Organ-sparing treatment of invasive transitional cell bladder carcinoma
|
|
- Curtis Joseph
- 5 years ago
- Views:
Transcription
1 Journal of BUON 7: , Zerbinis Medical Publications. Printed in Greece ORIGINAL ARTICLE Organ-sparing treatment of invasive transitional cell bladder carcinoma C. Damyanov, B. Tsingilev, V. Tabakov, R. Simeonov Department of Urology, National Oncological Center, Sofia, Bulgaria Summary Purpose: To assess the effectiveness of two approaches of organ-sparing treatment in patients with invasive transitional cell bladder carcinoma. Patients and methods: During the period from June 1996 to June 2000, 33 patients with invasive transitional cell carcinoma (T2-4) of the bladder were treated. Patients were divided into two groups. Group A included 17 patients treated with CMV systemic chemotherapy (methotrexate 30 mg/m 2 and vinblastine 3 mg/m 2, day 1; and cisplatin 70 mg/ m 2, day 2) repeated every 3 weeks for 3 courses, combined with intravesical BCG. Complete responders (CR) received maintenance intravesical BCG, while partial responders (PR) were subjected to transurethral bladder resection (TURB) or partial bladder resection. Group B included 16 patients treated with maximal TURB followed by 2 CMV courses and radiotherapy. Results: Group A patients have been followed-up for a period of 7 to 48 months (median 21.6 months). After completing the 2nd chemotherapy course, 2 patients refused further treatment and were excluded from the group. On completing chemoimmunotherapy 11 (73%) patients showed objective response (CR+PR) and preservation of the bladder was achieved. Four (27%) patients were treatment failures. Group B patients have been followed for a period of 9 to 47 months (median 27.5 months). On completing treatment 12 of 16 (75%) patients showed an objective response with preservation of the bladder. Treatment failure was diagnosed in 4 (25%) patients. The 2 groups differed significantly in terms of side-effects, which were more pronounced in Group B patients. Of the late complications in Group B a serious problem was the development of severe radiationinduced fibrosis leading to microcystis and a cystectomy was indispensable in one of the patients. Conclusion: The applied 2 approaches of combined organ-sparing treatment of invasive bladder carcinoma seem equally effective. Future randomized studies are needed to define reliable criteria for patient selection. Key words: bladder cancer, bladder preservation, chemoimmunotherapy, chemotherapy, quality of life, radiotherapy Introduction Received ; Accepted Author and address for correspondence: Christo Damyanov, MD Department of Urology National Oncological Center 6, Plovdivsko pole Street 1756 Sofia Bulgaria Tel/Fax: noch_urol@netbg.com Radical cystectomy still remains the standard method of treatment for invasive bladder carcinoma. Despite the improved results from radical surgery, there is also a number of disadvantages which accompanies this therapeutic modality. The necessity of urine derivation, loss of sexual function, psychological adaptation, and the possible complications in the continent urine derivation present a serious problem [1]. The different methods of orthotopic bladder replacement represent a remarkable progress of modern surgery. However, it should be mentioned that these methods are not applicable to all patients eligible for cystectomy. The idea of finding an alternative to radical cystectomy providing a better quality of life has increasingly drawn the investigators attention. Various methods of organ-sparing treatment have been applied in the clinical practice over the last 10 years, using a variety of combinations of chemotherapy, radiotherapy, and surgery. We initiated a clinical study of 2 approaches of combined treatment in order to assess their organ-sparing possibilities in patients with invasive bladder cancer. This paper focuses on the initial results of this study.
