PROGNOSTIC FACTORS AND RISK GROUPS IN T1G3 PATIENTS INITIALLY TREATED WITH BCG: RESULTS OF A MULTICENTER RETROSPECTIVE SERIES IN 2530 PATIENTS

Current views on intravesical treatment and chemoprophylaxis of superficial bladder cancer. The present role of epirubicin and doxorubicin.

Since 1972, a large number of studies have shown that intravesical treatment with doxorubicin (adriamycin) is effective against carcinoma in situ and multiple papillary tumors. Furthermore, it significantly reduces the recurrence rate after transurethral resection. Its efficacy has been compared with that of Bacillus Calmette-Guerin (BCG), which is the only treatment accepted by the US Food and Drug Administration for therapy of carcinoma in situ (Tis). In more recent years, a few studies have been performed using intravesical epirubicin in the hope that different properties of the molecule might enhance the activity of the anthracyclines, but produce fewer and milder side-effects. After we…

Conservative management of T1G3 transitional cell carcinoma of the bladder. Risk factor analysis in 165 selected patients

INTRODUCTION AND OBJECTIVE: The management of TlG3 transitional cell carcinoma of the bladder (TCCB), is still controversial. Some Authors support an immediate radical cystectomy. BCG is considered the treatment of choice. Limited encouraging experiences are reported with intravesical chemotherapy. Objectives; Evaluating a selected population of 165 patients with TlG3 TCCB, in absence of Tis, treated conservatively with TUR plus adjuvant intravesical therapy. METHODS: Between January 1976 and December 1999, 165 patients with TlG3 bladder tumors were treated by TUR plus adjuvant intravesical therapy. Patients with previuos T1G3, Tis, more than 3 tumors or greater than 3 em were excluded. A s…

Recurrence and progression according to stage at re-TUR in t1g3 bladder cancer patients treated with BCG: Not as bad as previously thought

Introduction & Objectives The goals of transurethral resection of a bladder tumour (TUR) are to completely resect the lesions and to make a correct diagnosis in order to adequately stage the patient. Persistent disease after TUR is not uncommon and is the reason why re-TUR is recommended in T1G3 patients. When there is T1 tumour in the re-TUR specimen, very high risks of progression (82%) have been reported1 and therefore cystectomy is considered to be mandatory. We analyse the tumour stage at re-TUR and the risk of recurrence, progression to muscle invasive disease and cancer specific mortality (CSM) in T1G3 patients treated with BCG. Material & Methods In our retrospective cohort …

EGFR CELL EXPRESSION IN BLADDER WASHINGS AS A RISK MARKER TOOL IN NON MUSCLE-INVASIVE BLADDER CANCER. PRELIMINARY EXPERIENCE

RE-TREATMENT BY INTRAVESICAL THERAPY IN RECURRING PATIENTS AFFECTED BY INTERMEDIATE RISK NON-MUSCLE INVASIVE BLADDER CANCER (NMI-BC)

Introduction & Objectives: Up to 70% of patients affected by intermediate risk NMI-BC recur after intravesical therapy (IT). The majority of them will be retreated by IT. The therapeutic strategy for these patients is not well defined. BCG is advocated when intravesical chemotherapy (ICH) fails. However, some patients are retreated by ICH and some others repeat BCG adopted as the first treatment. Not many studies have been published on second line IT. A retrospective analysis on 179 intermediate-risk patients undergoing re-treatment by IT is presented. Materials & Methods: The clinical files of patients affected by NMI-BC recurring after TUR and IT and retreated by IT were reviewed. The pat…

Prognostic role in common clinical practice of neutrophil-to-lymphocyte ratio in unselected bladder cancer

LIMITS OF TRANSURETHRAL RESECTION IN DETECTING UNCOMMON HISTOLOGICAL VARIANTS WITHIN BULKY BLADDER TUMORS IN REAL-LIFE CLINICAL PRACTICE

Is there a role for recombinant tumor necrosis factor alpha in the intravesical treatment of superficial bladder tumors?--a phase II study

Clinical use of recombinant tumor necrosis factor-alpha is strongly limited by its severe toxicity, mainly cardiovascular, when systemically administered. Recent studies suggest that topical (intrapleural, intraperitoneal, intratumoral) administration is free of significant toxicity. Human recombinant tumor necrosis factor-alpha was administered intravesically, at a dose of 500 mg dissolved in 30 ml of phosphate buffer (pH7.6-7.8) plus 0.25% human albumin, weekly for two months to 18 patients with papillary transitional cell carcinoma of the bladder. Of the 15 evaluable patients, four (26%) achieved a complete response. Systemic and local tolerability were excellent. Int J Urol 1995;2:100-1…

Complications in radical cystectomy and their prevention

We wish to dedicate this review article on radical cystectomy, its complications and their prevention to the memory of Prof. Luciano Giuliani. The article is based on a work written originally by Jim Montie and many other authors for the consensus meeting on bladder cancer held in Antwerp in 1994 and recently published in a booklet entitled “Global strategy for bladder cancer” (1). With the consent of Montie and the other co-authors, we have prepared on updated Italian version, inserting some parts (such as vascular complications) which were treated more superficially in the preliminary text.