scholarly journals NONMUSCLE INVASIVE TRANSITIONAL CELL CARCINOMA OF URINARY BLADDER – ADJUVANT INTRAVESICAL THERAPIES AFTER TRANSURETHRAL TUMOR RESECTION

2017 ◽  
Vol 64 (3) ◽  
pp. 207-210
Author(s):  
Nicolae Grigore ◽  
◽  
Valentin Pirvut ◽  
Ionela Mihai ◽  
Adrian Hasegan ◽  
...  
Keyword(s):  
Tumor Progression ◽  
Recurrence Rate ◽  
Transitional Cell ◽  
Invasive Disease ◽  
Intravesical Therapy ◽  
First Year ◽  
Progression Rate ◽  
Free Survival ◽  
Muscle Invasive ◽  
Intravesical Immunotherapy

Introduction. More than 70% of all bladder cancers are nonmuscle invasive involving only the mucosa and the submucosa. A large percentage of patients present local recurrence after endoscopic surgery, and many of them progress to muscle invasive disease necessitating radical cystectomy. The high recurrence and progression rate is the reason to use intravesical therapy to prevent recurrences. The aim of this study is to compare the efficacity and safety of intravesical immunotherapy with Bacillus Calmette Guerin (BCG) vs. chemotherapy (Pharmoribicin) after TUR-B for NMIBC. Material and methods. Following TURB and pathological analysis, NMIBC was stratified into low, intermediate and high-risk groups depending on the probability of recurrence and progression to muscle-invasive disease. Patients were treated with adjuvant intravesical therapies, BCG or Pharmorubicin. Results. Between 2008 and 2012, a total of 125 patients with NMIBC were diagnosed in the Urology Department Sibiu. Histopathological data show: pT1 G1 – 48 patients (38.4%), pT1 G2 – 69 patients (55.2%), pT1G3 and or Tis – 8 patients (6.4%). Adjuvant intravesical therapies with Pharmorubicin was administered to 83 patients (66.4%) and with BCG 42 patients (33.6%). Pharmorubicin, the recurrence rate was 22.8% in the first year and at 5 years there was a recurrence of 36.1%. For the group of patients treated with BCG recurrent rate was 14.2% in the first year and 33,3% at 5 years. For the whole group of patients tumor progression was 2.4% in the first year and 9.6% at 5 years. For the Pharmorubicin group, in the first year, the progression was 2.4% compared with 2.3% tumor progression in the BCG-treated group. Conclusions. Intravesical instillation treatment after TURB reduce the recurrence rate and tumor progression. In our series there are no major differences between efficacity of intravesical immunotherapy (BCG) vs. chemotherapy (Pharmoribicin). Disease-free survival and progression-free survival are comparable to the two studied lots.

Electromotive Drug Administration of Mitomycin C (EMDA/MMC) versus Intravesical Immunotherapy with Bacillus Calmette-Guérin (BCG) in Intermediate and High Risk Non Muscle Invasive Bladder Cancer

2021 ◽  
pp. 1-8
Author(s):  
Michele Zazzara ◽  
Arjan Nazaraj ◽  
Marcello Scarcia ◽  
Giuseppe Cardo ◽  
Roberto Carando ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
High Risk ◽  
Adjuvant Therapy ◽  
Adjuvant Treatment ◽  
Invasive Bladder Cancer ◽  
Intravesical Therapy ◽  
Progression Rate ◽  
Muscle Invasive Bladder Cancer ◽  
Free Survival ◽  
Muscle Invasive

