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Abramson Cancer CenterNCI CANCERLIT® Search: Therapy of Bladder Cancer - June 2002
National Cancer Institute®
Last Modified: June 1, 2002
- [Single instillation of epirubicin for the prophylaxis of recurrent primary superficial bladder carcinoma]
- [Radical cystectomy for superficial tumors in the BCG era]
- Randomized study of single early instillation of (2"R)-4'-O-tetrahydropyranyl-doxorubicin for a single superficial
- Treatment of carcinoma in situ with intravesical bacillus Calmette-Guerin without maintenance.
- Primary cisplatin, methotrexate and vinblastine chemotherapy with selective bladder preservation for muscle invasive carcinoma of the
- Management of bladder cancer: a nursing view.
- Valrubicin: an alternative to radical cystectomy for carcinoma in situ of the bladder.
- [Evaluation of side effects after intrabladder instillations of preparations in patients with superficial bladder carcinoma]
- Pelvic lymph node metastases from bladder cancer: outcome in 83 patients after radical cystectomy and pelvic lymphadenectomy.
- Re: pelvic lymph node metastases from bladder cancer: outcome in 83 patients after radical cystectomy and pelvic lymphadenectomy.
- Photodynamic therapy for superficial bladder cancer under local anaesthetic.
- Long-term follow-up of a randomized prospective trial comparing a standard 81 mg dose of intravesical bacille Calmette-Guerin with a
- A randomized comparative dose-ranging study of interferon-alpha and mitomycin-C as an internal control in primary or recurrent superficial
- [The significance of "atypical metaplasia" in the follow-up of patients operated for bladder cancer]
- [Second resection in patients with Ta-T1 bladder tumors]
- [Primary bladder adenocarcinoma: our experience in the last 10 years]
- Development of dextran derivatives with cytotoxic effects in human urinary bladder cancer cell lines.
Table of Contents
1
UI - 11955393
AU - Liu B; Zhang Y; Wang Z; Ding Q; Chen B; Wang J; Jiang H
TI -
[Single instillation of epirubicin for the prophylaxis of recurrent
primary superficial bladder carcinoma]
SO - Zhonghua Wai Ke Za Zhi 2002 Feb;40(2):112-5
AD - Department of Urology, Huashan Hospital, Fudan University, Shanghai
200040, China.
OBJECTIVE: To determine the feasibility of single dose intravesical
epirubicin in the prevention of recurrent superficial bladder carcinoma.
METHODS: We compared the effect of intravesical epirubicin or mitomycin
C on tumor recurrence and disease free interval and their side effects
after treatment of superficial bladder tumor. 47 postoperative patients
with stages Ta to T1 primary superficial bladder carcinoma of grades 1
or 2 were randomized into groups A: single 80 mg epirubicin; B: 40 mg
consecutive epirubicin; C: 40 mg consecutive mitomycin C. Patients were
followed up for clinical, analytical, and cystoscopic evaluations every
3 months. RESULTS: The disease free intervals of the three groups were
found no significant differences (F = 3.25, P > 0.05). The recurrence
rate was 6.25% (1/16), 13.3% (2/15), 12.5% (2/16) (chi(2) = 0.496, P >
0.05) in groups A, B, and C at 1 year, and 33.3% (5/15), 26.7% (4/15),
25% (4/16) (chi(2) = 0.290, P > 0.05) at 3 years after operation,
respectively. Side effects of group A (13.3%) were lower than those of
group B (46.7%) or C (43.8%) (chi(2) = 14.56, P < 0.01). CONCLUSIONS:
Single dose of epirubicin given intravesically immediately after tumor
resection is effective in preventing tumor recurrence.
2
UI - 11957752
AU - Huguet Perez J; Palou J; Millan Rodriguez F; Villavicencio Mavrich H;
TI -
Rodriguez JV
[Radical cystectomy for superficial tumors in the BCG era]
SO - Arch Esp Urol 2002 Jan-Feb;55(1):50-6
AD - Servicio de Urologia, Fundacion Puigvert, Barcelona, Espana.
urologia@fundacio-puigvert.es
OBJECTIVE: To analyze the indications and outcome of cystectomy for
superficial bladder cancer since the introduction of BCG therapy.
