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Abramson Cancer CenterNCI CANCERLIT® Search: Therapy of Bladder Cancer - May 2002
National Cancer Institute®
Last Modified: May 1, 2002
Table of Contents
1
UI - 11969046
AU - Saint F; Salomon L; Quintela R; Cicco A; Abbou CC; Chopin DK
TI -
[Classification, favorable characteristics, prevention and treatment of
adverse side-effects associated with Bacillus Calmette-Guerin in the
treatment of superficial bladder cancer]
SO - Ann Urol (Paris) 2002 Mar;36(2):120-31
AD - Service d'urologie, hopital Henri Mondor, 51, avenue du Marechal de
Lattre de Tassigny, 94000 Creteil, France.
The efficacy of Bacillus Calmette-Guerin (BCG) in the treatment of
superficial bladder cancer was first reported by Morales in 1976.
Several authors have since demonstrated the efficacy of BCG in the
prophylaxis and treatment of high-risk superficial bladder tumors
(pT1G3, CIS). Although BCG is now recommended as an adjunctive treatment
for superficial bladder tumors, the optimal treatment schedule remains
to be defined. Results reported by Lamm suggest that an initial
induction cycle of six weekly intravesical BCG instillations is
suboptimal unless maintenance therapy (three consecutive weekly
instillations) is given 3, 6, 12, 18, 24, 30 and 36 months later.
However, the use of maintenance therapy is hindered by troublesome
adverse reactions. This article reviews adverse reactions associated
with BCG treatment, proposed a classification and discusses their
prevention and treatment.
2
UI - 11904733
AU - Reale M; Intorno R; Tenaglia R; Feliciani C; Barbacane RC; Santoni A;
TI -
Conti P
Production of MCP-1 and RANTES in bladder cancer patients after bacillus
Calmette-Guerin immunotherapy.
SO - Cancer Immunol Immunother 2002 Apr;51(2):91-8
AD - Immunology Division, University of Chieti, Medical School, Via dei
Vestini, 66013 Chieti, Italy.
Bacillus Calmette-Guerin (BCG) therapy induces a local immunological
response mediated by cellular immune and inflammatory reactions that
enhance its anti-tumor efficacy in bladder cancer. Monocyte chemotactic
protein-1 (MCP-1) and the "regulated on activation normal T expressed
and secreted" chemokine (RANTES) are potent chemotactic molecules that
attract monocytes and memory T cells. MCP-1 and RANTES levels in
patients with superficial bladder cancer treated with intravesical
instillations of BCG are significantly higher than in untreated cancer
patients and controls. In the present study, the subjects were divided
into three groups: (1) control subjects; (2) bladder cancer patients who
did not receive BCG treatment; (3) bladder cancer patients who received
intravesical administration of BCG. No differences in the basal
production and expression of MCP-1 and RANTES mRNA were observed between
BCG-treated and untreated patients. BCG treatment influenced the
monocyte response to phytohemagglutinin (PHA) and BCG stimulation. After
24-h incubation, monocytes from BCG-treated bladder cancer patients
released more MCP-1 and RANTES than those from untreated bladder cancer
patients and controls. The anti-tumor effects of BCG observed in
superficial bladder cancer therapy may depend on stimulation of the
investigated chemokines, which attract monocytes/macrophages and memory
T cells.
3
UI - 11309436
AU - Au JL; Badalament RA; Wientjes MG; Young DC; Warner JA; Venema PL;
TI -
Pollifrone DL; Harbrecht JD; Chin JL; Lerner SP; Miles BJ; International
Mitomycin C Consortium
Methods to improve efficacy of intravesical mitomycin C: results of a
randomized phase III trial.
SO - J Natl Cancer Inst 2001 Apr 18;93(8):597-604
AD - Ohio State University, 496 W. 12th Ave., Columbus, OH 43210, USA.
au.1@osu.edu
BACKGROUND: Intravesical chemotherapy (i.e., placement of the drug
directly in the bladder) with mitomycin C is beneficial for patients
with superficial bladder cancer who are at high risk of recurrence, but
standard therapy is empirically based and patient response rates have
been variable, in part because of inadequate drug delivery. We carried
out a prospective, two-arm, randomized, multi-institutional phase III
trial to test whether enhancing the drug's concentration in urine would
improve its efficacy. METHODS: Patients with histologically proven
transitional cell carcinoma and at high risk for recurrence were
eligible for the trial. Patients in the optimized-treatment arm (n =
119) received a 40-mg dose of mitomycin C, pharmacokinetic manipulations
to increase drug concentration by decreasing urine volume, and urine
alkalinization to stabilize the drug. Patients in the standard-treatment
arm (n = 111) received a 20-mg dose without pharmacokinetic
manipulations or urine alkalinization. Both treatments were given weekly
for 6 weeks. Primary endpoints were recurrence and time to recurrence.