<b><i>Background:</i></b> Although TURB of tumor (TURBT) by itself can eradicate a non-muscle-invasive bladder cancer (NMIBC) completely, these tumors commonly recur and can progress to MIBC. It is, therefore, necessary to consider adjuvant therapy in most patients. The primary objective of the present study was to report our experience with EMDA/MMC and BCG, considering efficacy, progression, and recurrence, as adjuvant therapy in NMIBC patients; the secondary objective was to assess the efficacy of EMDA/MMC versus BCG as a comparative treatment. <b><i>Methods:</i></b> Between April 2016 and February 2020, a series of 216 patients, with a diagnosis of intermediate- and high-risk NMIBC after TURBT, underwent adjuvant intravesical therapy. In 26 cases with a failure of the treatment, in patients unfit and unwilling for radical cystectomy, a repeated intravesical therapy was performed (2 had a twice repetition). Out of 244 adjuvant therapies, 140 EMDA/MMC and 104 BCG treatments were done. The following data were collected for each patient: baseline demographics and clinical data and perioperative and postoperative data. Overall patients’ adjuvant intravesical therapies were included in a prospectively maintained institutional database, and a retrospective chart review was performed. We collected data on 2 main outcomes, recurrence-free survival (defined as a negative cystoscopy, cytology, and/or histology at the evaluation time point) and progression-free survival (defined as a negative cystoscopy or a nonprogressive tumor recurrence). <b><i>Results:</i></b> The NMIBC progression rate was higher in BCG than EMDA/MMC but not statistically significant (respectively, 4.2% vs. 2.5%; <i>p</i> = 0.703). In the overall population, the risk of NMIBC recurrence was higher after BCG than EMDA/MMC (<i>p</i> = 0.025). In the subgroups of 59 paired patients with similar characteristics, no difference was observed between groups in NMIBC progression and recurrence. <b><i>Conclusions:</i></b> Our findings suggest that EMDA/MMC and BCG are safe and reproducible approaches as adjuvant treatment in NMIBC. EMDA/MMC permits to achieve a fine oncological management as adjuvant treatment in NMIBC, which is not less than that obtained with BCG.

Multi-institutional review of sequential intravesical gemcitabine and mitomycin C chemotherapy for non-muscle-invasive bladder cancer.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 294-294
Author(s):  
Andrew J. Lightfoot ◽  
Benjamin N. Breyer ◽  
Henry M. Rosevear ◽  
Badrinath Konety ◽  
Michael A. O'Donnell
Keyword(s):  
Bladder Cancer ◽  
Mitomycin C ◽  
Median Time ◽  
Combination Chemotherapy ◽  
Invasive Bladder Cancer ◽  
Intravesical Therapy ◽  
Recurrence Free Survival ◽  
Muscle Invasive Bladder Cancer ◽  
Free Survival ◽  
Muscle Invasive

294 Background: Combination chemotherapy is the standard of care for neoadjuvant, adjuvant, and metastatic bladder cancer due to increased efficacy when compared to monotherapy. We report our experience with sequential intravesical combination chemotherapy using gemcitabine and mitomycin C (MMC) for non-muscle invasive bladder cancer (NMIBC). Methods: We performed a multi-institutional retrospective review of 47 consecutive patients who received 6 weekly treatments with sequential gemcitabine (1g) and mitomycin C (40mg) chemotherapy for NMIBC. Thirty patients received treatment at University of Iowa, 14 at UCSF and 3 at University of Minnesota. Results: A total 47 patients (median age 70, range 32-85; 36 males, 11 females) previously failing a median of 2 intravesical treatments were reviewed. The complete response (CR), 1-year recurrence-free survival (1-RFS) and 2-year recurrence-free survival (2-RFS) for all patients was 68%, 48% and 38%, respectively. In all, 14 of 47 patients (30%) remain free of recurrence with a median time to followup of 26 months (range 6-80 months). The median time to recurrence for all patients who recurred was 4 months (range 1-33 months). Ten patients required cystectomy. Conclusions: Sequential intravesical combination chemotherapy using gemcitabine and MMC appears to be a useful treatment for patients with a history of NMIC which has failed BCG or other intravesical therapy, in addition to patients with intermediate and high-risk disease.

scholarly journals Novel and emerging approaches in the management of non-muscle invasive urothelial carcinoma