cystectomy for transitional cell bladder tumor. A retrospective study
was carried out on 43 cases (11.1%) that underwent cystectomy for Tis,
Ta, T1 tumors. The characteristics of patients with superficial bladder
cancer, correlation between the clinical stage (determined after TUR)
and pathological findings (cystectomy specimen) and outcome were
analyzed. RESULTS: 36 patients were male and 7 were female; mean age 63
years (range 39-79). Mean follow-up was 48 months (8-120). Twenty-nine
patients received BCG therapy prior to surgery. No response to BCG was
the main indication for cystectomy. By clinical stage, 79% were high
grade, 65% T1 and 65% CIS. A correlation between the clinical stage and
the pathological findings was found in 32.5%, overstaging in 28% and
understaging in 39.5%. The increase in stage after analysis of the
surgical specimen in 13 patients (30%) was due to progression of the
superficial bladder tumor to infiltrating or metastatic tumor. Urinary
tract tumor was found during follow-up in 8 patients (18.6%). Eleven
patients died of bladder cancer, 3 of other causes and 29 (67%) are free
of disease. Seven of the 13 patients (53%) that were clinically
understaged and had infiltrating tumor or metastasis died. CONCLUSIONS:
No response to BCG therapy was the main indication for cystectomy.
Before starting conservative treatment for high risk superficial bladder
cancer, the possibility of endoscopic understaging should be taken into
account. Patients undergoing cystectomy for superficial bladder cancer
have a high risk of developing urinary tract tumor.
3
UI - 12015761
AU - Okamura K; Ono Y; Kinukawa T; Matsuura O; Yamada S; Ando T; Fukatsu T;
TI -
Ohno Y; Ohshima S; Nagoya University Urological Oncology Group
Randomized study of single early instillation of
(2"R)-4'-O-tetrahydropyranyl-doxorubicin for a single superficial
bladder carcinoma.
SO - Cancer 2002 May 1;94(9):2363-8
AD - Department of Urology, Chubu National Hospital, Gengo, Morioka-cho, Obu,
Japan.
BACKGROUND: Although transurethral resection of a bladder tumor (TUR-Bt)
alone has been standard treatment for single superficial bladder
carcinoma, some authors reported a certain prophylactic effect of a
single immediate intravesical instillation of chemotherapeutic agent
after TUR-Bt. A prospective randomized study was conducted to determine
whether a single (2"R)-4'-O-tetrahydropyranyl-doxorubicin (THP)
instillation immediately after TUR-Bt is beneficial to patients with a
single superficial bladder carcinoma. METHODS: One hundred seventy
patients with a single resectable superficial bladder carcinoma (Ta-1,
primary or recurrent with no recurrence during the last 1 year) were
enrolled in this study. THP (30 mg/30 mL of normal saline) was
administered into the bladder within 6 hours after TUR-Bt in arm A,
while TUR-Bt alone was done in arm B. RESULTS: Of the 170 patients, 160
(94.1%) were eligible and were followed up for a median time of 40.8
months. There was a significant difference in the recurrence free curve
between the 2 arms (log-rank test; P = 0.0026), with 92.4% recurrence
free rate at 1 year, 82.7% at 2 years, and 78.8% at 3 years in arm A (84
patients) and 67.0%, 55.7%, and 52.6%, respectively, in arm B. The
recurrence rate per year was 0.11 +/- 0.22 in arm A and 0.24 +/- 0.36 in
arm B, with a significant difference (P = 0.007). Toxicity included pain
with micturition in 9 patients (10.7%), urinary frequency/urgency in 5
patients (6.0%), and macroscopic hematuria in 7 patients (8.3%).
CONCLUSIONS: These data indicate that a single THP instillation
immediately after TUR reduces the recurrence of superficial bladder
carcinoma. Copyright 2002 American Cancer Society.DOI 10.1002/cncr.10496
4
UI - 11992047
AU - Griffiths TR; Charlton M; Neal DE; Powell PH
TI -
Treatment of carcinoma in situ with intravesical bacillus
Calmette-Guerin without maintenance.
SO - J Urol 2002 Jun;167(6):2408-12
AD - University Urology Unit, Freeman Hospital, Newcastle upon Tyne, United
Kingdom.