Treatment outcome was examined by use of Kaplan-Meier analysis with
log-rank tests. Statistical tests were two-sided. RESULTS: Patients in
the two arms did not differ in demographics or history of intravesical
therapy. Dysuria occurred more frequently in the optimized arm but did
not lead to more frequent treatment termination. In an intent-to-treat
analysis, patients in the optimized arm showed a longer median time to
recurrence (29.1 months; 95% confidence interval [CI] = 14.0 to 44.2
months) and a greater recurrence-free fraction (41.0%; 95% CI = 30.9% to
51.1%) at 5 years than patients in the standard arm (11.8 months; 95% CI
= 7.2 to 16.4 months) and 24.6% (95% CI = 14.9% to 34.3%) (P =.005,
log-rank test for time to recurrence). Improvements were found in all
risk groups defined by tumor stage, grade, focality, and recurrence.
CONCLUSIONS: This study identified a pharmacologically optimized
intravesical mitomycin C treatment with statistically significantly
enhanced efficacy.
4
UI - 11604485
AU - Masters JR
TI -
Re: methods to improve efficacy of intravesical mitomycin C: results of
a randomized phase III trial.
SO - J Natl Cancer Inst 2001 Oct 17;93(20):1574-5
5
UI - 11959532
AU - Anonymous
TI -
Bladder cancer.
SO - Harv Mens Health Watch 2002 Apr;6(9):3-6
6
UI - 11955743
AU - Rodel C; Grabenbauer GG; Kuhn R; Zorcher T; Papadopoulos T; Dunst J;
TI -
Schrott KM; Sauer R
Organ preservation in patients with invasive bladder cancer: initial
results of an intensified protocol of transurethral surgery and
radiation therapy plus concurrent cisplatin and 5-fluorouracil.
SO - Int J Radiat Oncol Biol Phys 2002 Apr 1;52(5):1303-9
AD - Department of Radiation Therapy, University of Erlangen, Erlangen,
Germany. claus.roedel@strahlen.med.uni-erlangen.de
PURPOSE: To assess safety, tolerance, and disease control of
transurethral resection of the bladder tumor (TURB) plus concurrent
cisplatin, 5-fluorouracil (5-FU), and radiation therapy (RT) with
selective organ preservation in patients with bladder cancer. PATIENTS
AND METHODS: Forty-five patients with muscle-invading or high-risk T1
(G3, associated carcinoma in situ, multifocality, >5 cm) bladder cancer
were entered into a protocol of TURB followed by concurrent cisplatin
(20 mg/m(2)/day, 20-min infusion) and 5-FU (600 mg/m(2)/day, 120-hour
continuous infusion), administered on Day 1-5 and 29-33 of RT (single
dose 1.8 Gy, total dose to the bladder 54-59.4 Gy). Response was
evaluated by restaging TURB 6 weeks later. In case of invasive residual
or recurrent tumor, salvage cystectomy was recommended. Median follow-up
was 35 months (range: 8-80 months). RESULTS: Thirty-nine patients (87%)
had no detectable tumor at restaging TURB; 29 patients (64%) have been
continuously free of tumor in their bladders. A superficial relapse
occurred in 4 patients, a muscle-invasive relapse in 6 patients. Overall
survival and survival with preserved bladder was 67% and 54%,
respectively, at 5 years. Hematologic Grade 3/4 toxicity occurred in
10%/4%; Grade 3 diarrhea occurred in 9%. Thirty-four patients (76%)
completed the protocol as scheduled or with only minor deviations. One
patient required salvage cystectomy because of a shrinking bladder.
CONCLUSION: This protocol of concurrent cisplatin/5-FU and RT has been
associated with acceptable toxicity. The complete response rate of 87%
and the 5-year survival with intact bladder of 54% are encouraging and
compare favorably with our historical control series using RT with
carboplatin and cisplatin alone.
7
UI - 11872027
AU - Yiou R; Patard JJ; Benhard H; Abbou CC; Chopin DK
TI -
Outcome of radical cystectomy for bladder cancer according to the
disease type at presentation.
SO - BJU Int 2002 Mar;89(4):374-8
AD - Service d'Urologie, CHU Henri Mondor, EMI INSERM 99-09, Creteil, France.
OBJECTIVE: To examine whether the outcome of cystectomy for invasive
transitional cell carcinoma (TCC) of the bladder was influenced by the
type of disease at initial presentation. PATIENTS AND METHODS: The
charts of 76 patients treated for TCC by radical cystectomy from 1987 to
1997 in our unit were reviewed. The patients were divided into three
groups: group 1 comprised 43 patients with primary invasive disease;
group 2 included 12 patients with progression of an initial superficial
bladder tumour after failure of conservative treatment; and group 3
comprised 21 patients who had a radical cystectomy for superficial TCC,
with a high risk of progression after attempts at conservative
treatment. The pathological findings on transurethral resection and
cystectomy specimens, cancer-specific survival and the time to
progression were compared among the three groups. RESULTS: The rate of
pT0 in cystectomy specimens was 16%, 41% and 24% in groups 1, 2 and 3,
respectively. Under-staging occurred in 24% of cases in group 3. The
10-year cancer-specific survival rates were 48%, 47% and 82% in groups
1, 2 and 3, respectively. The cancer-specific survival rate and
progression rate were not significantly different between groups 1 and
2, but were significantly lower/higher in these patients than in group 3
(P < 0.01). CONCLUSIONS: These data suggest that the prognosis of
superficial TCC which progresses despite conservative management is no
better than that of invasive TCC at initial presentation, despite the
closer follow-up received by the former patients. Early identification
of this group of patients may improve the cancer-specific survival, as
early cystectomy for high-risk superficial TCC yields better results.
