been histologically confirmed and was progressive at entry. In study patients, surgery was done within 4 weeks of randomisation, and immunotherapy (5x10(6) IU/m(2) subcutaneously three times per week) started 2-4 weeks later. In controls, immunotherapy was started within 1 working day of randomisation. Follow-up visits were monthly. All analyses were by intention to treat. FINDINGS 40 (53%) of 75 patients received at least 16 weeks of interferon-alfa treatment, which was also the median duration of treatment. Time to progression (5 vs 3 months, hazard ratio 0.60, 95% CI 0.36-0.97) and median duration of survival were significantly better in study patients than in controls (17 vs 7 months, 0.54, 0.31-0.94). Five patients responded completely to combined treatment, and one to interferon alfa alone. Dose modification was necessary in 32% of patients, most commonly because of non-haematological side-effects. INTERPRETATION Radical nephrectomy before interferon-based immunotherapy might substantially delay time to progression and improve survival of patients with metastatic renal cell carcinoma who present with good performance status.
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Affiliation(s)
- G H Mickisch
- Erasmus University and Academic Hospital Rotterdam-Dijkzigt, Rotterdam, Netherlands.
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46
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van der Meijden AP, Brausi M, Zambon V, Kirkels W, de Balincourt C, Sylvester R. Intravesical instillation of epirubicin, bacillus Calmette-Guerin and bacillus Calmette-Guerin plus isoniazid for intermediate and high risk Ta, T1 papillary carcinoma of the bladder: a European Organization for Research and Treatment of Cancer genito-urinary group randomized phase III trial. J Urol 2001; 166:476-81. [PMID: 11458050 DOI: 10.1097/00005392-200108000-00016] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE After transurethral resection, we compared the efficacy and side effects of weekly intravesical instillations of epirubicin, bacillus Calmette-Guerin (BCG), and BCG plus isoniazid during a 6-week interval followed by 3 weekly maintenance instillations at months 3, 6, 12, 18, 24, 30 and 36 in patients with intermediate and high risk Ta, T1 bladder cancer. MATERIALS AND METHODS A total of 957 patients were randomized at 44 institutions in a phase III multicenter trial. RESULTS The time to first recurrence was significantly longer in patients treated with BCG and BCG plus isoniazid compared to epirubicin (p = 0.0001) but there was no difference between the 2 BCG regimens (p = 0.27). Progression to muscle invasive cancer was rare (5%) and did not differ significantly among the 3 arms (p = 0.12). Drug induced cystitis was observed in 31% of the patients treated with epirubicin, 42% BCG and 45% BCG plus isoniazid. Systemic side effects, such as fever and malaise, were not observed in patients treated with epirubicin, but were noted in 31% BCG and 36% BCG plus isoniazid. CONCLUSIONS Intravesical BCG with or without isoniazid provokes more side effects than epirubicin. Prophylactic isoniazid does not reduce the side effects of BCG, while BCG with or without isoniazid prolongs the time to first recurrence compared to epirubicin. Further followup is required before long-term conclusions can be made for progression-to-muscle invasive disease and survival.
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Affiliation(s)
- A P van der Meijden
- Bosch Medicentrum, s'Hertogenbosch, University of Maastricht, The Netherlands
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47
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Jakse G, Hall R, Bono A, Höltl W, Carpentier P, Spaander JP, van der Meijden AP, Sylvester R. Intravesical BCG in patients with carcinoma in situ of the urinary bladder: long-term results of EORTC GU Group phase II protocol 30861. Eur Urol 2001; 40:144-50. [PMID: 11528191 DOI: 10.1159/000049765] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This phase II study was designed to assess the response rate, side effects and long-term efficacy of BCG in the treatment of carcinoma in situ (Cis) of the urinary bladder. METHODS 103 eligible patients with Cis were treated with 6 consecutive weekly intravesical instillations of 120 mg BCG-Connaught. In case of no response, a second 6-week course was given. RESULTS A complete response (CR) was observed in 77 of the 103 eligible patients (75%) and 93 evaluable patients (83%). In 6 of 10 patients the CR was induced by a second cycle of 6 weekly instillations. After a median follow-up of 7.6 years, 39 of the 77 CR patients (50%) are still alive and have retained their bladder, 31 (40%) without tumor recurrence. Another 7 patients underwent cystectomy and are still alive while 16 (20%) have died due to bladder cancer. Ten patients stopped treatment due to toxicity. In 2 patients, cystectomy was done because of severe cystitis and reduced bladder capacity. Drug cystitis, bacterial cystitis and fever occurred in 45, 15 and 15% of the patients, respectively. Severe drug cystitis was noted in 3 out of 10 patients receiving more than 6 instillations, necessitating cystectomy in 1 case. CONCLUSION Intravesical short-term BCG is an effective treatment modality in Cis, yielding a high CR rate. This therapy may however be suboptimal in some patients as the 5-year disease-free rate in complete responders drops to 60%. Still, this is an acceptable result for patients in whom cystectomy would otherwise be performed in virtually all cases.