2021 ◽  
Vol 13 ◽  
pp. 175883592110390
Author(s):  
Omid Yassaie ◽  
Cyrus Chehroudi ◽  
Peter C. Black
Keyword(s):  
Treatment Options ◽  
Unmet Need ◽  
Invasive Disease ◽  
Intravesical Therapy ◽  
Low Grade ◽  
High Grade ◽  
Bcg Therapy ◽  
Muscle Invasive ◽  
Considerable Morbidity ◽  
Intravesical Bcg Therapy

Non-muscle invasive bladder cancer (NMIBC) has traditionally been managed with transurethral resection followed by intravesical chemotherapy and/or bacillus Calmette–Guerin (BCG) in a risk-adapted manner. These tumors commonly recur and can progress potentially to lethal muscle invasive disease. A major unmet need in the field of NMIBC is bladder preserving therapy for recurrent high-grade NMIBC after adequate intravesical BCG therapy. The current gold standard treatment for these BCG-unresponsive patients is radical cystectomy, which is associated with considerable morbidity and mortality, particularly in older and frailer patients. It is therefore critical to provide alternative treatment options with acceptable oncological outcomes. In this review we explore novel bladder-sparing treatment options including combination intravesical therapy, enhanced instillation methods, immunotherapy, gene therapy, targeted therapy, photodynamic therapy and BCG variants across the spectrum of NMIBC disease states, ranging from low grade BCG-naïve patients through to high-grade BCG-unresponsive NMIBC.

scholarly journals TP7.2.3 The effect of immediate versus early instillation of mitomycin C after transurethral resection of bladder cancer: Is timing everything?

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Ricardo Fernandes ◽  
Ankur Mukherjee ◽  
Ameet Patel
Keyword(s):  
Bladder Cancer ◽  
Mitomycin C ◽  
Cohort Analysis ◽  
Invasive Disease ◽  
Intravesical Instillation ◽  
First Year ◽  
Retrospective Cohort Analysis ◽  
The Mean ◽  
Muscle Invasive

Abstract Introduction and Aims Almost three quarters of patients diagnosed with bladder cancer have non-muscle invasive disease. The European Association of Urology (EAU) guidelines recommend the use of intravesical instillation of Mitomycin C (MMC) to reduce the rate of recurrence. Methods A retrospective cohort analysis was carried out of all patients who underwent a TURBT between January 2016 and January 2019 in our Trust. A comparison of recurrence outcomes was investigated between patients who had immediate instillation of MMC (within 1 hours post-TURBT) versus early instillation (within 24 hours post-TURBT). Recurrence was assessed at 3 months cystoscopy and at 1 year follow-up. Results 201 patients were included. 100 underwent immediate MMC instillation (75% male, 25% female); 101 early instillation (72% male, 28% female). There was 11% recurrence (immediate) versus 13% (early) in instillation groups at 3 months. At first year, recurrence was seen in 12% (immediate) versus 14% (early) groups. Of these recurrences, there was an upstaging of tumour in 27% (immediate) versus 31% (early) at the 3 monthly follow-up and 25% (immediate) versus 28% (early) at the 1st year. The mean period of post-operative stay following initial TURBT was 0.8 days in the immediate versus 1.1 days in the early instillation groups. Conclusion Although no statistical differences were seen in this study, the results appear to favour immediate instillation of MMC after TURBT with respect to reduction in recurrence and upstaging rates. Post-operative length of stay in hospital was also shorter in patients who had an immediate MMC instillation.

scholarly journals To Compare Frequency of Tumour Recurrence in Low Risk Transitional Cell Carcinoma of Bladder Between Single Dose Mitomycin C Instillation and Control Group

2020 ◽  
Vol 10 (2) ◽  
Author(s):  
Sanaullah . ◽  
Mumtaz Ali ◽  
Nizamuddin . ◽  
Fazal Elahi ◽  
Amanullah . ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Mitomycin C ◽  
Recurrence Rate ◽  
Transitional Cell ◽  
Low Risk ◽  
Invasive Bladder Cancer ◽  
Muscle Invasive Bladder Cancer ◽  
Group A ◽  
Muscle Invasive ◽  
Group B