8
UI - 11889593
AU - Helpap B; Kloppel G
TI -
Neuroendocrine carcinomas of the prostate and urinary bladder: a
diagnostic and therapeutic challenge.
SO - Virchows Arch 2002 Mar;440(3):241-8
AD - Department of Pathology, Academic Hospital of the University of
Freiburg, Postfach 720, 78207 Singen, Germany.
pathologie@hegau-klinikum.de
This review addresses the various morphological, immunohistochemical and
cell kinetic aspects of pure and mixed neuroendocrine carcinomas of the
prostate and urinary bladder and of carcinomas with focal neuroendocrine
differentiation. It is important that neuroendocrine tumours of the
prostate and urinary bladder be clearly distinguished from their
nonneuroendocrine counterparts because of differences in treatment and
prognosis. In the case of high-grade neuroendocrine carcinomas, early
diagnosis and initiation of appropriate chemotherapy may increase
survival and potentially induce complete remission in individual cases.
9
UI - 11796234
AU - de Braud F; Maffezzini M; Vitale V; Bruzzi P; Gatta G; Hendry WF;
TI -
Sternberg CN
Bladder cancer.
SO - Crit Rev Oncol Hematol 2002 Jan;41(1):89-106
AD - START Project, European School of Oncology, Viale Beatrice d'Este 37,
20122 Milan, Italy.
Bladder cancer is the second most frequent tumour of the urogenital
tract. Tobacco smoke has been shown to increase the risk of bladder
cancer two- to fivefold as well as the exposure to metabolites of
aniline dyes and other aromatic amines. Seventy-five per cent of bladder
cancers are superficial at initial presentation, limited to the mucosa,
submucosa, or lamina propria. Recurrence rates after initial treatment
are 50-80%, with progression to muscle-invading tumour in 10-25%. In
muscle-invading bladder cancers, there is a 50% risk of distant
metastases. Surgery is the mainstay of standard treatment both in the
form of transurethral endoscopic resection, mainly for superficial
disease, and in the form of open ablative surgery with urinary diversion
for muscle invasive disease. Endovesical administration of BCG has been
employed after endoscopic resection as the most effective agent for both
prophylaxis of disease recurrence and progression from superficial to
invasive disease. The accepted treatment for muscle infiltrative disease
is radical cystectomy. Response rates to combination chemotherapy
regimens of up to 70% in patients with advanced metastatic disease have
led to an investigation of its use for locally invasive disease in
combination with conventional modalities of treatment.
10
UI - 11930736
AU - Zhou X; Mei H; Gao X
TI -
[Clinical study of detenia cecal-ascending colon continent cutaneous
urinary reservoir]
SO - Zhonghua Wai Ke Za Zhi 2001 Nov;39(11):842-4
AD - Department of Urology, Third Affiliated Hospital, Sun Yat-Sen University
of Medical Sciences, Guangzhou 510630, China.
OBJECTIVE: To construct a good continent urinary diversion which is easy
to be performed and has a low incidence of complications. METHODS: 26
cases of bladder cancer were given radical cystectomy before the
cecal-ascending colon was excluded and 15-20 cm of the cecal-ascending
colon was isolated. The colon teniae were then incised at the interval
of 0.5-1.0 cm to construct the detenia cecal-ascending colon continent
urinary diversion open to the umbilicus. RESULTS: All the patients were
followed up for 21.1 +/- 10.1 months. Reliable continence was achieved
in all with a low incidence of complications. The capacity of the
reservoirs reached 350-600 ml 6 month after operation. Self
catherizations were carried out every 3 to 6 hours, Urodynamic data
showed a mean maximum filling pressure of 58.7 +/- 24.5 cmH2O, and a
mean maximum urethral (efferent) closure pressure of 104.3 +/- 33.8
cmH2O. CONCLUSION: Detenia cecal-ascending colon continent urinary
diversion is an ideal method.
11
UI - 11930737
AU - Xu Y; Qiao Y; Sa Y
TI -
[Enhanced continent mechanism of the tapered ileum in continent urinary
reservoir]
SO - Zhonghua Wai Ke Za Zhi 2001 Nov;39(11):845-7
AD - Department of Urology, Shanghai Sixth Municipal Hospital, Shanghai
200233, China.
OBJECTIVE: To construct a reliable continent tube that is easy to
tapered as an efferent tube and the partial efferent tube was placed
between the back surface of the rectus muscle and the wall of the ileal
pouch. The internal orifice of the tapered ileum was anastomosed to the
ileal pouch and its external orifice of the tapered ileum was
anastomosed to the umbilicus. Urodynamic study of the efferent tubes and
pouch was done 1.5 to 3 months and 6 to 17 months after operation.
