National Cancer Institute®
Last Modified: July 1, 2002
UI - 12024673
AU - Shishkov D
TI - [Orthotopic bladder from the small intestine following radical cystectomy according to Studer's procedure]
SO - Khirurgiia (Sofiia) 2001;57(3-4):41-3
After radical cystoprostatovesikulectomy, an ileal bladder substitute had been performed in 14 male patients a modo Studer. In order to avoid peristalsis with high pressure peaks resulting in incontinence, the antimesenteric border was transsected, and an ileal low-pressure pouch was created. One to two months after operation, the continence for urine was good or excellent. After a follow-up time of 12 months, no metabolic disorders requirling any substitution, nor pyelonephritic changes were observed.
UI - 11598443
AU - Bassi P; Iafrate M; Longo F; Iannello A; Mostaccio G; Ingrassia A;
TI - Repele M; Tavolini IM Intracavitary therapy of noninvasive transitional cell carcinomas of the upper urinary tract. A review of the literature.
SO - Urol Int 2001;67(3):189-94
AD - Department of Urology, University of Padua Medical School, Via Giustiniani, 2, I-35128 Padua, Italy. email@example.com
Noninvasive (stages Ta, T1, Tis) transitional cell carcinomas of the upper urinary tract are suitable for a conservative therapeutic approach. Intracavitary therapy (alone or as adjuvant treatment) has recently been proposed and successfully used by some authors. Even though bacillus Calmette-Guerin is the most frequent agent employed, chemotherapeutic drugs, such as mitomycin C and thiotepa, have also been successfully used. The current information available in the literature is therefore reviewed. According to the data available, intracavitary therapy is a worthwhile conservative therapeutic option for noninvasive upper urinary tract urotheliomas with acceptable side effects. For this reason it may be included in the routine urological armamentarium.
UI - 11829043
AU - Cheung YL; Molassiotis A; Chang AM
TI - A pilot study on the effect of progressive muscle relaxation training of patients after stoma surgery.
SO - Eur J Cancer Care (Engl) 2001 Jun;10(2):107-14
AD - Department of Surgery, Tseung Kwan O Hospital, Hong Kong.
Eighteen patients who had undergone stoma surgery were assessed with respect to their anxiety level and self-reported quality of life (QoL) on three occasions; namely, immediately after surgery, 5 weeks after surgery, and 10 weeks after surgery. The patients were randomised into a control group (n = 10) and an experimental group (n = 8). A 20-min set of audiotaped instructions on progressive muscle relaxation training (PMRT) was given to the patients in the experimental group for home practice. Assessment instructions included the Chinese State-Trait Anxiety Inventory (C-STAI), the Quality of Life Index for Colostomy (QoL-Colostomy) and the Hong Kong Chinese version of the World Health Organisation Quality of Life Scale (WHOQoL). Results indicated that there was a significant decrease in both the C-STAI score (F = 4.66, P < 0.05) and the WHOQoL score (F = 4.74, P < 0.05) in the experimental group. Among the domains of WHOQoL, a significant difference was shown in physical health/independence and general perception of QoL, with the experimental group demonstrating better functioning. For the QoL-Colostomy, however, there was no significant difference between the control and experimental groups. The results suggest that the use of PMRT could enhance quality of life and decrease state anxiety in patients after stoma surgery.
UI - 12050510
AU - Chang SS; Cole E; Smith JA Jr; Cookson MS
TI - Pathological findings of gynecologic organs obtained at female radical cystectomy.
SO - J Urol 2002 Jul;168(1):147-9
AD - Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
PURPOSE: Historically anterior pelvic exenteration has been the recommended treatment for invasive urothelial carcinoma in women undergoing radical cystectomy. We evaluated the pathological features of reproductive organs removed during exenteration to determine the incidence of malignant pathology in these organs and the need for removal. MATERIALS AND METHODS: We reviewed the records of all patients Of these 382 patients, we identified 68 females who underwent radical cystectomy for urothelial carcinoma. We reviewed preoperative, operative and pathological findings, including bladder, lymph nodes, uterine and adnexal pathology, in these female patients. RESULTS: Median patient age was 64 years (range 35 to 86). Gynecologic organs were present in 40 of the 68 surgical specimens (59%). The reasons for absent gynecologic pathology were previous hysterectomy in 26 cases and the preservation of organs during orthotopic urinary diversion creation in 2. Malignancy was identified in 3 specimens, including invasive urothelial carcinoma in 2 (5%). In these 2 cases invasion was clearly identified intraoperatively. Low grade stromal sarcoma of the uterus was present in 1 specimen (2%). CONCLUSIONS: In the absence of clinical suspicion radical hysterectomy at cystectomy rarely improves cancer control. Furthermore, secondary malignancies are rare. The functional impact of preserving gynecologic organs is a subject of ongoing study.
UI - 12050514
AU - Dutta SC; Chang SC; Coffey CS; Smith JA Jr; Jack G; Cookson MS
TI - Health related quality of life assessment after radical cystectomy: comparison of ileal conduit with continent orthotopic neobladder.