Background: Many regimes of intravesical therapy have been tried in attempt to reduce the recurrence rate of non muscle invasive bladder cancer, these generally require frequent attendance for instillation. Multiple non-comparative studies have demonstrated the favourable outcomes of the immediate treatment by instillation of mitomycin C after transurethral resection of bladder tumor (TURBT) in cases of non-muscle invasive Transitional Cell Carcinoma.Objective: To compare frequency of tumour recurrence in low risk transitional cell carcinoma of bladder between single dose Mitomycin C instillation and control group.Material and Methods: This study was conducted at urology departmentsaidu teaching hospital and Nawaz sharif kidney center swat. Study Design Quasi Experimental.Study Duration was (From: Feb 2018 to February 2019). Total 62 patients fulfilling the inclusion criteria were selected. Patient were divided between group A and B according to Non probability purposive sampling. TURBT was done in all patients. In those assigned to group A Mitomycin C 40mg was instilled through foleys catheter and clamped within 12 hrs of resection once haematuria has cleared. Mitomycin C was retained for 2 hrs and then foleys catheter was removed.Results: Mean age of patients in Group-A and in Group-B was 54.90±11.48 and 60.03±13.58 years respectively. In Group-A 1(3.2%) and in Group-B 9(29%) patients had recurrence after 3 months follow up time period. Recurrence rate of Group-B was significantly higher. i.e. (p-value=0.006).Conclusion: Results of this study showed the superiority of mitomycin C in patients with low risk non muscle invasive bladder cancer in terms of significantly lower recurrence rate as compared to that of control group. So, it can be said that single mitomycin C instillation significantly decrease recurrence in patients with low risk non muscle invasive bladder cancer.

scholarly journals Prospective Randomized Study between Intravesical BCG and Mitomycin-C for Non-Muscle-Invasive Urothelial Carcinoma of Urinary-Bladder Post TURBT

2016 ◽  
Vol 15 (1) ◽  
pp. 74-77 ◽  
Author(s):  
Hari Pada Mondal ◽  
Kapang Yirang ◽  
Chandranath Mukhopadhyay ◽  
Shyam Sundar Adhikary ◽  
Biswajit Dutta ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Side Effects ◽  
Urinary Bladder ◽  
Mitomycin C ◽  
Recurrence Rate ◽  
Long Term Results ◽  
Intravesical Therapy ◽  
Intravesical Bcg ◽  
Muscle Invasive

Background: Approximately 70% of urinary bladder cancer are non-muscle invasive at presentation. It is notorious for its high incidence and recurrence rate. The five-year recurrence rate varies between 30 and 60%. The intravesical treatment evolved out of need to prevent tumour recurrence after local surgical resection.Objectives: To compare intravesical Mitomycin C and BCG therapies in the prevention of recurrences and severity of their side effects.Materials and Methods: 40 patients with superficial bladder cancer were studied in urology unit of surgery department of North Bengal Medical College, Darjeeling from June, 2012 to May, 2013. They underwent transurethral resection of bladder tumour. Post operatively 19 patients were treated by intravesical Mitomycin C and 21 patients with BCG. Post intravesical therapy, patients were monitored 3 monthly for recurrence and side effects.Results: No recurrence was observed at the 3rd month follow up, two recurrences were observed at the end of 6th month in the Mitomycin C group. Regarding side effects, cystitis had no significant difference between the two groups but fever, hematuria and retention of urine were found significantly in BCG group during the study period.Conclusions: In the prevention of recurrences, intravesical Mitomycin C and BCG therapies have comparable efficacies at the end of 6 months. A further follow up period is required to see and compare the long term results. The incidence of the side effects although mild was much higher with intravesical BCG therapy.Bangladesh Journal of Medical Science Vol.15(1) 2016 p.74-77