RESULTS: The stoma was easily catheterized with a 16 F catheter in all
patients. One patient died of heart disease 55 days after the operation,
while 18 of the remaining 19 were completely continent day and night. At
1.5 to 3 months, the urodynamic study of the efferent tubes showed the
maximum close pressure with a full pouch of 46-124 cmH2O(91.53 +/-
17.21), and when the pouch was empty it was 34-84 cmH2O(66.68 +/-
11.60). The difference in the mean maximum closure pressure in full and
empty pouches was statistically significant (t = 10.59, P < 0.01). At 6
to 17 months, urodynamic study was performed in 12 patients, the maximum
closure pressure in the efferent tube was 77 to 154 cmH2O (100.92 +/-
20.88) when the pouch was filled with saline. When the pouch was empty,
it was 56 to 115 cmH2O (74.08 +/- 14.59). The difference in the mean
maximum closure pressure in full and empty pouches was statistically
significant (t = 8.54, P < 0.01). Reservoir capacity was 360 to 750 ml
(455 +/- 110.74). When it was filled to the maximum, the reservoir
pressure was 16 to 35 cmH2O (23.17 +/- 5.82). There was no contractive
wave in filling in any patient. CONCLUSIONS: This study indicates that
the continent mechanism of the tapered ileum can be greatly enhanced by
fixing it between the abdominal and pouch walls. This maneuver also
provides easy catheterization and surgical simplicity.
12
UI - 11930738
AU - Lu H; Zang Y; Liu L
TI -
[Orthotopic detenia cecal-ascending colon urinary reservoir: report of
18 cases]
SO - Zhonghua Wai Ke Za Zhi 2001 Nov;39(11):848-9
AD - Department of Urology, People's Hospital of Weifang, Weifang 261041,
China.
OBJECTIVE: To improve the technique of detenia cecal-ascending colon
continent urinary reservoir for farther improving the life quality of
the patient. METHODS: Orthotopic detenia cecal-ascending colon urinary
reservoir was carried out by complete resection of all the tenia and
multiple transverse incision of colonic circular muscular layer for 18
patients with bladder cancer underwent radical cystectomy. RESULTS: The
patients have been followed up for 6-20 months. All were completely
continent during the day and 13 patients got complete continence at the
night. Only 3 patients had nocturnal incontinence. The capacity of the
urine reservoir was 410-520 ml. The maximum intrareservoir pressure was
39-60 cmH2O, while the post-micturition residual volume was 15-46 ml and
the maximum flow rate was 12-28 ml/per second. No evidence of ureter
reflux and ureteral obstruction was observed and serum electrolytes were
normal in all patients. CONCLUSIONS: Orthotopic detenia cecal-ascending
colon urinary reservoir shows good clinical and functional results, and
the simple technique, exerts low pressure in the reservoir and produces
minimal complications.
13
UI - 11836593
AU - Matsushima H; Kawabe K; Fujime M; Kitamura T; Homma Y; Kishi H; Kawamura
TI -
T; Umeda T; Ohishi Y; Murai M; Kawai T; Yoshida H; Fukuda T
Treatment of patients with superficial bladder cancer by intravesical
instillation of anticancer drugs plus oral chemotherapy following
TUR-Bt: a randomized controlled trial.
SO - Oncol Rep 2002 Mar-Apr;9(2):283-8
AD - Department of Urology, Tokyo Metropolitan Police Hospital 10-41,
Chiyoda-ku, Tokyo 102-0071, Japan. h-matsu@fides.dti.ne.jp
We conducted a randomized controlled trial to compare local recurrence
rate after transurethral resection of superficial bladder cancer treated
by either intravesical instillation of an anticancer drug alone (method
A) and the intravesical instillation plus oral chemotherapy
(doxifluridine, 5'-DFUR, an intermediate metabolite of capecitabine)
(method B). Results between groups showed no difference in
recurrence-free survival curves in 196 patients subjected to primary
analysis. However, patients subjected to secondary analysis (method B,
over 3 months administration of 5'-DFUR) showed a significantly better
prognosis than method A (p=0.0244, Wilcoxon). Regarding correlation
between thymidine phosphorylase (TP, an enzyme to convert 5'-DFUR to
5-fluorouracil) level and prognosis, method A patients showed poorer
prognosis in higher TP level cases than in lower TP levels. However,
there was no significant difference in prognosis between those with
higher and lower TP levels. In method B patients, there was no
difference in prognosis between those with higher and lower TP levels.
Method A patients tended to show a slightly better prognosis than those
with lower TP levels, while method B patients tended to have a slightly
better prognosis with higher TP levels, but no significant difference
was observed. These findings suggested 5'-DFUR showed a mild efficacy in
patients with higher TP levels and that patients with higher TP levels
resulted in poorer prognosis.
14
UI - 11989905
AU - Sternberg CN; Calabro F
TI -
The management of bladder cancer in the elderly.
SO - Tumori 2002 Jan-Feb;88(1 Suppl 1):S128-9
AD - Vincenzo Pansadoro Foundation, Rome.
