scholarly journals Photodynamic Diagnosis for Superficial Bladder Cancer: Do All Risk-Groups Profit Equally from Oncological and Economic Long-Term Results?

2009 ◽  
Vol 3 ◽  
pp. CMO.S1012 ◽  
Author(s):  
Wolfgang Otto ◽  
Maximilian Burger ◽  
Hans-Martin Fritsche ◽  
Andreas Blana ◽  
Wolfgang Roessler ◽  
...  

Objective Photodynamic diagnosis (PDD) of superficial bladder cancer decreases recurrence rates. We present oncological results of a randomized, prospective study, comparing transurethral resection (TUR) performed under conventional white light (WL) with PDD. The follow-up period is the longest reported to date. As costs might be reimbursed by prolonged recurrence-free survival in certain patients cost analysis in regard to risk-groups was performed. Material and methods Using chi-square test and log-rank test we compared recurrence rates of 103 patients after WL-TUR and of 88 patients after PDD-TUR. Cost analysis was performed according to risk-groups of recurrence. Results Mean follow-up was 99 months. Recurrence rate was 57% in WL vs. 28% in PDD (p < 0.001). Costs incurred by subsequent TUR averaged € 2310 per WL patient vs. € 713 per PDD patient. Savings per patient by PDD amounted to € 1597. PDD costs were reimbursed in low, intermediate and high risk patients, respectively. Conclusions PDD-TUR is significantly superior to conventional WL-TUR in terms of recurrence rate. While economic benefit is most prominent in intermediate risk patients, PDD related costs are reimbursed in all risk-groups.

2016 ◽  
Vol 15 (1) ◽  
pp. 74-77 ◽  
Author(s):  
Hari Pada Mondal ◽  
Kapang Yirang ◽  
Chandranath Mukhopadhyay ◽  
Shyam Sundar Adhikary ◽  
Biswajit Dutta ◽  
...  

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


1988 ◽  
Vol 6 (9) ◽  
pp. 1450-1455 ◽  
Author(s):  
H W Herr ◽  
V P Laudone ◽  
R A Badalament ◽  
H F Oettgen ◽  
P C Sogani ◽  
...  

The effectiveness of BCG in preventing disease progression in patients with superficial bladder cancer is evaluated. Long-term follow-up of high-risk patients treated in a previously reported randomized control trial of intravesical plus percutaneous BCG shows that progression occurred in 41/43 (95%) of control and 23/43 (53%) of BCG-treated patients. Muscle invasive and/or metastatic disease occurred with equal frequency in the two groups, but was significantly delayed by BCG treatment (P = .012). Cystectomies were required in 18/43 (42%) control and 11/43 (26%) BCG-treated patients. Median time to cystectomy was 8 months for control v 24 months for BCG-treated patients. Based on initial treatment, survival was improved by BCG therapy (P = .032) (median follow-up 6 years). These results suggest that in high-risk patients intravesical BCG can delay disease progression, prolong the period of bladder preservation, and increase overall survival.


2006 ◽  
Vol 175 (4S) ◽  
pp. 268-269 ◽  
Author(s):  
Jessie L. Au ◽  
Robert A. Badalament ◽  
M. Guillaume Wientjes ◽  
Donn C. Young ◽  
Tong Shen ◽  
...  

2021 ◽  
pp. 51-54
Author(s):  
Md. Shafiqur Rahman ◽  
Sanjeeb Bhakta Bista ◽  
Md. Sayedul Islam ◽  
A. S. M. Shafiul Azam ◽  
Md. Shamim Hossain ◽  
...  

Background: Transurethral resection of the bladder tumor (TURBT) is the cornerstone of diagnosis and TURBT followed by selective adjuvant intravesical chemotherapy or immunotherapy is the gold standard of treatment for the patients with non-muscle invasive bladder cancer (NMIBC). Even after complete resection of the tumor there is high risk of residual tumor and subsequent recurrence and progression of the disease. The recurrence of T1 tumor is found to be around 71 % within 5 years and High grade T1 lesions recur in more than 80% of the cases and progress in 50% of the patients within 3 years. Disease status at 3 months after initial resection is an important predictor of subsequent recurrence and progression. To assess the tumor recurrence rat Objective: e among patients with newly diagnosed T1 bladder cancer between repeat transurethral resection group and single TURBT group. Ra Type of study: ndomized controlled trial. Place of study: Department of urology, BSMMU, Dhaka, Bangladesh. This Randomi Materials And Methods: zed Controlled Trial was conducted in urology department of BSMMU, Dhaka, Bangladesh from February 2017 till September 2018. A total of 50 patients, diagnosed as a case of T1 bladder cancer and who fulll the selection criteria were randomly divided in two groups consisting of 25 patients in each group. After informed consent, repeat TUR was done after 4 weeks of the initial TURBT for only 22 patients in group I since 3 of the patients did not show up on the scheduled date of surgery. Whereas, repeat TUR was not done for other 25 patients in group II. All the patients in both the groups were further treated with intravesical therapy according to the histopathological report. The patients in both the groups were followed up at 3 months and 6 months of the initial intervention where detailed history was taken, relevant investigations were done and check cystoscopy was done. TURBT was done for recurrent tumors. Out of 22 patients in group I, 2 patients were excluded for follow up on the basis of repeat TUR ndings. Whereas in group II, 2 patients missed the follow up and one of them missed the normal scheduled dose of intravesical therapy. Hence, 22 patients completed the study in group II. The baseline variables like age and Results: sex were similar in both the groups with higher male predominance. There was no statistical signicant difference in tumor characteristics such as size, number and grade of the tumor between the two groups. Out of 22 patients in group I who underwent repeat TUR at 4 weeks of initial TUR, residual disease was found in 8 (36.36%) patients. One of the patient was found to have T2 disease and 1 patient had CIS during repeat TUR. These 2 patients were not followed up since the treatment strategy changed after the results of repeat TUR. After 6 months of follow up of all the patients, 2 (10%) out of 20 patients in group I were found to have tumor recurrence however, in group II, 9 (40.9%) patients had tumor recurrence. The tumor recurrence rate between the two groups was found to be statistically signicant (p=0.023). In the light of ndings of this Conclusion: study, it can be concluded that performing repeat transurethral resection in patients with newly diagnosed T1 bladder cancer at 4 weeks of initial TURBT, helps to detect signicant number of residual tumor and reduce early recurrence rate of the tumor.