SO - J Urol 2002 Jul;168(1):164-7
AD - Department of Urologic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
PURPOSE: Health related quality of life after urinary diversion has been increasingly recognized as an important outcome measure. However, few studies have directly compared patients with an ileal conduit with those with a continent orthotopic neobladder and even fewer have used validated quality of life instruments. Therefore, we compared health related quality of life in patients who underwent neobladder versus ileal conduit creation using validated questionnaires. MATERIALS AND METHODS: We mailed 2 validated questionnaires that are measures of health related quality of life, namely the RAND 36-Item Health Survey (SF-36) and Functional Assessment of Cancer Therapy-General (FACT-G), to patients who underwent radical cystectomy for urothelial carcinoma performed, including univariate and multivariate analysis. RESULTS: A total of 112 patients were available for assessment. A total of 72 (64%) questionnaires were returned, including 23 (32%) and 49 (68%) from patients with an ileal conduit and neobladder, respectively. On the SF-36 questionnaire there were significant univariable relationships between treatment and age (p <0.001 and 0.01, respectively). Younger patients and those with a neobladder had higher health related quality of life scores, including significant differences in 5 of the 9 SF-36 domains (general health, physical functioning, physical health, social functioning and energy/fatigue). There was no relationship between health related quality of life and the final pathological stage (p = 0.25). On multivariate analysis adjusting for age led to a suggestive but nonsignificant difference in health related quality of life scores favoring neobladders (p = 0.09). On the FACT-G there were no significant differences in health related quality of life due to treatment (p = 0.28), pathological stage (p = 0.5), age (p = 0.72) or current disease status (p = 0.27). On the FACT-G 2 of the 4 domains (emotional and functional well-being) were significantly in favor of neobladders. Overall satisfaction was high in the 2 groups with 96% and 85% of patients with a neobladder and ileal conduit, respectively, reporting that they would make the same choice of diversion. CONCLUSIONS: Based on validated health related quality of life instruments these findings suggest that patients with an orthotopic neobladder have marginal quality of life advantages over those with an ileal conduit. However, differences in health related quality of life in the 2 types of urinary diversion are confounded by age since patients who underwent orthotopic diversion were younger and as a result of age would be expected to have a higher health related quality of life score. A prospective longitudinal study of health related quality of life after adjusting for differences in age among patients undergoing urinary diversion is currently underway to extend further these observations.
UI - 12050515
AU - Henningsohn L; Steven K; Kallestrup EB; Steineck G
TI - Distressful symptoms and well-being after radical cystectomy and orthotopic bladder substitution compared with a matched control population.
SO - J Urol 2002 Jul;168(1):168-74; discussion 174-5
AD - Clinical Cancer Epidemiology, Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
PURPOSE: We compared subjective quality of life, well-being, urinary tract symptoms and distress in patients after radical cystectomy and orthotopic urinary reconstruction with those in a matched control population. MATERIALS AND METHODS: Included in this study were 101 consecutive recurrence-free patients who underwent radical cystectomy and orthotopic bladder substitution with an ileal urethral Kock neobladder at Herlev Hospital with a minimum followup of 1 year. A frequency matched control group comprising 147 individuals was selected from the same geographical region. Information was collected by an anonymous postal questionnaire and analyzed externally in Sweden. RESULTS: The prevalence of low or moderate psychological well-being (32% versus 36%) and subjective quality of life (30% versus 38%), and high or moderate anxiety (23% versus 18%) and depression (26% versus 37%) was similar in patients with an orthotopic neobladder and population controls. Patients with a neobladder felt as attractive as the control population. Of the operated men 94% had erectile dysfunction compared with 48% of controls. Daytime and nighttime urinary frequency was similar in patients and controls (3% and 3%, and 15% and 13%, respectively), while the prevalence of urinary leakage at least once monthly was higher in patients (18% versus 5%). Intermittent self-catheterization was performed by 26% of patients with a neobladder. Urinary tract infection (14% versus 6%) was more common and the prevalence of distressful bowel symptoms (14% versus 9%) was slightly more common in patients than in controls. CONCLUSIONS: Well-being and subjective quality of life in patients after radical cystectomy and orthotopic bladder substitution were similar to those in a matched control population.
UI - 12050495
AU - Goebell PJ; Otto T; Suhr J; Rubben H
TI - Evaluation of an unconventional treatment modality with mistletoe lectin to prevent recurrence of superficial bladder cancer: a randomized phase II trial.
SO - J Urol 2002 Jul;168(1):72-5
AD - Department of Urology, University of Essen, Essen, Germany.
PURPOSE: The indication for topic chemotherapy or immunotherapy for well differentiated, noninvasive superficial bladder cancer remains controversial. Side effects of these treatments promoted use of unconventional therapies with cytokines, immunomodulators and mistletoe extracts. However, there are no controlled clinical data available on the efficacy of these extracts for bladder cancer. We evaluate the influence of subcutaneously applicated mistletoe lectin on bladder tumor recurrence after transurethral resection. MATERIALS AND METHODS: The study consists of 45 patients with pTa G1-2 bladder cancer treated with transurethral resection during a 3-year period. Median patient age was 65 years and 33 patients were male. The study cohort was randomly divided into a treatment group receiving adjuvant therapy with mistletoe lectin and a control group receiving no additional treatment. Patients in the treatment group received mistletoe lectin according to schedule 2 weeks after transurethral resection. Clinical followup was assessed 3, 6, 9, 12 and 18 months after the initial resection, and included uretherocystoscopy. RESULTS: Both study arms comprised similar patients with regard to total number of previous tumors (mean 2.6 versus 2.9), number of primary lesions (14 versus 12) and number of recurrent tumors (8 versus 11). After followup of 18 months the recurrence-free interval in both study arms was similar (p = 0.76) and the total number of recurrences comparable (p = 0.48). CONCLUSIONS: Subcutaneous use of mistletoe lectin as adjuvant treatment after transurethral resection does not seem to affect the time to first recurrence, total number of recurrences or recurrence-free outcome.
