Trattamento conservativo e sopravvivenza in pazienti affetti da urotelioma vescicale T1G3. Quando proporlo e quando la cistectomia?
Urologia;2009, Vol. 76 Issue S-15, pS31
INTRODUCTION. Conservative management is not applicable to all T1G3 tumors. The appropriate treatment should minimize mortality while assuring reduced morbidity and good quality of life. Several attempts have been done to identify categories of T1G3 patients at higher risk. The role of biologic markers is unclear and the prognostic risk factors are mainly clinical. The proper time to abandon the conservative approach in favor of cystectomy is still object of debate. OBJECTIVES. The aim of the present study is to assess the clinical tumor features showing a detrimental effect on survival, identify the clinical risk factors impacting survival in patients undergoing conservative management of T1G3 bladder tumor, and to analyze the prognostic role of recurrence. METHODS. The present analysis is extended to 236 patients with T1G3 bladder tumors treated by TUR plus intravesical therapy between 1976 and 2005. Patients with previous T1G3, Tis, more than 3 tumors or greater than 3cm were excluded. Urinary cytology was obtained within 30 days after TUR. Since 2000 re-TUR has been performed. A sequential combination of mitomycin-C (30mg/30ml) and epirubicin (50mg/50ml) was adopted in 106 patients (44.9%). BCG or other agents were given intravesically in 85 (36.0%) and 38 (16.1%) patients, respectively. Seven (3%) patients refused intravescical therapy. In the case of Ta-TI recurrence, TUR and one year of adjuvant intravesical therapy were repeated. Patients went off study if Tis, T1G3 or T-category tumor over Ti were detected. Age, previous history, number of tumors, re-TUR, adjuvant therapy, recurrence and progression were considered for survival analysis. RESULTS. Tumors were primary in 177 (75.3%) and single in 144 (61.5%) cases. At a mean follow-up of 52 months (range: 3-246 months), 116 patients (49.2%) relapsed. The recurring tumor was Ti in 47(40.5%) cases and T1G3 in 33 (28.4%). In 11 additional patients (9.5%) a Tis was detected. Twenty-five patients (10.6%) progressed and 15 patients (6.4%) underwent cystectomy. Median overall survival was 167 months. The 5-year progression-free survival rate was 87.8%. Thirty-two patients (13.6%) died, 22 (9.3%) for bladder cancer. A higher mortality was detected in recurrent (p= 0.002) and multiple (p=0.009) tumors undergoing conservative management. Survival was decreased by NM! recurrence (p<0.0001) and by progression (p=0.009). No statistical significant difference in survival was evident in relation to the grade and stage of the recurrent tumor. CONCLUSIONS. Previous positive history and multiplicity are relevant risk factors for survival in patients affected by T1G3 NMI TCCB conservatively treated. Survival is decreased if conservative management is not given up at the time of NMI recurrence, independently from its grade and stage.
- Bladder Ca guidelines support BCG, mitomycin Tx. Overmyer, Mac // Urology Times;Dec99, Vol. 27 Issue 12, p1
Reports that intravesical bacillus Calmette-Guerin and mitomycin are the preferred therapies following removal of T1 and high-grade Ta bladder cancer tumors. Guidelines from the American Urological Association; Lack of optimal dosages recommended for intravesical therapy and immunotherapy.
- Bladder leiomyosarcoma in a patient with chronic ketamine abuse: A case report. Kazuhiro Matsumoto; Tatsuo Gondo; Nozomi Hayakawa; Takahiro Maeda; Akiharu Ninomiya; So Nakamura // Canadian Urological Association Journal;Jul/Aug2015, Vol. 9 Issue 7/8, pE514
Bladder leiomyosarcoma is a rare mesenchymal tumour, accounting for less than 0.5% of all primary bladder malignancies. Adult women of reproductive age have the higher incidence of bladder leiomyosarcoma. Exposure to local pelvic radiotherapy or systemic chemotherapy, especially cyclophosphamide...
- BCG. // Reactions Weekly;10/29/2011, Issue 1375, p8
The article describes the case of a 72-year-old man who developed necrotising granulomatus epididymitis after receiving a six-week induction course of BCG for bladder cancer.
- BCG vaccine. // Reactions Weekly;5/1/2010, Issue 1299, p9
The article describes the case of a 9-year-old who developed lupus vulgaris following administration of BCG vaccine.
- BCG. // Reactions Weekly;11/6/2010, Issue 1326, p10
The article describes the case of a 58-year-old man who developed granulomatous hepatitis while receiving treatment with Bacillus Calmette-GuÃ©rin (BCG) for superficial bladder carcinoma.
- BCG. // Reactions Weekly;1/22/2011, Issue 1335, p10
The article describes the case of a 65-year-old man who acquired sepsis while undergoing treatment with Bacillus Calmette-GuÃ©rin (BCG).
- BCG. // Reactions Weekly;1/29/2011, Issue 1336, p10
The article describes the case of a 71-year-old man who presented with systemic granulomatous disease and syndrome of inappropriate antidiuretic hormone (SIADH) while receiving treatment with Bacillus Calmette GuÃ©rin (BCG) for bladder cancer.
- BCG. // Reactions Weekly;1/22/2011, Issue 1335, p11
The article describes the case of a 78-year-old man who acquired systemic inflammatory response syndrome (SIRS) and granulomatous hepatitis while undergoing treatment with Bacillus Calmette-GuÃ©rin (BCG).
- Effective management of superficial bladder cancer. Lamm, Donald L. // Contemporary Urology;Feb2005 Supplement, Vol. 17, p1
Presents information on the use of the bacillus Calmette-GuÃ©rin (BCG) vaccine for the treatment of bladder cancer and carcinoma in situ. History of BCG immunotherapy; Comparison of the effectiveness of BCG with intravesical chemotherapy; Findings of a study of patients with bladder tumors...
Read the Article
Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM
Sorry, but this item is not currently available from your library.Try another library?