2000 ◽  
Vol 164 (3 Part 1) ◽  
pp. 680-684 ◽  
Author(s):  
F. MILLÁN-RODRÍGUEZ ◽  
G. CHÉCHILE-TONIOLO ◽  
J. SALVADOR-BAYARRI ◽  
J. PALOU ◽  
F. ALGABA ◽  
...  

2007 ◽  
Vol 6 (2) ◽  
pp. 171 ◽  
Author(s):  
S. Gudjonsson ◽  
B.L. Isfoss ◽  
K. Hansson ◽  
A.M. Domanski ◽  
J. Warenholt ◽  
...  

2018 ◽  
Vol 7 (1) ◽  
pp. R26-R37 ◽  
Author(s):  
Nidan Qiao

Introduction It is unclear whether the proportions of remission and the recurrence rates differ between endoscopic transsphenoidal surgery (TS) and microscopic TS in Cushing’s disease (CD); thus, we conducted a systematic review and meta-analysis to evaluate studies of endoscopic TS and microscopic TS. Methods We conducted a comprehensive search of PubMed to identify relevant studies. Remission and recurrence were used as outcome measures following surgical treatment of CD. Results A total of 24 cohort studies involving 1670 adult patients were included in the comparison. Among these studies, 702 patients across 9 studies underwent endoscopic TS, and 968 patients across 15 studies underwent microscopic TS. Similar baseline characteristics were observed in both groups. There was no significant difference in remission between the two groups: 79.7% (95% CI: 73.1–85.0%) in the endoscopic group and 76.9% (95% CI: 71.3–81.6%) in the microscopic group (P = 0.485). It appears that patients who underwent endoscopic surgery experience recurrence less often than patients who underwent microscopic surgery, with recurrence proportions of 11.0% and 15.9%, respectively (P = 0.134). However, if follow-up time is taken into account, both groups had a recurrence rate of approximately 4% per person per year (95% CI: 3.1–5.4% and 3.6–5.1%, P = 0.651). Conclusions We found that remission proportion and recurrence rate were the same in patients who underwent endoscopic TS as in patients who underwent microscopic TS. The definition of diagnosis, remission and recurrence should always be considered in the studies assessing therapeutic efficacy in CD.


2005 ◽  
Vol 72 (3) ◽  
pp. 307-317
Author(s):  
P.F. Bassi ◽  
V. Serretta ◽  
F. Pinto ◽  
A. Calpista ◽  
A. Galuffo ◽  
...  

Most bladder cancers present as a superficial disease, confined to the bladder mucosa or submucosal layer, without muscle invasion. Most superficial tumors have a propensity for recurrence after transurethral resection; some have a high risk for progression to muscle invasion. The treatment aim in superficial bladder cancer with intravesical therapy is three-fold: (1) eradicate existing disease, (2) prevention of recurrence, (3) prevention of tumor progression. The prognostic factors (tumor stage, grade, size, number and recurrence pattern) allow the stratification of tumors in different risk groups to plan treatment. Studies on pharmacokinetics have proved the efficacy of optimized drug delivery. Comparing resection with and without intravesical chemotherapy, a short-term reduction, approximately 15%, in tumor recurrence with chemotherapy can be obtained, but no effect on progression was proven. No agent has proved to be more effective than the others. A single instillation of chemotherapy immediately after transurethral resection has proven to be effective, but the role of maintenance therapy is controversial. Immunotherapy, in the form of Bacillus Calmette-Guerin, is generally shown to be more effective than chemotherapy, even if the results in comparison to mitomycin C do not result conclusive. Several new approaches are being explored to improve the efficacy of this therapy.


Cancer ◽  
1995 ◽  
Vol 76 (5) ◽  
pp. 833-839 ◽  
Author(s):  
John A. Freeman ◽  
David Esrig ◽  
John P. Stein ◽  
Anne R. Simoneau ◽  
Eila C. Skinner ◽  
...  

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