A combined phase I/II trial of intravesical nanoparticle albumin-bound paclitaxel in the treatment of refractory non–muscle- invasive transitional cell bladder cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16047-e16047
Author(s):  
L. Barlow ◽  
M. Laudano ◽  
M. Mann ◽  
M. Desai ◽  
D. Petrylak ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Phase I ◽  
Dose Escalation ◽  
Phase I Trial ◽  
Transitional Cell ◽  
Intravesical Therapy ◽  
Systemic Absorption ◽  
Imaging Results ◽  
Muscle Invasive ◽  
Ongoing Phase

e16047 Background: Up to 50% of patients treated with intravesical agents for non-muscle-invasive bladder cancer will recur. Response rates to current second line intravesical therapies average less than 20%. For these high risk patients, novel agents are necessary. Our previously completed phase I trial showed docetaxel to be a safe and efficacious agent for intravesical therapy. Nanoparticle albumin-bound (nab-) paclitaxel has been shown to have increased solubility and lower toxicity compared to docetaxel in systemic therapy and is therefore an appropriate candidate for further investigation as an intravesical agent. Methods: The ongoing phase I component of this combined phase I/II trial began enrollment on 1/1/08 and has reached 72% accrual as of 1/1/09. Inclusion criteria include recurrent high grade (HG) Ta, T1 and Tis transitional cell carcinoma failing at least one prior regimen with any intravesical agent. In phase I, 6 weekly instillations of nab-paclitaxel were administered beginning at a dose of 150 mg with a dose escalation model used until a maximal tolerated dose (MTD) was achieved. The primary endpoints were dose- limiting toxicity (DLT) and MTD; the secondary endpoint was response rate. Efficacy was evaluated by cystoscopy with biopsy, cytology, and CT imaging. Results: 13/18 patients have enrolled in this phase I trial to date, and the distribution of stages included 5 patients with Tis, 4 patients with HGTa, and 4 patients with HGT1. No patient has had any systemic absorption of nab-paclitaxel as measured by HPLC assays, and no grade 3 or 4 DLT has been encountered. Fifty-four percent (7/13) patients were noted to experience grade 1 toxicities, with dysuria being the most common. Forty-two percent (5/12) of completed patients had no evidence of disease at their post-treatment cystoscopy. None of the patients who developed recurrent disease have had disease progression. Conclusions: Intravesical nab-paclitaxel has exhibited minimal toxicity and no systemic absorption in the first ever human intravesical dose escalation trial. Upon completion of this ongoing phase I trial, we plan to evaluate this agent in a larger phase II efficacy study. No significant financial relationships to disclose.

Oncological outcomes of intravesical gemcitabine and docetaxel for select patients with high grade recurrent NMIBC.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 4546-4546 ◽  
Author(s):  
Niv Milbar ◽  
Max Kates ◽  
Meera R. Chappidi ◽  
Mark P. Schoenberg ◽  
Trinity Bivalacqua
Keyword(s):  
Disease Free Survival ◽  
Standard Of Care ◽  
Intravesical Therapy ◽  
Johns Hopkins Hospital ◽  
Bladder Preservation ◽  
Free Survival ◽  
Cox Proportional Hazard ◽  
Cox Proportional Hazard Models ◽  
Clinically Meaningful Outcomes ◽  
Muscle Invasive