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Affiliation(s)
- G Jakse
- Department of Urology, RWTH Aachen, Germany.
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Rex JH, Walsh TJ, Nettleman M, Anaissie EJ, Bennett JE, Bow EJ, Carillo-Munoz AJ, Chavanet P, Cloud GA, Denning DW, de Pauw BE, Edwards JE, Hiemenz JW, Kauffman CA, Lopez-Berestein G, Martino P, Sobel JD, Stevens DA, Sylvester R, Tollemar J, Viscoli C, Viviani MA, Wu T. Need for alternative trial designs and evaluation strategies for therapeutic studies of invasive mycoses. Clin Infect Dis 2001; 33:95-106. [PMID: 11389501 DOI: 10.1086/320876] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2000] [Revised: 11/07/2000] [Indexed: 11/03/2022] Open
Abstract
Studies of invasive fungal infections have been and remain difficult to implement. Randomized clinical trials of fungal infections are especially slow and expensive to perform because it is difficult to identify eligible patients in a timely fashion, to prove the presence of the fungal infection in an unequivocal fashion, and to evaluate outcome in a convincing fashion. Because of these challenges, licensing decisions for antifungal agents have to date depended heavily on historical control comparisons and secondary advantages of the new agent. Although the availability of newer and potentially more effective agents makes these approaches less desirable, the fundamental difficulties of trials of invasive fungal infections have not changed. Therefore, there is a need for alternative trial designs and evaluation strategies for therapeutic studies of invasive mycoses, and this article summarizes the possible strategies in this area.
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Affiliation(s)
- J H Rex
- Division of Infectious Diseases, Department of Internal Medicine, Center for the Study of Emerging and Reemerging Pathogens, University of Texas Medical School, Houston, TX, USA.
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Julien J, Bijker N, Fentiman I, Delledonne V, Rouanet P, Avril A, Sylvester R, Mignolet F, Bartelink F, Van Dongen J. Radiotherapy in breast-conserving treatment for ductal carcinoma in situ: first results of the EORTC randomised phase III trial 10853. Cancer Radiother 2001. [DOI: 10.1016/s1278-3218(00)00064-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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50
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Mack D, Höltl W, Bassi P, Brausi M, Ferrari P, de Balincourt C, Sylvester R. The ablative effect of quarter dose bacillus Calmette-Guerin on a papillary marker lesion of the bladder. J Urol 2001; 165:401-3. [PMID: 11176382 DOI: 10.1097/00005392-200102000-00011] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Low dose bacillus Calmette-Guerin (BCG) for stage TaT1 transitional cell carcinoma of the bladder has been given in various studies with the aim of decreasing side effects while maintaining the same efficacy as full dose bacillus Calmette-Guerin. However, its application in clinical practice remains controversial. We examined the ablative activity and incidence of side effects of intravesical quarter dose BCG given for a papillary marker lesion of the bladder. MATERIALS AND METHODS Included in our study were 44 patients with primary or recurrent, multiple but no more than 10 lesions of stage pTaT1, grades 1 to 2 transitional cell carcinoma of the bladder. Intravesical treatment begun 14 days after the complete transurethral resection of all visible tumors except 1 marker lesion no larger than 1 cm. consisted of instillations of 30 mg. Connaught strain BCG diluted in 50 ml. saline once weekly for 6 consecutive weeks. Two weeks after the last instillation any residual tumor was completely resected. In cases of complete disappearance of the marker lesion deep biopsy of the tumor area was done. Urine cytology was also performed. RESULTS There was a complete response in 27 of the 44 patients (61%), no response in 12 (27%) and progression to carcinoma in situ in 1 (2%), while the response was not evaluable in 4. Local side effects included dysuria in 54% of cases and macroscopic hematuria in 39%. Neither BCG induced infection nor BCG sepsis was observed. CONCLUSIONS Quarter dose BCG has a clear ablative effect on superficial bladder cancer with a 61% response rate. Phase III trials are now required to compare its efficacy and toxicity to those of full dose BCG.
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