PURPOSE: Data concerning the relative efficacy of intravesical bacillus
Calmette-Guerin (BCG) on subgroups of carcinoma in situ of the bladder
are limited. We report the outcome of primary carcinoma in situ and
carcinoma in situ associated with Ta or T1 transitional cell carcinoma
of the bladder treated with BCG. MATERIALS AND METHODS: Between 1987 and
1997, 135 patients (median age 70 years) with biopsy proven bladder
carcinoma in situ underwent a standard course of 6 BCG instillations.
Patients were divided into group 1-23 patients with primary carcinoma in
situ, group 2-37 with carcinoma in situ associated with Ta transitional
cell carcinoma and group 3-75 with carcinoma in situ associated with T1
transitional cell carcinoma. RESULTS: Median followup was 41 months. For
groups 1 to 3, complete response rates at 3 months were 74% (17 of 23
cases), 70% (26 of 37) and 75% (56 of 75), respectively. The overall
progression rates at 5 years were 20% (3 of 15 cases), 18% (4 of 22) and
49% (25 of 51). Cancer specific survival rates were 83% (10 of 12
patients), 86% (12 of 14) and 59% (17 of 29), and the numbers of
patients alive with the bladder intact were 60% (9 of 15), 58% (11 of
19) and 30% (12 of 40). Patients in group 3 treated with BCG had
progression significantly earlier than those in groups 1 and 2 (log-rank
test p = 0.013). A complete response to BCG in group 3 patients
significantly delayed time to progression (Cox regression p = 0.001) but
did not reduce death from transitional cell carcinoma. Indeed, only 38%
(8 of 21) of complete responders were alive with the bladder intact at 5
years. CONCLUSIONS: A single course of BCG is remarkably effective for
primary carcinoma in situ and carcinoma in situ associated with Ta
transitional cell carcinoma but is suboptimal in patients with carcinoma
in situ associated with T1 transitional cell carcinoma. Better outcomes
in each of the 3 groups may have occurred with maintenance BCG.
5
UI - 11992048
AU - de la Rosa F; Garcia-Carbonero R; Passas J; Rosino A; Lianes P; Paz-Ares
TI -
L
Primary cisplatin, methotrexate and vinblastine chemotherapy with
selective bladder preservation for muscle invasive carcinoma of the
bladder: long-term followup of a prospective study.
SO - J Urol 2002 Jun;167(6):2413-8
AD - Urology Department, Hospital Universitario Doce de Octubre, Av. Cordoba
Km. 5.4, 28041 Madrid, Spain.
PURPOSE: We evaluate the efficacy and bladder preservation rate of
combined modality therapy consisting of deep transurethral resection of
the primary bladder tumor followed by cisplatin, methotrexate and
vinblastine chemotherapy in patients with muscle invasive transitional
cell carcinoma of the bladder. MATERIALS AND METHODS: A total of 40
consecutive patients with clinical stage T2-T4 NX M0 bladder cancer were
included in the study and treated with transurethral resection followed
by 3 courses of chemotherapy. Chemotherapy consisted of 100 mg./m.2
cisplatin intravenously on day 1, 30 mg./m.2 methotrexate intravenously
on days 1 and 8, and 4 mg./m.2 vinblastine intravenously on days 1 and 8
administered every 21 days. Patients with disease in complete clinical
remission after cycle 3 of therapy received 3 additional chemotherapy
courses. Patients in whom complete clinical remission persisted after
cycle 6 were closely followed with no further therapy until disease
progression. RESULTS: A complete clinical remission was achieved in 21
patients (53%) after the first 3 cycles of therapy and a partial
response occurred in 10 (25%), for an overall response rate of 78% (95%
confidence interval [CI] 62% to 89%). With a median followup of 78
months (range 70 to 109) the estimated 7-year progression-free and
overall survival rates were 40% (95% CI 25% to 55%) and 35% (95% CI 20%
to 50%), respectively. The 7-year survival rate with a functional
bladder for complete clinical remission cases was 52% (95% CI 30% to
74%). Low grade, small tumor, absence of concomitant carcinoma in situ
and response to therapy were all significant predictors for an increased
probability of bladder preservation in univariate analysis. However,
response to therapy was the only variable with independent prognostic
value in the multivariate analysis (p = 0.002). CONCLUSIONS:
Transurethral resection of bladder tumor followed by cisplatin,
methotrexate and vinblastine chemotherapy results in long-term bladder
preservation in a significant proportion of responding patients, and may
be an acceptable alternative to radical surgery in select patients with
muscle invasive bladder cancer.