UI - 11528191
AU - Jakse G; Hall R; Bono A; Holtl W; Carpentier P; Spaander JP; van der
TI - 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.
SO - Eur Urol 2001 Aug;40(2):144-50
AD - Department of Urology, RWTH Aachen, Germany. firstname.lastname@example.org
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.
UI - 11528192
AU - Henningsohn L; Wijkstrom H; Dickman PW; Bergmark K; Steineck G
TI - Distressful symptoms after radical cystectomy with urinary diversion for urinary bladder cancer: a Swedish population-based study.
SO - Eur Urol 2001 Aug;40(2):151-62
AD - Department of Urology, Huddinge University Hospital, Stockholm, Sweden.
OBJECTIVE: To study the excess prevalence of distressful symptoms after radical surgery for urinary bladder cancer. METHODS: We included all patients who underwent cystectomy due to bladder cancer before 1996 in Stockholm County. A control group was randomly selected from the general population. Information was collected by means of an anonymous postal questionnaire. RESULTS: Completed questionnaires were returned by 310 (71%) controls and 251 (85%) cystectomized individuals. A 5-fold (reservoir) and 9-fold (conduit) increase in defecation urgency and a 4-fold (reservoir) and 6-fold (conduit) increase in faecal leakage were reported in individuals operated on. Urinary tract infection was increased 3-fold in cystectomized individuals compared with controls, during the previous year 26% of the patients reported a symptomatic infection. The perception of a reduced physical attractiveness due to disease was more than 5-fold increased in the men operated on compared to the controls. The majority, 135 out of 201 (67%), reported that they would have refused alternative bladder-sparing procedures if they decreased the prospects of survival by even as little as 1%. CONCLUSIONS: The patient's situation after cystectomy is considerably impaired due to changed bowel and sexual function, urinary tract infections and a sense of decreased attractiveness. However, most patients are in spite of this unwilling to compromise survival.
UI - 11684849
AU - Huguet-Perez J; Palou J; Millan-Rodriguez F; Salvador-Bayarri J;
TI - Villavicencio-Mavrich H; Vicente-Rodriguez J Upper tract transitional cell carcinoma following cystectomy for bladder cancer.
SO - Eur Urol 2001 Sep;40(3):318-23
AD - Department of Urology, Fundacio Puigvert, Barcelona, Spain.
PURPOSE: We assessed the incidence of upper urinary tract tumors (UUTTs) after cystectomy for invasive or superficial transitional cell carcinoma (TCC) of the bladder. The risk factors, patients' characteristics and evolution of those who developed UUTTs are analyzed. MATERIALS AND were performed for TCC of the bladder: in 469 instances (82.5%) due to invasive tumor (T2-T4), and in 99 cases (17.5%) for superficial tumor (Ta, T1, Tis). All patients were followed for at least 5 years or until death. A retrospective study of patients who developed UUTTs has been performed. A revision of bladder tumor and UUTT characteristics, and the intervals between both is also evaluated. RESULTS: 26 patients (4.5%) developed UUTTs: 11 of the 99 patients cystectomized for superficial TCCs (11.1%); 6 of the 392 patients with primary invasive TCC (1.5%), and 9 of the 77 (11.6%) patients with invasive tumors and a prior history of superficial TCC. The interval to the development of UUTT was higher after cystectomy for superficial tumor. TCCs of the bladder that subsequently developed UUTTs were high grade in 84%, multifocal in 80%, or had carcinoma in situ in 65%, tumor in the prostatic urethra in 52%, and involvement of the distal ureter in 57%. Twenty-two UUTTs (84%) were located in the calyces or the renal pelvis, 3 were bilateral (11.5%), 14 multiple (58%) and 4 superficial (16%). With a median follow-up time of 18 (range 3-103) months, 14 patients (53.8%) died of tumor, 2 were alive with disease, 2 were lost for follow-up, and 8 (30%) were alive and free of disease. CONCLUSIONS: We found that patients cystectomized for superficial or invasive TCC with a prior history of superficial TCC have a higher incidence of UUTTs. These cases require follow-up with annual urography or loopography.
UI - 11684850
AU - Popov I; Jelic S; Radosavljevic D; Nikolic-Tomasevic Z
TI - Amsacrine and cisplatin in poor prognosis patients with metastatic transitional cell carcinoma of the urothelium: a phase-II study.