4546 Background: Bacillus Calmette-Guerin (BCG) unresponsive patients with Non-Muscle Invasive Bladder Cancer (NMIBC) who prefer bladder preservation over Radical Cystectomy (RC) or are poor surgical candidates may be offered intravesical therapies. 2nd line intravesical Gemcitabine (GEM) combined with Docetaxel (DOCE) has been offered at Johns Hopkins Hospital (JHH). Our objective was to evaluate JHH experience with GEM/DOCE, and specifically to address appropriate endpoints for 2nd-line therapies in NMIBC. Methods: 33 patients who received full induction courses of GEM/DOCE since 2011, per the protocol adapted from Michael O’Donnell at U. Iowa, were identified in the IRB-approved JHH NMIBC database. Multivariable logistic regression determined factors associated with LG and HG recurrence. Cox proportional hazard models evaluated risk factors for disease free survival (DFS) and HG recurrence-free survival (HG-RFS). Results: Median DFS was 6.5 months with 42% 1-year and 24% 2-year DFS. Median HG-RFS was 17.1 months with 56% 1-year and 42% 2- year HG-RFS. Median HG-RFS among patients who initiated GEM/DOCE with HG pathology was 15.7 months, with 51% 1-year HG-RFS and 34% 2-year HG-RFS. Within initial HG-NMIBC presentation, 46% (13/28) had HG recurrence. 80% (4/5) of patients with initial LgTa had LG recurrence and 20% (1/5) had HG recurrence. There were no significant predictors for HG-RFS or DFS. There were 5 LG recurrences, and 16 HG recurrences, with 6 progressions among these. 7 patients underwent RC at a median of 14.9 months. Conclusions: GEM/DOCE is a well-tolerated alternative to immediate RC for highly selected patients with HG-NMIBC. As anticipated, including LG recurrence as an endpoint made GEM/DOCE appear less efficacious. However, since standard of care for LG recurrence is further intravesical therapy and recurrence does not result in worse cancer outcomes, it may not be an appropriate endpoint. Future studies of 2nd line therapies for NMIBC should identify endpoints based on clinically meaningful outcomes of interest.

scholarly journals Can re-cTURBT be useful in pT1HG disease as a risk indicator of recurrence and progression? A single centre experience

2017 ◽  
Vol 89 (4) ◽  
pp. 272
Author(s):  
Roberto Giulianelli ◽  
Barbara Cristina Gentile ◽  
Gabriella Mirabile ◽  
Luca Albanesi ◽  
Paola Tariciotti ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
High Risk ◽  
Transurethral Resection ◽  
Invasive Disease ◽  
Definitive Treatment ◽  
Progression Rate ◽  
Persistent Disease ◽  
Muscle Invasive ◽  
Muscle Invasion ◽  
Bladder Tumours