2 242 Patients and methods Patient selection During the period from June 1996 to June 2000, 33 patients with advanced, histologically proven transitional cell bladder cancer entered the study. Eligibility criteria included T2-T4NXM0 tumors; World Health Organization (WHO) performance status 0-2; age up to 75 years; and normal liver and kidney function. The patients included in the study had refused radical surgical treatment. Patients were divided into 2 groups for combined organ-sparing treatment: Group A:17 patients treated with chemotherapy in combination with intravesical BCG and followed by surgery in those achieving a PR or in nonresponders. Group B:16 patients treated with maximal TURB followed by chemotherapy and radiotherapy. Nonresponders were offered surgery. Patient evaluation Pretreatment clinical evaluation included bimanual examination, intravenous pyelogram, computed tomography (CT) and/or ultrasound of the abdomen and pelvis, cystoscopy with biopsy, urinary cytology, electrocardiogram (ECG), chest X-rays, complete blood count, and serum biochemistry. Patients were staged according to the TNM staging system. Table 1 shows the clinical characteristics of the treated population. Treatment The treatment of Group A patients included 3 chemotherapy courses, repeated at 3-week intervals, with the following combination: methotrexate 30 mg/m 2 and Table 1. Patient characteristics Characteristic Group A (n=17) Group B (n=16) Males 16 (94) 14 (87) Females 1 (6) 2 (13) Age, years median (range) 55.7 (40-68) 64.4 (43-70) T2 6 (35) 7 (25) T3a 9 (53) 4 (25) T3b 2 (12) 4 (25) T4a 1 (6) N0 16 (94) 14 (87) N1 1 (6) 2 (13) G1 1 (6) 1 (6) G2 9 (53) 4 (25) G3 5 (29) 9 (56) G4 2 (12) 2 (13) vinblastine 3 mg/m 2, day 1; cisplatin 70 mg/m 2, day 2 with appropriate pre and posthydration (CMV). Following each chemotherapy course, 2 intravesical instillations were performed weekly using 4 ampoules (1 amp mg) of BCG vaccine (Calgevax). After completing the 3rd chemoimmunotherapy course, complete clinicoimaging re-evaluation, including serum biochemistry, cystoscopy, and urinary cytology was carried out, and, depending on the treatment response, further treatment strategy was determined. Complete responders remained under close observation and maintenance BCG instillations were performed (one instillation monthly for one year). Patients with PR were subjected to organ-sparing operation (TURB or partial bladder resection) followed by maintenance BCG instillations (one instillation monthly for one year). Cystectomy or radiotherapy were offered to nonresponders. Treatment of Group B patients started with maximal TURB, followed by 2 CMV courses. This was followed by a concomitant administration of cisplatin 70 mg/m 2 with radiotherapy of the bladder and the regional lymph basin by means of a four-field box technique up to 45 Gy. Complete responders received a boost dose to the bladder up to 64.8 Gy. Nonresponders were planned to undergo radical cystectomy. On completing the 3rd chemoimmunotherapy course of Group A patients, and radiotherapy of Group B patients, a comparative re-evaluation was carried out, including abdominopelvic CT and/or ultrasound, cystoscopy with biopsy and urinary cytology. Response criteria Criteria for objective evaluation of the treatment efficacy were defined as follows: CR: complete disappearance of all measurable lesions detected physically, biochemically, radiologically and cystoscopically (including biopsy). PR: 50% decrease of the overall tumor mass with no appearance of new lesion(s). Disease stabililization (SD): 50% decrease of the overall tumor mass with no appearance of new lesion(s). No response (NR): any other response different to those mentioned above, including tumor progression. Follow-up Patients in both groups were followed-up at 3-month intervals for the 1st and 2nd year, 6-month intervals for the 3rd year, and once a year thereafter with clinical examination, CT and/or ultrasound of the abdomen and pelvis, cystoscopy with biopsy, urinary cytology, complete blood count, and serum biochemistry.