SO - Eur Urol 2001 Sep;40(3):324-9
AD - Institute of Oncology and Radiology of Serbia, Belgrade, FR Yugoslavia. email@example.com
OBJECTIVES: Amsacrine, as a single agent, was reported to be effective in patients with metastatic transitional cell carcinoma of the urinary bladder. Amsacrine is also associated with a lower toxicity than cyclophosphamide, doxorubicin and cisplatin therapy and has similar activity. But amsacrine has been forgotten in clinical studies of transitional cell carcinoma of the urinary bladder. The aim of present study was to investigate the toxicity and efficacy of amsacrine and cisplatin in chemotherapy-naive patients with metastatic transitional cell carcinoma of the urinary bladder. METHODS: We have treated 54 patients (41 males/13 females) with a median age of 62 (38-72) years. Performance status was 0/2, I/27 II/17 and III/8. The treatment included: amsacrine 85 mg/ m(2), days 1-2, and cisplatin 30 mg/m(2), days 2-5. Cycles were repeated every 4 weeks. We applied 169 cycles (median 3/patient). Of 54 patients, 39 had previous surgery and 12 had previous radiotherapy. Histological tumor grade was I/7, II/27 and III/20. RESULTS: 51 patients were evaluable for response (3 patients refused further treatment during the first cycle): 2 complete remission (4%); 15 partial remission (29%); 23 stable disease (45%), and 11 progressive disease (22%). The response rate was 33% (95% CI 21-46). On an intent-to-treat basis the response was 32% (95% CI 19-44). Durations of complete and partial responses were 14 (range 12-16) and 6.5 (range 3-11) months, respectively. Median survival was 9 (range 3-21) months. All patients were evaluable for toxicity. Grades III-IV toxicity was as follows: anemia 11%; neutropenia 37%, and thrombocytopenia 20%. None of the patients was excluded from the study because of toxicity. CONCLUSION: The combination of amsacrine and cisplatin is a regimen with mild and manageable toxicity. The present regimen seems to be active. Randomized study of the present regimen versus another low-toxicity regimens are necessary, especially for poor prognosis patients including those with a low performance status.
UI - 11828993
AU - Jichlinski P; Leisinger HJ
TI - Photodynamic therapy in superficial bladder cancer: past, present and future.
SO - Urol Res 2001 Dec;29(6):396-405
AD - Department of Urology, University Hospital, CHUV, Lausanne, Switzerland. Patrice.Jichlinski@chuv.hospvd.ch
For many reasons, such as toxicity and lack of selectivity of photosensitisers, as well as complexity of technical procedures and inconstant therapeutic results, photodynamic therapy of highly recurrent superficial bladder cancer never gained wide acceptance in the urological community. However, the 25 years of experience combined with the recent discovery of new photosensitisers, such as protoporphyrin IX (PpIX) induced by 5-aminolevulinic acid (ALA) or ALA-derivatives or hypericin open new, very interesting perspectives in this therapeutic field.
UI - 11718635
AU - Xiaoxu L; Jianhong L; Jinfeng W; Klotz LH
TI - Bladder adenocarcinoma: 31 reported cases.
SO - Can J Urol 2001 Oct;8(5):1380-3
AD - Department of Urology, The Second Affiliated Hospital of Shanxi Medical University, Taiyuan, 030001 Shanxi, P.R. of China.
SUMMARY: retrospective review of 31 cases of bladder adenocarcinoma. METHODS: All patients diagnosed with adenocarcinoma of the bladder at the second affiliated hospital and commercial worker's hospital in Shanxi between 1985 and 1999 were reviewed. RESULTS: The cohort consisted of 31 patients, 25 with primary bladder adenocarcinoma, and 6 patients with urachal adenocarcinoma. Compared to the patients with primary adenocarcinoma, the urachal group were younger (67 versus 56 years), and more likely to be female (M:F 3:1 versus 1:2), and had a worse survival (45% versus 20% at 3 years). In the primary bladder adenocarcinoma group, the 3-year survival rate was 45% after radical cystectomy, and 33% after partial cystectomy. Local tumor recurrence after partial cystectomy was 25%. CONCLUSION: Urachal adenocarcinoma occurred in a younger age group with a female predominance compared to primary adenocarcinoma. Partial cystectomy was associated with a relatively high rate of local tumor recurrence.
UI - 12057150
AU - Izawa JI; Grossman HB
TI - Localized bladder cancer.
SO - Curr Treat Options Oncol 2000 Dec;1(5):423-32
AD - Department of Urology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Box 110, Houston, TX 77030, USA.
Transitional cell carcinoma (TCC) of the bladder makes up 90% of bladder cancers. The approach to the management of localized TCC includes accurate clinical and histologic diagnosis and staging with pathologic material obtained through endoscopy. Once the diagnosis of superficial TCC has been established, histologically based prognostic factors guide which therapy or combination of therapies is indicated in the management of individual patients. Surgery alone (transurethral resection) is appropriate initial therapy for noninvasive papillary TCC. For lamina propria invasive tumors and carcinoma in situ, intravesical immunotherapy with bacille Calmette-Guerin (BCG) is often the first line of treatment to decrease tumor recurrence and to possibly decrease progression and improve survival. Intravesical chemotherapy and interferon are alternative therapies that can also decrease recurrence rates. For BCG-refractory TCC, durable response rates with alternative intravesical therapies are low. For superficial TCC that is refractory to endoscopic procedures and intravesical agents or for disease progression, radical cystectomy with neobladder formation or other forms of urinary diversion is the treatment of choice.