Introduction: Understaging after initial transurethral resection is common in patients with high-risk non muscle infiltrating bladder cancer (NMIBC) and can delay accurate diagnosis and definitive treatment. The rate of upstaging from T1 to T2 disease after repeated transurethral resection ranges from 0 to 28%, although the rate of upstaging may be even higher up to 49% when muscularis propria is absent in the first specimen. A restaging classic transurethral resection of bladder tumour (re-cTURBT) is the better predictor of early stage progression. According to some reports, the rate of positivity for tumor in re-cTURBT performed within eight weeks after initial cTURBT was as high as 18-77%, and in about 40% of the patients a change in tumor stage was reported. We aimed to investigate, in high risk group, the presence of residual tumor following white light classical transurethral resection of bladder tumor (WLre-cTURBT) and the different recurrence and progression rate between patients with persistent or negative (pT0) oncological disease after WLre-cTURBT. Materials and methods: A cohort of 285 patients presenting with primitive bladder cancer underwent to WLcTURBT from January 2011 to December 2015; out of them 92 (32.28%) were T1HG. In according to EAU guidelines 2011, after 4-6 weeks all HG bladder cancer patients underwent a WL recTURBT . All patients were submitted to a subsequent followup including cystoscopy every 3 months with multiple biopsies, randomly and in the previous zone of resection; urinary citology on 3 specimens and kidney/bladder ultrasound every 6 months. The average follow-up was 48 months. Results: Following WLre-cTURBT we observed a persistent disease in 18 (15.2%) patients: 14 (77.7%) with a HG-NMIBC and 4 (22.2%) with a high grade (HG) muscle invasive bladder cancer (pT2HG). After follow up of all 92 patients according to the guidelines EAU, we observed recurrence in 36/92 (39.1%) and progression in 14/92 (15.2%). Of 14 NMIBC with persistent disease, 10 patients (71.4%) showed recurrence: 4 patients (40%) were pT1HG with concomitant carcinoma in situ (CIS), 3 patients (30%) multifocal pTaHG, 2 (20%) patients CIS and one patient (10%) a muscle invasive neoplasm (pT2HG). Instead of the group of 48 patients pT0 following WL recTURBT, we observed recurrence in 26 patients (54.1%) and in two patients (4.1%) progressions, who presented after 3 months in association with CIS. The remaining 22 patients (45.9%) with initial pT1HG are still progression free. Multivariate analysis showed that the most important variable of early progression were persistent neoplasm and histopathological findings at WLre-cTURBt (p = 0.01), followed by the Summary No conflict of interest declared. INTRODUCTION Bladder cancer is a common genito-urinary malignancy, with transitional cell carcinoma comprising nearly 90% of all primary bladder tumours. At the first diagnosis 70% to 80% of urothelial tumours are confined to the epithelium, the remainder is characterized by muscle invasion. A significant number of patients with high risk non-muscle invasive bladder tumours (HG-NMIBT) treated with white light classic transurethral resection of bladder tumours (WLcTURBT) and intravesical BCG will progress to invasive disease (1-3). Progression to muscle invasion (pT2) mandates immediate radical cystectomy (4). WLcTURBT is the standard initial therapy for NMIBT, but the high percentage of recurrence after surgery is still an unresolved problem (5). High grade pT1 bladder neoplasm (pT1HG) really represents a therapeutic challenge due to the high risk of progression (about 15-30%) to muscle-invasive disease, usually within 5 years (6). However, no consensus exists regarding the treatment of patients with recurrent bladder tumours that invade the lamina propria (pT1) (7-9). Recent studies suggested that the first cTURBT may be incomplete in a significant number of cases (10). Understaging at the time of the initial transurethral resection is common for patients with high-risk NMIBC and can delay accurate diagnosis and definitive treatment. It is therefore recommended for patients with high-risk disease and in those with large or multiple tumors or when the initial transurethral resection is incomplete, to repeat WLre-cTURBT within 2-6 DOI: 10.4081/aiua.2017.4.272 result of the first cystoscopy (p = 0.002) and presence of CIS (p = 0.02). Discussion: Following WLre-cTURBt in HG-NMIBC patients we identified in 15% of cases a persistent disease with a 4.3% of MIBC. In the high risk persistent bladder neoplasms group we observed recurrent and progression rate higher than in T0 bladder tumours group (Δ = + 17.3% and = Δ + 62.5%, p < 0.05

scholarly journals Advances in risk stratification of bladder cancer to guide personalized medicine

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 1137 ◽  
Author(s):  
Justin T. Matulay ◽  
Ashish M. Kamat
Keyword(s):  
Bladder Cancer ◽  
Risk Stratification ◽  
Clinical Outcomes ◽  
Specific Treatment ◽  
Invasive Disease ◽  
Intravesical Therapy ◽  
Sequencing Data ◽  
Prognostic Information ◽  
Genetic Sequencing ◽  
Muscle Invasive

Bladder cancer is a heterogeneous disease that poses unique challenges to the treating clinician. It can be limited to a relatively indolent papillary tumor with low potential for progression beyond this stage to muscle-invasive disease prone to distant metastasis. The former is best treated as conservatively as possible, whereas the latter requires aggressive surgical intervention with adjuvant therapies in order to provide the best clinical outcomes. Risk stratification traditionally uses clinicopathologic features of the disease to provide prognostic information that assists in choosing the best therapy for each individual patient. For bladder cancer, this informs decisions regarding the type of intravesical therapy that is most appropriate for non-muscle-invasive disease or whether or not to administer neoadjuvant chemotherapy prior to radical cystectomy. More recently, tumor genetic sequencing data have been married to clinical outcomes data to add further sophistication and personalization. In the next generation of risk classification, we are likely to see the inclusion of molecular subtyping with specific treatment considerations based on a tumor’s mutational profile.

Sign in / Sign up

Export Citation Format

Share Document