6
UI - 12029884
AU - Roodhouse A
TI -
Management of bladder cancer: a nursing view.
SO - Prof Nurse 2000 Dec;16(3):987-90
AD - Ashford and St Peters NHS Trust, Ashford, Middlesex.
More than 13,000 new cases of bladder cancer are diagnosed in the UK
each year. Haematuria is the most common presenting symptom and should
always be investigated. Superficial cancers are usually treated with
transurethral resection and intravesical therapy. Radical cystectomy,
radiotherapy, chemotherapy are used to treat invasive disease.
7
UI - 11998112
AU - Randall S
TI -
Valrubicin: an alternative to radical cystectomy for carcinoma in situ
of the bladder.
SO - Urol Nurs 2001 Feb;21(1):30-1, 34-6
AD - Urology Health Center, New Port Richey, FL, USA.
Treatment options for patients who fail BCG therapy are limited. While
cystectomy may be curative, not all patients can withstand the medical
and/or psychologic stresses associated with surgery or resection.
Valrubicin represents a safe and effective second-line intravesical
therapy.
8
UI - 11957800
AU - Kaczmarek P; Blaszczyk J; Kowalski J; Niemirowicz J
TI -
[Evaluation of side effects after intrabladder instillations of
preparations in patients with superficial bladder carcinoma]
SO - Pol Merkuriusz Lek 2002 Jan;12(67):39-42
AD - Oddzial Urologii Szpitala MSWiA, lodzi.
Permanent increase in neoplasm incidence including also bladder
neoplasms makes physicians to search for new forms and methods of
treatment. Application of new preparations entails in many cases
appearance of side effects which are difficult to fight off and thus
must be monitored constantly. To avoid complications which in case of
BCG application are very burdensome and sometimes dangerous for patient
it is necessary to intervene in due time. In the years 1990-1998 in
Department of urology, Ministry of Internal Affairs and Administration
Hospital in Lodz, 241 patients were treated due to superficial bladder
carcinoma. In this group in 145 cases after carcinoma electroresection
BCG suspension intrabladder infusion were applied. In 42 patients
epirubicin, in 16 adriblastin intrabladder instillations were performed;
32 patients did not receive any preparation. A detailed history was
taken from the patients before each next infusion, whereas blood was
collected for testing before the first infusion and on the seventh day
after completion of the therapy. Material for studies was collected
before the first intrabladder infusion and on the seventh day after
4-week cycle completion. Side effects of the applied preparations were
presented basing on toxicity grades acc. to WHO and divided into
subjective and objective ones. The observation period comprised the time
from the first infusion to the seventh day after the last infusion. In
the group of 145 patients with applied BCG suspension 836 intrabladder
instillations were performed. In 17 (12%) cases the treatment was
stopped after 4 infusions due to intense dysuric symptoms. In the
investigated group of patients strongly marked symptoms like polyuria
(in 98% of patients), burning in urethra during miction (in 86%),
haematuria and ill-being were observed. Objective symptoms were
significantly marked and were not of importance in further management.
In group II (epirubicin) and III (adriblastin) both subjective and
objective effects were of insignificant percentage and were not of
importance in the continuation of the treatment of superficial bladder
carcinoma. Accurate subjective examination, careful analysis of the
observed unfavourable symptoms, their intensity, close co-operation of
the physician with the patient concerning full information on possible
complications and side effects and personal procedure with them allow
for safe and effective treatment of superficial bladder carcinomas with
both BCG suspension and anthracycline antibiotics (in the form of
intrabladder infusions).
9
UI - 11435814
AU - Mills RD; Turner WH; Fleischmann A; Markwalder R; Thalmann GN; Studer UE
TI -
Pelvic lymph node metastases from bladder cancer: outcome in 83 patients
after radical cystectomy and pelvic lymphadenectomy.
SO - J Urol 2001 Jul;166(1):19-23
AD - Department of Urology and Institutes of Pathology, University of Berne,
Berne, Switzerland.