UI - 11392221
AU - Zyrianov BN; Selivanov SP
TI - [Bladder wall permeability to to topically administered cisplatin]
SO - Urologiia 2000 Sep-Oct;(5):28-30
The aim of the study was quantitation of cisplatinum in the wall of normal urinary bladder, tumor tissue, inflamed mucosa and blood in intravesical administration of cisplatinum. The samples of the tissue were radiated in the flow of heat neutrons 5 x 10(12)-5 x 10(13) neut/cm followed by radiochemical purification of the material and platinum assay in the tissue using analyser LP-4900 with semiconductor radiation detector. The samples were taken from 32 patients with transitional cancer of the bladder. Tumor tissue contained platinum in amounts 33.7 times exceeding those in normal tissue after intravesical administration of 100 mg of the drug. After intravenous administration of 100 mg cisplatinum normal bladder tissue and tumor tissue contained almost similar quantities of the drug. Thus, tumor tissue absorbs more cisplatinum than normal tissue of the bladder in intravesical administration.
UI - 12084297
AU - Kamat AM; Lamm DL
TI - Immunotherapy for bladder cancer.
SO - Curr Urol Rep 2001 Feb;2(1):62-9
AD - Department of Urology, PO Box 9251, Health Sciences Center, West Virginia University, Morgantown, WV 26506, USA.
The primary role of immunotherapy for bladder cancer is to treat superficial transitional cell carcinomas (ie, carcinoma in situ, Ta, and T1). Immunotherapy in the form of bacille Calmette-Guerin (BCG), interferon, bropirimine, keyhole limpet hemocyanin, and gene therapy is intended to treat existing or residual tumor, to prevent recurrence of tumor, to prevent progression of disease, and to prolong survival of patients. Presently, BCG is commonly used and is the most effective immunotherapeutic agent against superficial transitional cell carcinoma. Data support that BCG has a positive impact on tumor recurrence, disease progression, and survival. Proper attention to maintenance schedules, route of administration, dosing, strains, and viability is essential to obtain the maximum benefits of BCG immunotherapy. This review highlights and summarizes the recent advances concerning immunotherapy, with special emphasis on BCG therapy for transitional cell carcinoma.
UI - 12010328
AU - Sousa-Escandon A; Vazquez S; Quintero-Aldana G; Picallo JA; Neira J;
TI - Garcia-Novio F; Mateo A; Rico M; Mel JR Neo-adjuvant treatment of infiltrating transitional-cell carcinoma of the bladder with paclitaxel and cisplatin: a phase II trial.
SO - Int J Urol 2002 Mar;9(3):162-6
AD - Department of Urology, Comarcal Hospital of Monforte, 27400 Monforte de Lemos, Lugo, Spain.
BACKGROUND: A phase II multicentric trial of paclitaxel and cisplatin was conducted in previously untreated patients, with locally advanced transitional-cell carcinoma (TCC) of the bladder, to assess its toxicity and efficiency in preserving the bladder. METHODS: Forty-four patients with locally advanced TCC of the bladder (seven with T3a, 27 with T3b, and eight with T4a) were treated with paclitaxel 175 mg/m(2) over 3 h, and cisplatin 75 mg/m(2) over 30 min, on the first day of each 21-day treatment cycle. Therapy was continued for three cycles. Patients were re-evaluated and scheduled for radiotheraphy or radical surgery depending on tumoral response. Tumoral response was measured by citology, computed tomographical scans, and deep randomized biopsies of the bladder. RESULTS: Thirty-two out of 42 patients (76%; 95% confidence interval 45-93%) showed a major response (22 complete, and 10 partial). Response times ranged from 18 to 54 months. Three patients with T4 bladder primary tumors experienced a pathological CR. At a median follow-up of three years, 20 patients remain free of disease (47.6%), six patients are alive with disease (14.3%), 12 patients died of disease (28.5%), and four others died of unrelated causes (9.5%). Hematological toxicity included anemia, thrombocytopenia, and neutropenia. No grade four febrile neutropenia was observed. Non-hematological toxicity included alopecia (93.2%), diarrhea (11.4%), vomiting (18.5%) mucosytis (4.6%), and neuropathy (4.6%). Drug omissions or dose delay for adverse events were only necessary in one patient (2.2%), and three patients (6.8%), respectively. CONCLUSIONS: Paclitaxel and cisplatin is an active and well-tolerated neo-adjuvant regimen for previously untreated patients with pure TCC of the bladder, achieving a vesical preservation rate of 52%.
UI - 12084241
AU - Doherty A; Burkhard F; Holliger S; Studer U
TI - Bladder substitution in women.
SO - Curr Urol Rep 2001 Oct;2(5):350-6
AD - Department of Urology, University Hospital Berne, Anna Seiler-Haus, CH-3010 Berne, Switzerland. firstname.lastname@example.org
Bladder substitution in women with transitional cell carcinoma (TCC) is not a universally accepted procedure. There are many concerns, one of which is the potential risk of metachronous and synchronous urethral transitional cell carcinoma involvement. Another concern is that voiding dysfunction may be more frequent than in male patients. The numbers of female patients who have had this procedure are still small, and follow-up data are relatively brief. Thus, the true role for orthotopic bladder substitution in the female is still being evaluated. This paper reviews the data on this type of surgery in women, with emphasis on urethral TCC risk and on voiding dysfunction. Early results from a number of institutions are encouraging, particularly in correctly selected patients. Based on more than 15 years experience in an albeit small number of patients, we believe that if there is a functional external sphincter and tumor margins can be safely cleared, this form of surgery offers patients the best opportunity to preserve quality of life following cystectomy.