15
UI - 11989907
AU - Bernardi D
TI -
Is it possible to use anthracyclines in patients older than 70 years?
Pro.
SO - Tumori 2002 Jan-Feb;88(1 Suppl 1):S133-5
AD - Centro di Riferimento Oncologico, Divisione di Oncologia Medica A,
Aviano (PN).
16
UI - 11876735
AU - Gaitonde K; Goyal A; Nagaonkar S; Patil N; Singh DR; Srinivas V
TI -
Retrospective review and long-term follow-up of radical cystectomy in a
developing country.
SO - BJU Int 2002 Mar;89 Suppl 1():57-61
AD - Department of Urology, PD Hinduja National Hospital and Medical Research
Centre, Mahim, Mumbai 400016, India.
OBJECTIVE: To retrospectively review the clinical data from patients
undergoing radical cystectomy for bladder cancer, and to analyse the
complications and survival rates associated with this operation in a
developing country. PATIENTS AND METHODS: The study comprised 105
patients who underwent radical cystectomy from 1986 to 1993. Data were
collected from retrospective reviews of hospital and physician's office
records, and by contact with the patients. Metastatic status was
evaluated before surgery and tumours staged using the
Tumour-Nodes-Metastasis classification. The indication for surgery was
histologically confirmed muscle invasion after transurethral resection
biopsy, or endoscopically uncontrollable superficial disease. The data
were analysed to assess the perioperative complications and long-term
survival, with 5-year survival rates determined using Kaplan-Meier
survival curves. RESULTS: The complication rate was 27.6%; most of the
complications were managed conservatively with good results and
re-operation was required in only two patients. There were two deaths
(1.9%) at 15-45 days after surgery, but none during surgery. Patients
were divided into node-negative and node-positive groups for analysis
and 5-year survival rates determined; for node-negative organ-confined
disease (< or =pT3A) the survival was 68% and for nonorgan-confined
disease (> or =pT3B) 25%. The 5-year survival rate in the presence of
nodal metastases was 13% for N1 and none for N2 disease. Six patients
developed urethral recurrence, detected on follow-up urethral-wash
cytology. Five of these patients underwent urethrectomy, and four of the
six survived for 5 years. Pelvic recurrence occurred in five patients
(4.7%), none of whom survived for 5 years. CONCLUSION: Radical
cystectomy and pelvic lymph node dissection remains the mainstay of
treatment in muscle-invasive bladder cancer. This is a relatively safe
procedure with minimal morbidity and mortality; 68% of the present
patients with organ-confined disease survived 5 years and 12 patients
were alive at 10 years, indicating the effectiveness of this operation
in selected cases. However, < 29% of patients with nonorgan-confined and
nodal metastatic disease survived 5 years, thereby implying the need for
more effective adjuvant therapy in these patients. Radical cystectomy is
a viable option in developing countries, with 5-year survival rates
comparable with most large published series.
17
UI - 11687012
AU - Shelley MD; Barber J; Mason MD
TI -
Surgery versus radiotherapy for muscle invasive bladder cancer.
SO - Cochrane Database Syst Rev 2001;(3):CD002079
AD - Research Laboratories, Velindre NHS Trust, Velindre Road, Whitchurch,
Cardiff, Wales, UK, CF4 7XL. mike.shelley@velindre-tr.wales.nhs.uk
BACKGROUND: Muscle invasive bladder cancer is a serious clinical problem
and is fatal for the majority of patients. Alternative treatments for
this condition are radical cystectomy or radical radiotherapy. The
choice of treatment varies according to the resident country. The ideal
treatment would be a bladder preserving therapy with total eradication
of the tumour without compromising survival. OBJECTIVES: The objective
of this review was to compare the survival after radical surgery
(cystectomy) versus radical radiotherapy in patients with muscle
invasive cancer. SEARCH STRATEGY: We searched the Cochrane Controlled
authors of unpublished data were undertaken. SELECTION CRITERIA:
Randomised trials comparing surgery versus radiotherapy were eligible
for assessment. DATA COLLECTION AND ANALYSIS: Three reviewers assessed
trial quality based on the Cochrane Guidelines. Data was extracted from
the text of the article or extrapolated from the Kaplan-Meier plot. The
Peto odds ratio was determined to compare the overall-survival and
disease-specific survival. Analysis was performed on an
intention-to-treat basis and treatment actually received. MAIN RESULTS:
Three randomised trials comparing pre-operative radiotherapy followed by
radical cystectomy (surgery) versus radical radiotherapy with salvage
cystectomy (radical radiotherapy) were eligible for assessment. These
trials represented a total of 439 patients, 221 randomised to surgery
and 218 to radical radiotherapy. Peto odds ratio analysis consistently
favoured surgery in terms of survival. It was significant at 3 (OR =
2.11, 95% CI 1.10,4.07) and 5 years (OR = 2.40, 95% CI 1.35, 4.29) for
overall survival and at 3 years (OR = 1.96, 95% CI 1.06,3.65) for
disease-specific survival for patients that actually received the
protocol treatment. On an intention-to-treat analysis for
disease-specific survival, the results were significantly in favour of
surgery at 3 years (OR = 1.96, 95% CI 1.06,3.65) but not at 5 years.