PURPOSE: We evaluate the outcome in patients with node positive bladder
cancer with particular reference to the effect of individual
characteristics of positive nodes on survival after meticulous pelvic
lymphadenectomy at cystectomy. MATERIALS AND METHODS: This prospective
analysis contains 452 cases of bladder cancer staged preoperatively as
N0M0, managed with pelvic lymphadenectomy and cystectomy between 1984
and 1997. A total of 83 (18%) patients with histologically confirmed
node positive disease are included in our study. RESULTS: The median
overall survival of patients with positive nodes was 20 months. Median
5-year survival was 29%. Patients who survived were found with positive
nodes at each site in the pelvis. The median survival of 57 patients
with less than 5 positive nodes was 27 months, compared with 15 months
for 26 with 5 nodes or more (log-rank test p = 0.0027). Median survival
of 26 patients with no lymph node capsule perforation was 93 months,
compared with 16 months for 57 with capsule perforation (p = 0.0004).
The median survival of 18 patients with a maximum diameter of lymph node
metastasis up to 0.5 cm. was 64 months, compared with 16 months for 65
with nodal metastasis greater than 0.5 cm. (p = 0.024). Contralateral
positive nodes were found in 16 of 39 (41%) patients with unilateral
bladder cancer. CONCLUSIONS: Long-term survival is possible with node
positive bladder cancer. Those patients with few as well as smaller and,
therefore, unsuspected nodal metastases, and those without lymph node
capsule perforation have the best results after removal of pelvic
metastatic nodal disease. Because patients who survive may be found
regardless of the site of pelvic nodal metastases, meticulous bilateral
pelvic lymphadenectomy is warranted in all patients at the time of
attempted curative cystectomy for bladder cancer, particularly if there
is no clinical evidence of nodal involvement.
10
UI - 11792943
AU - Neulander EZ
TI -
Re: pelvic lymph node metastases from bladder cancer: outcome in 83
patients after radical cystectomy and pelvic lymphadenectomy.
SO - J Urol 2002 Feb;167(2 Pt 1):651
11
UI - 11966622
AU - Shackley DC; Briggs C; Gilhooley A; Whitehurst C; O'Flynn KJ; Betts CD;
TI -
Moore JV; Clarke NW
Photodynamic therapy for superficial bladder cancer under local
anaesthetic.
SO - BJU Int 2002 May;89(7):665-70
AD - Department of Urology, Hope Hospital, Salford Royal Hospitals Trust,
Salford, UK. daveshackley@hotmail.com
OBJECTIVES: To evaluate the use of local anaesthesia (LA) in
5-aminolaevulinic acid (ALA) photodynamic therapy (PDT) for superficial
transitional cell carcinoma (TCC) of the bladder, and to provide further
toxicity and tolerability data on this new method within the context of
a phase 1 trial. PATIENTS AND METHODS: ALA PDT was administered to 19
patients with recurrent superficial TCC (stage Ta/carcinoma in situ,
grades 1-3) using escalating doses of ALA (3-6%) and 633 nm laser light
(25-50 J/cm2) under various LA (lignocaine) protocols. Pain was assessed
using a linear analogue scale from 0 to 10. The endpoints of
tolerability and toxicity were assessed for the different LA, light and
ALA doses, with lignocaine levels. RESULTS: ALA PDT is painful and
requires some form of anaesthesia. The discomfort was immediate,
associated with bladder spasm, and was a function of the ALA
concentration rather than the total light dose given. Simple passive
diffusion (PD) of 2% lignocaine instilled for 40 min before PDT gave
adequate anaesthesia with 3% ALA (n=8; median pain score 1, range 0-2).
With 6% ALA the pain was dramatically increased using PD (n=6; median
pain score 8, range 5-10) and therefore the more potent LA technique of
electromotive drug administration (EMDA) of 2% lignocaine was used, with
excellent results (n=3; median pain score 1, range 0-2). All patients
had transient bladder irritability that typically lasted 9-12 days, with
no subjective/objective change in long-term bladder function. No other
toxicity was reported. Serum lignocaine levels were minimal. CONCLUSION:
Bladder ALA PDT is both safe and feasible under LA. At a dose of 3% ALA,
the procedure was well-tolerated using PD of lignocaine. At higher doses
(6% ALA) more effective anaesthesia is required and this can be obtained
satisfactorily with EMDA of lignocaine. With refinement, ALA PDT may be
feasible as an outpatient treatment for superficial bladder TCC.