UI - 12102156
AU - Fossa SD; Skovlund E
TI - Selection of patients may limit the generalizability of results from cancer trials.
SO - Acta Oncol 2002;41(2):131-7
AD - Norwegian Radium Hospital, University of Oslo. email@example.com
Despite the development of apparently effective curative strategies according to results from clinical trials, survival rates for major cancer types have improved only slowly during recent years. Patient selection is discussed as an important reason for this observation. From 1989 to 1995 the Norwegian Radium Hospital entered 85 patients in an international multicentre trial assessing cisplatin-based neoadjuvant chemotherapy in T2-T4a bladder cancer. Forty-three eligible patients, among whom there were 36 non-consenting patients, and 106 ineligible patients received comparable local treatment outside the trial. The 3-year overall survival rates for the above three groups were 62%, 58%, and 31%, respectively (p < 0.001). Differences in overall as well as cancer-specific survival could be demonstrated, even after adjustment for prognostic factors. There was a significant difference in overall survival (p = 0.01) between the 85 trial patients and the 36 eligible patients who refused trial inclusion. Results and treatment recommendations from a trial can be transferred to daily practice only if eligibility criteria and selection of patients are taken into account. By registering patients undergoing comparable treatment outside a trial, the overall applicability of the treatment in question can be assessed.
UI - 12062605
AU - Van der Steen-Banasik EM; Visser AG; Reinders JG; Heijbroek RP; Idema
TI - JG; Janssen TG; Leer JW Saving bladders with brachytherapy: implantation technique and results.
SO - Int J Radiat Oncol Biol Phys 2002 Jul 1;53(3):622-9
AD - Joint Center for Radiation Oncology, Arnhem-Nijmegen, Radian-Arti, Wagnerlaan 47, 6815 AD Arnhem, The Netherlands. e.vandersteen@Radian.nl
PURPOSE: To analyze and report the treatment results of brachytherapy for solitary bladder cancer in the Arnhem Radiotherapy Institute. patients with a solitary bladder tumor were treated with a combination of transurethral resection, external beam radiotherapy (EBRT), and interstitial radiotherapy. The indications for bladder-conserving treatment were tumor < or =5 cm, T1G3 (n = 14), T2G2 (n = 8), T2G3 (n = 37), and T3a (n = 4). The prescribed implant dose was either 55 Gy (range 50-65 Gy) in combination with small pelvis external beam RT, 3-4 fractions of 3.5 Gy (n = 58), or 30 Gy in combination with 20 fractions of 2 Gy external beam radiotherapy (n = 5). Brachytherapy was performed with 2-8 137Cs needles until 1995 (n = 48) and 2-5 afterloading catheters (192Ir) since 1996 (n = 15). Follow-up cystoscopies were performed at 3-month intervals during the first 2 years, then every 6 months for 3 years, and annually after the fifth year. The median follow-up was 4.9 years. RESULTS: Twenty patients developed local recurrences, of which 6 were "true in-implant recurrences," 12 were in second bladder locations, and 2 were urethral recurrences. All recurrences developed within 2.5 years after treatment. Of these 20 patients, 13 underwent cystectomy: 6 stayed disease-free, 1 died of postoperative complications, 2 developed regional metastases, and 4 developed distant metastases. The 5-year disease-specific survival rate was 80% for patients with Stage T1 and 60% for those with Stage T2 disease. The local control rate was 70% in the whole patient population and 80% after salvage cystectomy. Forty-four bladders were saved. Acute complications were seen in 14 patients, and no significant late complications occurred. CONCLUSION: Using this treatment technique, a high cure rate with conservation of the bladder and only minor toxicity can be obtained in a selected patient population having a solitary tumor < or =5 cm.
UI - 12094336
AU - Culine S
TI - The present and future of combination chemotherapy in bladder cancer.
SO - Semin Oncol 2002 Jun;29(3 Suppl 9):32-9
AD - Department of Medicine, CRLC Val d'Aurelle, Cedex, France.
The combination of methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) has dominated the landscape of chemotherapy for advanced bladder cancer for over 15 years. Randomized studies have shown its superiority over cisplatin alone or in combination with cyclophosphamide and doxorubicin. However, it exhibits a significant toxicity profile and achieves only a slight impact on overall survival. Gemcitabine is among the new cytotoxic drugs in development for treatment of advanced urothelial cancer. The combination of gemcitabine and cisplatin represents a new standard alternative of treatment in the disease based on similar efficacy to and lower toxicity than the classic MVAC regimen. Future drug development will focus on the clinical usefulness of three-drug regimens (including gemcitabine, paclitaxel or docetaxel, and a platinum salt), and nonplatinum-based combinations, as well as showing the impact of adjuvant postcystectomy chemotherapy on survival. Copyright 2002, Elsevier Science (USA). All rights reserved.