REVIEWER'S CONCLUSIONS: The evidence from this review suggests that
there is no overall statistically significant benefit to radiotherapy or
surgery ( with pre-operative radiotherapy) in muscle invasive bladder
cancer in terms of survival, but the trends consistently favour surgery.
18
UI - 11869621
AU - Shelley MD; Barber J; Wilt T; Mason MD
TI -
Surgery versus radiotherapy for muscle invasive bladder cancer.
SO - Cochrane Database Syst Rev 2002;(1):CD002079
AD - Research Laboratories, Velindre NHS Trust, Velindre Road, Whitchurch,
Cardiff, Wales, UK, CF14 2TL. mike.shelley@velindre-tr.wales.nhs.uk
BACKGROUND: Muscle invasive bladder cancer is a serious clinical problem
and is fatal for the majority of patients. Alternative treatments for
this condition are radical cystectomy or radical radiotherapy. The
choice of treatment varies according to the resident country. The ideal
treatment would be a bladder preserving therapy with total eradication
of the tumour without compromising survival. OBJECTIVES: The objective
of this review was to compare the overall survival after radical surgery
(cystectomy) versus radical radiotherapy in patients with muscle
invasive cancer. SEARCH STRATEGY: We searched the Cochrane Controlled
authors of unpublished data were undertaken. SELECTION CRITERIA:
Randomised trials comparing surgery versus radiotherapy were eligible
for assessment. DATA COLLECTION AND ANALYSIS: Three reviewers assessed
trial quality based on the Cochrane Guidelines. Data were extracted from
the text of the article or extrapolated from the Kaplan-Meier plot. The
Peto odds ratio was determined to compare the overall survival and
disease-specific survival. Analysis was performed on an
intention-to-treat basis and treatment actually received. MAIN RESULTS:
Three randomised trials comparing pre-operative radiotherapy followed by
radical cystectomy (surgery) versus radical radiotherapy with salvage
cystectomy (radical radiotherapy) were eligible for assessment. These
trials represented a total of 439 patients, 221 randomised to surgery
and 218 to radical radiotherapy. Three trials were combined for the
overall survival results and one for the disease-specific analysis
[Bloom 1982]. The mean overall survival (intention-to-treat analysis) at
3 and 5 years were 45% and 36% for surgery, and 28% and 20% for
radiotherapy, respectively. Peto odds ratio (95% Confidence Interval)
analysis consistently favoured surgery in terms of overall survival. The
results were significantly in favour of surgery at 3 years (OR = 1.91,
95% CI 1.30 -2.82) and at 5 years (OR = 1.85 95% CI 1.22 - 2.82). On a
'treatment received' basis, the results were significantly in favour of
surgery at 3 (OR = 1.84, 95% CI 1.17 - 2.90) and 5 years (OR = 2.17, 95%
CI 1.39 - 3.38) for overall survival and at 3 years (OR = 1.96, 95% CI
1.06,3.65) for disease-specific survival. REVIEWER'S CONCLUSIONS: The
analysis of this review suggests that there is an overall survival
benefit with radical surgery compared to radical radiotherapy in
patients with muscle-invasive bladder cancer. However, it must be
considered that only three trials were included for analysis, the
patients numbers were small and that many patients did not receive the
treatment they were randomised to. It must also be noted that many
improvements in both radiotherapy and surgery have taken place since the
initiation of these trials.
19
UI - 11893883
AU - Albers P; Siener R; Hartlein M; Fallahi M; Haeutle D; Perabo FG; Steiner
TI -
G; Blatter J; Muller SC; German TCC Study Group of the German
Association of Urologic Oncology
Gemcitabine monotherapy as second-line treatment in cisplatin-refractory
transitional cell carcinoma - prognostic factors for response and
improvement of quality of life.
SO - Onkologie 2002 Feb;25(1):47-52
AD - Klinik und Poliklinik fur Urologie, Universitatsklinikum Bonn, Germany.