12
UI - 11966623
AU - Martinez-Pineiro JA; Flores N; Isorna S; Solsona E; Sebastian JL;
TI -
Pertusa C; Rioja LA; Martinez-Pineiro L; Vela R; Camacho JE; Nogueira
JL; Pereira I; Resel L; Muntanola P; Galvis F; Chesa N; De Torres JA;
Carballido J; Bernuy C; Arribas S; Madero R; for CUETO (Club Urologico
Espanol de Tratamiento Oncologico)
Long-term follow-up of a randomized prospective trial comparing a
standard 81 mg dose of intravesical bacille Calmette-Guerin with a
reduced dose of 27 mg in superficial bladder cancer.
SO - BJU Int 2002 May;89(7):671-80
AD - Hospital La Paz, Avenida San Luis 95, 28033 Madrid, Spain.
mpineiro@pulso.com
OBJECTIVES: To determine the efficacy of a three-fold reduced dose (RD,
27 mg) of intravesical bacille Calmette-Guerin (BCG) against the
standard dose (81 mg) in patients with superficial bladder cancer,
assessing recurrence, progression and differences in toxicity. PATIENTS
AND METHODS: Five hundred patients with superficial bladder cancer (Ta,
T1, Tis) were enrolled and randomly assigned to be treated after
transurethral resection of all visible lesions with intravesical BCG
Connaught strain (weekly x six and thereafter fortnightly x six) either
with the standard or RD instillation. RESULTS: All but one of the 500
patients were evaluable for efficacy and toxicity (252 in the standard
arm and 247 in the RD arm). The median follow-up was 69 months (maximum
104); 71 (28%) patients in the standard arm and 76 (31%) in the RD arm
developed recurrences; the median time to recurrence has not yet been
attained, but at 5 years the mean (sd) percentage of recurrence-free
patients was 70.5 (3.12) and 70.4 (3.1) for the standard and RD arms,
respectively. In patients presenting with multifocal tumours, the
standard dose was more effective against recurrences than the RD
(P=0.0151). In those with G3 and high-risk tumours overall, the
superiority of the standard dose was marginal (P=0.060 and P=0.082).
Twenty-nine (11.5%) tumours in the standard arm and 33 (13.3%) in the RD
arm progressed to invasive disease; the median time to progression has
not yet been attained, but the percentage of progression-free patients
at 5 years was 88.8 (2.23) and 86.9 (2.31) for the standard and RD arms,
respectively. The standard dose was more effective than the RD against
progression only in patients with multifocal disease (P=0.048). Twelve
(4.8%) cystectomies were performed in the standard and 15 (6.1%) in the
RD arm. Currently, 106 (21.2%) patients have died, but only 38 (7.6%)
from bladder cancer, i.e. 20 (7.9%) in the standard and 18 (7.5%) in RD
arm. Overall the disease-specific death rate was lower for those
patients who completed the scheduled treatment. The cause-specific
survival at 5 years did not differ between the arms (P=0.76) but there
was a trend toward better cause-specific survival for patients with
multifocal tumours in the standard arm. Toxicity differed between the
arms, significantly more patients having no toxicity in the RD arm, and
fewer having delayed instillations or withdrawing. However, severe
systemic toxicity occurred even in patients treated with the RD, in a
similar proportion to those receiving the standard dose. CONCLUSION:
Overall, the RD gave similar results for recurrence and progression but
with significantly less toxicity. However, patients with multifocal
tumours fared better with the standard dose and there was a trend
towards better recurrence rates in patients with high-risk tumours. We
recommend continuing to use the standard dose for high-risk tumours,
while we consider the reduced dose safe and effective for
intermediate-risk lesions and for maintenance schedules.
13
UI - 11966624
AU - Malmstrom PU
TI -
A randomized comparative dose-ranging study of interferon-alpha and
mitomycin-C as an internal control in primary or recurrent superficial
transitional cell carcinoma of the bladder.
SO - BJU Int 2002 May;89(7):681-6
AD - Department of Urology, University Hospital, Uppsala University,
Akademiska sjukhuset, SE-75185 Uppsala, Sweden.
per-uno.malmstrom@kirurgi.uu.sc
OBJECTIVE: To compare, in a phase II study, the activity and toxicity of
three dose levels of interferon-alpha, and of mitomycin-C given
intravesically (as an internal control to validate the results), the
primary objective being to investigate the percentage of complete
responses (complete disappearance of a marker lesion) induced by the
three interferon-alpha dose levels on a marker lesion; a secondary
objective was to compare the interferon-alpha doses for toxicity.