UI - 11816602
AU - Nunez Mora C; Chamorro Ramos L; Rendon Sanchez D; Rios Gonzalez E;
TI - Pastor Arquero T; Aguilera Bazan A; Tabernero Gomez A; Cisneros Ledo J; Garcia Caballero J; de la Pena Barthel JJ [Clinical pathway for TUR of bladder neoplasms. Analysis of the first 2 years of its implementation]
SO - Arch Esp Urol 2001 Oct;54(8):777-86
AD - Servicio de Urologia, Hospital Universitario La Paz, Universidad Autonoma de Madrid, Madrid, Espana.
OBJECTIVE: To analyze the results of the first two years of application of the clinical pathway for transurethral resection (TUR) of bladder tumors at La Paz University Hospital. METHODS: We developed a clinical pathway of 4 hospital stays (5 days) for TUR of the bladder that included the following: matrix-verification, treatments prescribed, verification of changes, patient information sheet and patient satisfaction questionnaire. The information for the evaluation of the results were obtained from the pathway records and data on the activities of the Urology services. To assess the results for efficiency in the use of resources, the mean duration of hospital stay of patients in the pathway were compared with that of a control group comprised of 50 randomly selected patients submitted to TUR of the bladder in 1997. patients entered the clinical pathway. CONCLUSIONS: In our experience, the clinical pathway for the urinary bladder is a useful instrument for developing the clinical management of this condition. It reduces the unwanted changes in patient care and hospital stay, carries a low incidence of complications and readmissions, and achieves a high degree of patient satisfaction.
UI - 11816603
AU - Salinas Sanchez AS; Segura Martin M; Lorenzo Romero JG; Hernandez Millan
TI - I; Fernandez Olano C; Virseda Rodriguez JA [Quality of life of patients after radical surgery of bladder cancer]
SO - Arch Esp Urol 2001 Oct;54(8):787-95
AD - Servicio de Urologia, Complejo Hospitalario y Universitario de Albacete, Albacete, Espana. firstname.lastname@example.org
OBJECTIVE: To analyze the impact of surgery for bladder cancer on the patient's quality of life. METHODS: The SF-36 questionnaire was utilized to assess the quality of life of 53 cystectomized patients. Sociodemographic data, associated and surgery-related morbidity, type of urinary diversion, anatomopathological stage and current oncological status were analyzed. RESULTS: Patient mean age was 64.3 years. There were 46 males (86.8%), 33 (62.3%) had no schooling, 32 (68.1%) were social class IV and 35 (66.0%) had chronic associated conditions. External urinary diversion had been performed in 28 (52.8%) and bladder substitution in 21 (39.6%) patients. The early complication rate was 37.7% (n = 20) and the late complication rate was 86.8% (n = 46). Tumor stage was < or = pT2 in 28 cases (52.8%). Age correlated inversely with Physical Performance (r = -0.324; p = 0.018). Patients with chronic conditions had a lower score for Physical Performance, Vitality and SFI. Patients with tumor stage < or = pT2 scored higher for Physical Performance (p = 0.034), Vitality (p = 0.046), Mental Health (p = 0.036), Emotional Role (p < 0.05) and MSI (p < 0.05). Those with postoperative complications had a worse score for Physical Performance (p = 0.031), Vitality (p = 0.027), Emotional Role (p = 0.014), Mental Health (p = 0.012) and MSI (p = 0.015). The SF-36 showed no differences between the types of urinary diversion except that patients that had undergone orthotopic bladder substitution had a higher score for Physical Performance (p = 0.014) and FSI (p = 0.045). CONCLUSIONS: Although the quality of life of cystectomized patients is worse than that of the general population, it is better in younger patients without chronic associated conditions, no postoperative complications, lower tumor stage and those submitted to orthotopic bladder substitution.
UI - 11816613
AU - Mastroeni F; Aragona M; Caldarera E; Piccolo A; Rotondo S; Spinnato L;
TI - Aragona C Deep venous thrombosis in patients undergoing salvage radical cystectomy.
SO - Arch Esp Urol 2001 Oct;54(8):839-41
AD - Unita Operativa di Urologia, Azienda Ospedaliera Papardo-Messina, Italy. email@example.com
OBJECTIVE: The possible occurrence of venous thrombosis in tumor-bearing patients had already been reported by Trousseau in the past century. The blood clotting alterations in cancer-bearing patients can cause Deep Venous Thrombosis (DVT), especially in those patients with disseminated metastases. Anti-tumor chemotherapy can increase the risk of thrombosis. Herein we report our past experience on a sample of patients who underwent pelvic surgery to treat infiltrating bladder tumors. METHODS: We have retrospectively analyzed the records of patients with infiltrating bladder tumors who underwent salvage radical cystectomy. RESULTS: We observed the highest incidence of DVT (33.3%; 3 out of 9) in those patients with a higher risk due to anesthesia and an absolute need for extensive surgery. One of our patients died of pulmonary embolism. CONCLUSION: The diagnosis of DVT and Pulmonary Embolism is not always easy to achieve and all possible tests must be performed whenever possible (e.g. clinical examination, hematological test, etc.).