peter.albers@ukb.uni-bonn.de
OBJECTIVES: i) To evaluate objective response, toxicity, and quality of
life (QoL) of gemcitabine monotherapy as second-line treatment in
patients with cisplatin-refractory, metastatic transitional cell
carcinoma (TCC). ii) To assess prognostic parameters for response to
treatment and for improvement of QoL parameters. PATIENTS AND METHODS:
30 patients were prospectively enrolled in this open-label,
nonrandomized multicenter phase II trial. Patients received up to 6
courses of gemcitabine monotherapy (1,250 mg/m(2) on day 1 and 8 of a
21-day course). 28 of 30 patients were available for response
evaluation. RESULTS: Objective response (OR) was seen in 3/28 (11%) of
patients (2 complete remissions, 1 partial remission). The mean time to
progression (TTP) was 4.9 +/- 3.5 months and mean disease-specific
survival time was 8.7 +/- 4.7 months. 13 of 28 patients did not progress
(OR + 10 stable diseases), and TTP (8.0 +/- 2.7 months, p < 0.001) as
well as survival time (10.2 +/- 3.8 months, p < 0.05) differed
significantly from those who showed progressive disease within 18 weeks
of treatment. Pain values significantly improved in the group of
responders from 4.3 +/- 1.9 to 5.8 +/- 1.3 points (p < 0.05). Response
to cisplatin pretreatment was the best prognosticator for the response
to gemcitabine. CONCLUSIONS: Gemcitabine monotherapy as second-line
treatment is justified in patients with metastatic TCC who are
refractory to cisplatin treatment. Patients with initially OR to
cisplatin benefit most from second-line treatment. QoL remains stable
during treatment, and pain improves especially in patients with bone
metastases. Copyright 2002 S. Karger GmbH, Freiburg
20
UI - 11872337
AU - Sternberg CN
TI -
Current perspectives in muscle invasive bladder cancer.
SO - Eur J Cancer 2002 Mar;38(4):460-7
AD - Vincenzo Pansadoro Foundation, Clinic Pio XI, Via Aurelia 559, 00165,
Rome, Italy. cstern@mclink.it
Muscle-infiltrating bladder cancer should be dealt with in a
multimodality approach with collaboration between the urologist, medical
oncologist and radiotherapist. Neo-adjuvant chemotherapy has not been
proven to improve survival, but may be useful in programs of bladder
preservation. Response to M-VAC neo-adjuvant chemotherapy is an
important prognostic factor, but may represent patient selection
factors. It is not known whether it is better to administer chemotherapy
in the neo-adjuvant or in the adjuvant setting, that may spare some
patients unnecessary chemotherapy. The international adjuvant
chemotherapy trial coordinated by the EORTC (protocol 30994) will
hopefully clarify some of the unanswered questions concerning whether or
not adjuvant chemotherapy immediately following cystectomy improves
survival.
21
UI - 11912367
AU - Soloway MS; Sofer M; Vaidya A
TI -
Contemporary management of stage T1 transitional cell carcinoma of the
bladder.
SO - J Urol 2002 Apr;167(4):1573-83
AD - Department of Urology, University of Miami, Miami, Florida, USA.
PURPOSE: Transitional cell carcinoma involving the lamina propria (stage
T1) is associated with a high recurrence and progression rate with
implications for patient survival and quality of life. A better
understanding of the natural history of and treatment alternatives for
this tumor may improve the outcome in patients with this stage of
bladder cancer. MATERIALS AND METHODS: Literature of the last decade was
comprehensively reviewed in regard to clinical and pathological
diagnosis, adjuvant treatments, prognosis, and the role and timing of
cystectomy. The information was gathered from MEDLINE, current urology
journals, abstracts from recent urological meetings and personal
experience. RESULTS: High grade and the depth of lamina propria invasion
are important prognostic factors. Early diagnosis and accurate
pathological assessment are essential for determining the most adequate
treatment pathway. Initial treatment consists of complete transurethral
resection and adjuvant treatment with intravesical instillation of
bacillus Calmette-Guerin (BCG). Immediate postoperative instillation of
mitomycin C decreases the risk of recurrence possibly related to tumor
implantation. Intravesical treatment does not substantially decrease the
chance of progression. Lack of a complete response to BCG at 3 to 6
months, high grade, the depth of lamina propria invasion, the
association of carcinoma in situ and prostate mucosa or duct involvement
represent significant predictors for progression. Cystectomy should be
suggested for recurrent stage T1 tumor after BCG, new onset or
persistent carcinoma in situ, tumor located at a difficult site for
resection, prostatic duct or stromal involvement and muscle invasion.
CONCLUSIONS: High grade stage T1 transitional cell carcinoma is a highly
malignant tumor. Complete resection followed by immediate mitomycin C
instillation and 6 weekly BCG instillations results in an acceptably low
recurrence and progression rate. Rigorous long-term surveillance and
continuous reconsideration of radical cystectomy in concordance with the
evolution of the disease are essential.
22
UI - 11912378
AU - Holmang S; Johansson SL
TI -
Stage Ta-T1 bladder cancer: the relationship between findings at first
followup cystoscopy and subsequent recurrence and progression.
SO - J Urol 2002 Apr;167(4):1634-7
AD - Department of Urology, Sahlgrenska University Hospital, Goteborg,
Sweden.