PATIENTS AND METHODS: In all, 115 patients were enrolled, with the
inclusion criteria being multiple grade 1 or 2, stage Ta or T1, primary
or recurrent transitional cell carcinoma of the bladder.
Interferon-alpha (30, 50 and 80 MU) and mitomycin-C (40 mg) intravesical
treatments were given as follows. Patients randomized to one of three
interferon-alpha dose levels were treated weekly for 12 weeks. However,
in week 9 (first cystoscopy after baseline) interferon-alpha treatment
was stopped if there was a complete response or disease progression.
Patients randomized to mitomycin-C were treated weekly for 8 weeks only
and in week 9 underwent follow-up cystoscopy. RESULTS: Interferon-alpha
at doses of 30, 50 and 80 MU gave response rates at 13 weeks of 19%, 33%
and 41%, respectively. Although the response rates were higher for 50
and 80 MU than for 30 MU, the differences were not statistically
significant. All three interferon-alpha groups had significantly lower
response rates than the internal control, mitomycin-C (72%). The safety
analysis showed that most of the adverse events were of mild to moderate
severity. Adverse events were experienced by 37%, 37% and 48% of
patients receiving 30, 50 and 80 MU interferon-alpha, respectively, and
by 55% of patients receiving mitomycin-C. The corresponding rates for
severe adverse events related to treatment were 9% for interferon-alpha
and 10% for mitomycin-C. CONCLUSION: Ablative therapy with
interferon-alpha was less effective than mitomycin-C in patients with
superficial bladder cancer. Both drugs were well tolerated, although
interferon-alpha appeared to have a slightly better overall safety
profile.
14
UI - 11455318
AU - Giovagnoli MR; Rocchi M; Grillo L; Vecchione A
TI -
[The significance of "atypical metaplasia" in the follow-up of patients
operated for bladder cancer]
SO - Minerva Urol Nefrol 2001 Jun;53(2):93-7
AD - II Facolta di Medicina e Chirurgia, Scuola di Specializzazione in
Oncologia II, Universita degli Studi La Sapienza, Rome.
mariarosaria.giovagnoli@uniromal.it
BACKGROUND: The aim of this study was to evaluate the clinical
usefulness of urinary cytology in the follow-up of patients who
under-went surgery for bladder cancer. Particularly, the positive
predictive value of urinary cytology and time elapsed between a positive
test and the diagnosis of a cystoscopically confirmed bladder tumor are
analyzed. METHODS: This study was carried out at the Cytological
Laboratory Department of Experimental Medicine and Pathology, University
La Sapienza, Rome. Among 230 cases studied since 1996, 30 male patients
over 50 were examined (25 with a previous bladder cancer and 5 with a
previous prostate cancer) with long time follow-up, who underwent more
than two cytological examinations on voided urine (2-12) at pre-fixed
intervals. RESULTS: Nine (30%) of the patients suffered from recurrent
disease. The cytological examinations was positive in 8 out of the 9
positive cases and negative in 17 out of the 21 negative cases. Absence
of disease was confirmed in all the latter cases both by cystoscopic
examination and clinical follow-up. One negative case showed clearly
malignant cells in more than one specimen taken at different time
intervals. This patient is actually under strict control. In 5 cases
atypical metaplasia was present in the cytological specimen. In two of
those cases cystoscopic examination 5 and 8 months later confirmed
progressive disease. In the other three cases cystoscopy showed no
evidence of disease. Two of the patients are well and alive after 2 and
14 months respectively. One is dead of prostatic cancer. CONCLUSIONS:
Considering the cases of atypical metaplasi as positive the cytological
examinations showed 100% sensibility, 81% specificity, a predictive
negative value of 1 and a predictive positive value of 0.66.
15
UI - 11692797
AU - Rodriguez-Rubio Cortadellas FI; Garrido Insua S; Rivas Aguayo D; Hens
TI -
Perez A; Bachiller Burgos J; Beltran Aguilar V; Varo Solis C; Sanchez
Bernal C; Juarez Soto A; Gonzalez Moreno D
[Second resection in patients with Ta-T1 bladder tumors]
SO - Actas Urol Esp 2001 Sep;25(8):553-8
AD - Servicio de Urologia, Hospital Universitario de Puerto Real, Cadiz.