UI - 11761685
AU - Saint F; Irani J; Salomon L; Debois H; Abbou CC; Chopin D
TI - [Tolerance and efficiency of intravesical instillation of Calmette-Guerin in the prophylactic treatment of superficial bladder tumors, using a maintenance treatment]
SO - Prog Urol 2001 Sep;11(4):647-56
AD - Service d'Urologie, Hopital Henri Mondor, 51, avenue du Marechal de Lattre de Tassigny, 94010 Creteil. firstname.lastname@example.org
Maintenance treatment with complementary BCG instillations in the prevention of superficial bladder tumour could improve the results of this immunotherapy. This maintenance treatment is limited by accentuation of the adverse effects related to BCG. OBJECTIVES: To evaluate the impact of maintenance treatment on tumour recurrence and progression, and to evaluate the influence of adverse effects on maintenance treatment and the recurrence rate. MATERIAL AND METHODS: 72 patients were treated with six weekly instillations of 81 mg of BCG (Immucyst) followed by three complementary instillations 3, 6, 12, 18, 24, 30 and 36 months later. Adverse effects (AE) were classified into four classes, according to their type, severity and duration, and were recorded prospectively for 518 instillations. An adverse effect score was determined for each patient. RESULTS: 84.9% of patients did not present any recurrence, 12.5% developed recurrence and 2.6% progressed. The instillation regimen was completed by 19% of patients, the dose had to be decreased for 57% of patients and treatment had to be discontinued for 39% of patients. An initial adverse effect score (AESi) greater than 1.5 was associated with an increased risk of discontinuation of treatment or reduction of the dosage during maintenance treatment (p = 0.01). CONCLUSIONS: Maintenance treatment was associated with a very low recurrence and progression rate. We have established and validated an adverse effect severity scale and the consequences of these adverse effects on maintenance treatment. This scale could be used to prospectively define the most appropriate maintenance instillation regimen, by preventively decreasing the doses or deferring instillation.
UI - 11822064
AU - Bassi P; Iafrate M; Spinadin R; Carando R; Iannello R; Repele M;
TI - Mostaccio G; Ingrassia A; Pappagallo G [Superficial bladder neoplasia unresponsive to endocavitary treatment: when should the treatment approach be changed?]
SO - Arch Ital Urol Androl 2001 Dec;73(4):181-6
AD - Istituto di Urologia, Universita di Padova, Italia. email@example.com
PURPOSE: The appropriate treatment of superficial bladder neoplasm is still debated. The urologist must weigh the risk of tumor recurrence and progression against the possible side effects of conservative treatment (transurethral resection, intravesical therapy). Furthermore it is difficult to decide exactly when to abandon the conservative therapy and proceed with radical cystectomy and urinary diversion in order to prevent the potentially lethal sequelae of invasive bladder cancer. There are no certain scientific data on the appropriate therapeutic approach of recurrences of superficial bladder cancer after intravesical therapy and often the urologist takes a decision based on his personal experience ("art rather than science"). Based on these considerations, our aim was to evaluate applicable criteria to predict the risks of tumor recurrence and progression and so decide the best treatment for each patient. METHODS: 148 patients with multifocal, multirecurrent or persistent superficial bladder cancer (stage Ta-T1-Tis, G1-3) were treated with transurethral resection and/or two or more administration of intravesical chemo- (Mitomycin C, Doxorubicin, Epirubicin, Mitoxantron) or immuno-therapy (BCG) using common treatment schedule. Our first end point was the disease-free survival (DFS) evaluated by three different criteria: 1) "dynamic" stage (stage T1 diagnosed at the beginning, or during the follow-up or never); 2) "dynamic" grade (G3 tumor diagnosed at the beginning or during the follow-up or never); 3) "number of positive cystoscopies at the 3-year follow-up". Data were evaluated by a univariate statistical analysis (log-rank test) and a multivariate ones (MPLR stepwise procedure and L-ratio Cox's test). RESULTS: "Dynamic" stage: patients who never developed a T1 stage tumor have a better DFS than patients who developed a T1 stage tumor and even more than patients in which T1 was diagnosed from the beginning (p < 0.0001). "Dynamic" grade: patients who never developed a G3 tumor have a better DFS than patients who developed a G3 tumor and patients in which G3 tumor was diagnosed from the beginning (p < 0.0017). "Number of positive cystoscopies at the 3-year follow-up": patients with less than 3 positive cystoscopies have a better prognosis than patients with 3 or more positive cystoscopies at the three-year follow-up (p < 0.0380). DISCUSSION: We have found three independent predictive prognostic factors: "dynamic" stage, "dynamic" grade and number of positive cystoscopies at the 3-year follow-up. The statistical univariate and multivariate analyses allow us to define three risk categories for tumor progression (> or = T2): low, moderate, high.
UI - 11723435
AU - Fischetti G; Barrese F; Cuzari S; Marino C; Mariani S; Morello P
TI - [Neoadjuvant chemotherapy and conservative surgery in invasive bladder cancer. Personal experience]
SO - Minerva Urol Nefrol 2001 Sep;53(3):119-23
AD - Dipartimento di Urologia U. Bracci IV SS, Universita degli Studi La Sapienza, Rome, Italy.
BACKGROUND: To evacuate the efficacy of conservative treatment in invasive stage T2 bladder tumours by means of deep transurethral resection of the bladder (TURB) follo