PURPOSE: We studied the relationship of first cystoscopy findings with
recurrence and progression rates in a large, population based series of
patients with bladder cancer. MATERIALS AND METHODS: All 463 patients
with an initial diagnosis of stage Ta-T1 bladder cancer in western
Sweden in 1987 to 1988 were followed at least 5 years. The 355 patients
who were treated with transurethral resection only until repeat
cystoscopy or longer were selected for this report. RESULTS: Negative
first cystoscopy findings were associated with significantly decreased
recurrence and progression rates for all grades, and for stage Ta and T1
tumors. However, some patients with initial high grade carcinoma (WHO 2
to 3) had stage progression despite negative first cystoscopy. On
multivariate analyses first cystoscopy findings and papillary urothelial
neoplasm of low malignant potential versus grades 1 to 3 but not stage
and the number of tumors had prognostic significance for time to
recurrence. Only first cystoscopy findings and grade had prognostic
significance for time to stage progression. CONCLUSIONS: Our data
support other groups who recommend a less intense cystoscopy followup
schedule in patients with negative cystoscopy findings 3 months after
initial transurethral bladder resection. We recommend that patients with
initial papillary urothelial neoplasm of low malignant potential and low
grade carcinoma (WHO 1) with negative first cystoscopy findings undergo
repeat cystoscopy at month 12. In our opinion followup should not be
less intense in patients with high grade carcinoma (WHO 2-3), even in
those with stage pTa disease.
23
UI - 11912431
AU - Colombo R
TI -
Re: sexuality preserving cystectomy and neobladder: initial results.
SO - J Urol 2002 Apr;167(4):1803
24
UI - 11942977
AU - Kolaczyk W; Dembowski J; Lorenz J; Dudek K
TI -
Evaluation of the influence of systemic neoadjuvant chemotherapy on the
survival of patients treated for invasive bladder cancer.
SO - BJU Int 2002 Apr;89(6):616-9
AD - Urology Department, District Hospital, Legnica, Poland.
OBJECTIVE: To assess the influence of neoadjuvant systemic chemotherapy
using a modified methotrexate, vinblastine, doxorubicin and cisplatin
(MVAC) scheme in patients with invasive bladder cancer. PATIENTS AND
METHODS: Two groups of patients were reviewed retrospectively; group 1
included 51 who received chemotherapy before cystectomy and group 2
included 62 who were treated only with surgery. The mean (range)
duration of follow-up was 3.2 (0.25-10.25) years. The patients in group
1 were divided into two subgroups: those with tumour confined to the
bladder (T1, T2 and T3a) and the remaining patients with tumour beyond
the bladder (T3b, T4a,b). The chemotherapy was administered as routine
MVAC, except vinblastine and methotrexate were given at 15 and 22 days
during the cycle. A mean of three cycles were administered. RESULTS: The
5-year survival rate in group 1 and 2 was 66% and 58%, respectively (P >
0.3); after 8 years of follow-up the survival rates were 58% and 33%,
respectively, and significantly different (P < 0.01). CONCLUSION:
Systemic chemotherapy using the modified MVAC scheme in patients
subsequently undergoing radical cystectomy improved the survival rate
after 8 years of follow-up.
25
UI - 11942978
AU - Kolodziej A; Dembowski J; Zdrojowy R; Wozniak P; Lorenz J
TI -
Treatment of high-risk superficial bladder cancer with maintenance
bacille Calmette-Guerin therapy: preliminary results.
SO - BJU Int 2002 Apr;89(6):620-2
AD - Department of Urology, University School of Medicine, Wroclaw, Poland.
urologiawroclaw@poctza.onet.pl
OBJECTIVE: To evaluate, in a prospective study, the effects and results
of maintenance therapy with bacille Calmette-Guerin (BCG) in treating
patients with high-risk superficial bladder cancer. PATIENTS AND
METHODS: In all, 155 patients were enrolled in a randomized study of
transurethral resection alone (53) or combined with intravesical BCG
(102) as a treatment for superficial bladder cancer. BCG was
administered for six consecutive weeks followed by three weekly
instillations in months 3, 6, 12, 18, 24, 30 and 36 after resection.
Recurrence, progression, prognostic factors and side-effects were
assessed and analysed. RESULTS: After a median (range) follow-up of 23
(6-42) months, 83 of the 102 patients treated with BCG (81%) were
disease-free, compared with 24 of the 53 treated with resection alone
(45%). There was also a significant difference in tumour progression and
time to progression between the trial arms. The disease progressed in
eight patients (8%) treated with BCG and in 12 (23%) of those treated by
resection alone. Independent risk factors for progression were DNA
ploidy status and stage. Only the completion of treatment was predictive
of outcome (risk of recurrence) for patients treated with BCG.
CONCLUSION: Maintenance BCG therapy was better than resection alone in
reducing the incidence of recurrence and progression in patients with
high-risk superficial bladder cancer.
26
UI - 11942979
AU - Borkowski A
TI -
Superficial bladder cancer T1G3: the choice of treatment.
SO - BJU Int 2002 Apr;89(6):623-7
AD - Department of Urology, Medical University, Warsaw, Poland.
urolwa@warman.com.pl
27
UI - 11942983
AU - Cooke PW
TI -
Evaluation of the cellular tumour rejection mechanisms in the
peritumoral bladder wall after bacillus Calmette-Guerin treatment.
SO - BJU Int 2002 Apr;89(6):635
The above citations and abstracts reflect those newly added to CANCERLIT for the month and topic listed in the title. The citations have been retrieved from CANCERLIT using a predefined search strategy of indexed subject terms. Although the search strategy has been refined as best as possible, citations may appear that are not directly related to the topic, and occasionally relevant references may be omitted.
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