OBJECTIVES: To study the incidence of "residual/recurrence" tumor after
a second bladder resection (2nd TUR). METHODS: 40 patients with new or
recurrent superficial bladder tumor underwent repeat transurethral
resection within 3 months after the initial resection. 37 patients were
staged as Ta-T1. We study the incidence of tumor after the 2nd TUR both
macroscopically detected or included in the bladder scar. We also study
the influence of possible factors as the time between both resections,
stage, grade, number of tumor size, localization in the bladder, primary
or recurrent tumor and tumor pattern. RESULTS: After the 2nd TUR we
found tumor in 14 of 37 (37.8%) Ta-T1 bladder tumors. Among the 14
tumors, 10 (71.5%) were macroscopically visible tumors and 4 cases the
tumor were found after resection of the bladder scar of the first
resection. We did not find relation between the presence of tumor in the
2nd TUR and any of the variables. CONCLUSIONS: After a TUR of
superficial bladder tumor the complete removal of tumor is not always
achieved. The early 3 months cystoscopy may not find residual tumor.
Although we have found tumor in 37.8% in the 2a TUR we can not recommend
routine 2nd TUR in superficial bladder cancer.
16
UI - 11692800
AU - Sanchez Zalabardo D; Rodriguez Gonzalez J; Fernandez Montero JM; Lopez
TI -
Ferrandis J; Arocena Garcia-Tapia J; Sanz Perez G; Rosell Costa D;
Zudaire Bergera JJ; de Alava Casado E; Berian Polo JM
[Primary bladder adenocarcinoma: our experience in the last 10 years]
SO - Actas Urol Esp 2001 Sep;25(8):573-7
AD - Servicio de Urologia, Clinica Universitaria de Navarra.
Adenocarcinoma of the bladder is an uncommon neoplasm corresponding as
usual to a metastases and with a lower frequency to a primary vesical
tumour. We present the primary adenocarcinoma treated in our hospital in
the last 10 years. The moment at the diagnosis is related to the
prognosis because of its tendency to muscle infiltration. The most
accepted treatment is the radical cistectomy and if recurrence occurs
complementary proceedings must be consider.
17
UI - 12014645
AU - Marquez M; Du J; Edgren M; Nilsson S; Lennartsson L; Hiltunen J; Westlin
TI -
JE; Tammela T; Raitanen M; Laato M; Jonsson G; Holmberg AR
Development of dextran derivatives with cytotoxic effects in human
urinary bladder cancer cell lines.
SO - Anticancer Res 2002 Mar-Apr;22(2A):741-4
AD - Karolinska Institute, Cancer Center Karolinska, Stockholm, Sweden.
BACKGROUND: In a previous study we reported on a new approach describing
intravesical instillation of charged dextran in patients with
superficial bladder carcinoma. The cationic derivative showed a strong
tumor-selective accumulation. To develop this approach, the present
study investigates the cytotoxic effect of cationic dextran derivatives
on two urinary bladder cancer cell lines (J82 and 5637). METHODS: The
dextran conjugates were prepared by periodate activation and subsequent
coupling by reductive amination. A fluorimetric cytotoxicity assay
(FMCA) was used for the cytotoxicity assay. The tumor cells were seeded
into 96-well microtiter plates and different cationic dextran
derivatives were added and incubated for 72 hours. RESULTS: The results
showed that cationic epirubicin-dextran had a clear inhibitory effect on
the growth in both cell lines (40-95% growth inhibition). The
corresponding values for epirubicin (the reference) was 90-100%
inhibition. Interestingly, cationic dextran had, by itself, a growth
inhibitory effect. This cytotoxic effect could be strongly enhanced to
be almost equal to the reference by changing the cationic sidegroup to
aminohexane. Dextran alone showed no effect. CONCLUSION: The finding
that cationic dextran by itself can be made cytotoxic, together with its
capacity to accumulate in superficial bladder cancer, suggests
possibilities for new therapeutic constructs. Cationic dextran with
different cationic side-groups and in combination with cytotoxic drugs
will be studied further. The cytotoxic mechanism needs to be elucidated.
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