3 243 Results The Group A patients have been followed-up for a period of 7 to 48 months (median 21.6 months). After completing of the 2nd chemoimmunotherapy course, 2 of the patients refused further treatment and were excluded from the study. On completing the 3rd chemoimmunotherapy course 2 of 15 (13%) patients achieved CR while 9 of 15 (60%) patients showed a PR, for an overall objective response rate of 73%. The 9 PR patients underwent resection of the residual tumor (8 by TURB and one by partial cystectomy). So, preservation of the urinary bladder was possible in 11 of 15 (73%) patients. Four of 15 (27%) patients showed NR to treatment. Three of them underwent radical cystectomy after the 3rd chemoimmunotherapy course, and one died of progressive disease. One of the patients with PR and subsequent TURB was diagnosed with liver and retroperitoneal lymph node metastases on the 29th month following completion of treatment, with no tumor recurrence in the bladder. This patient died 2 months later. Another patient of the same group developed a superficial recurrence in the bladder 3 months after treatment completion, which was successfully treated by TURB. The Group B patients have been followed-up for a period of 9 to 47 months (median 27.5 months). Twelve of 16 (75%) patients achieved CR after the complete course of treatment. NR with tumor persistence was diagnosed in 4 of 16 (25%) patients. Three of them died within the first year from starting treatment. The fourth patient underwent palliative TURB three times because of disease progression and severe hematuria. Metastasis to the renal pelvis was diagnosed in a CR patient on the 11th month after completing treatment. Radical nephroureterectomy was performed, but 5 months later liver and lumbar vertebral metastases developed. Another patient with CR was diagnosed with a superficial recurrence in the bladder on the 16th month, which was successfully treated by TURB. Table 2 summarizes the results from the treatment applied to both patient groups and Table 3 depicts response in relation with T category. Table 4 shows the side-effects from the treatment applied to both patient groups. Discussion A number of randomized studies in recent years showed considerable advantages of polychemotherapy compared to single-agent chemotherapy in bladder carcinoma [2]. Regimens such as MVAC, CISCA, Table 2. Treatment results Result Group A (n=17) Group B (n=16) Objective response (CR+PR) 11 (73) 12 (75) with bladder preservation Treatment failure 4 (27) 4 (25) Recurrence 2 (11.7) 2 (12.5) Table 3. Treatment results in relation to T category (n=31) CR PR nonresponders n(%) n(%) n(%) Group A Group B Group A Group B Group A GroupB T2 0 (0) 6 (37) 4 (26) 0 (0) 1 (7) 1 (6) T3 2 (13) 6 (37) 5 (33) 0 (0) 3 (20) 2 (12) T4 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 1 (6) Table 4. Side-effects Side-effect Group A (n=17) Group B (n=16) Urethral stricture 1 (5.8) 1 (6.2) Toxic hepatitis* 1 (5.8) Acute renal failure* 1 (5.8) Fever 1 (5.8) Leukopenia 3 (18.7) Cystitis 4 (25) Proctitis 2 (12.5) Hematuria 2 (11.5) Severe hematuria 3 (18.7) Full incontinence 2 (12.5) Microcystis 1 (6.2) *chemotherapy- induced, intercurrent infection, WHO grade I and CMV proved very effective in the treatment of transitional cell carcinoma of the bladder [2,3]. Neoadjuvant chemotherapy aims at improving the efficacy of the conventional local methods of treatment by achieving local tumor control and possible eradication of micrometastases. The multimodality concept in the treatment of bladder cancer is the basis of the organ-saving strategy, a subject of multiple clinical studies in the last years [4].There seem to be two main versions of organ-saving treatment: chemotherapy combined with surgical treatment or radiotherapy, and a combination of chemotherapy, radiotherapy and surgery [4-6].
4 244 In a study carried out in 1986 we combined neoadjuvant chemotherapy with intravesical BCG and surgery. The main idea behind this approach originated from the bladder cancer heterogeneity. Including intravesical BCG makes it possible to influence superficial tumors and carcinoma in situ (often concomitant with invasive tumors) which are largerly nonresponsive to chemotherapy, to reduce the postoperative recurrence rate and to increase the recurrence-free interval [7,8]. Chemoimmunotherapy in combination with surgery, administered to 44 patients with invasive T2-4 tumors, produced objective response in 22 (55%) of them. Eighteen (82%) of the responders with preserved bladder survived more than 5 years. The overall recurrence rate was 36% [7]. Despite the encouraging results from applying different versions of organ-sparing treatment, there are questions still open to discussion concerning patient selection, effectiveness of the various therapeutic regimens and impact on the patient survival. In an attempt to search for an answer of a number of problems concerning the organ-sparing treatment, we applied two therapeutic approaches to 33 patients with invasive bladder carcinoma. The selection of the combination of maximal TURB, chemotherapy, and radiotherapy in the Group B patients was based on literature data [9-12]. The results achieved to date show an identical therapeutic activity for both treatment schemes: objective response rate and preserved bladder in 73 % of the Group A patients and 75% of the Group B patients. This rate does not differ significantly from the rates reported in the relevant literature, which vary between 47 to 78%. In 6 Group A patients extending the 3 basic chemotherapy courses with 1-2 additional ones a better local response was achieved, indicating that 3 courses are probably insufficient in achieving maximal therapeutic response. On the other hand, it seems reasonable that patients not responding after the 2nd chemotherapy course should undergo radical cystectomy or radiotherapy. The recurrence rate was also identical in both groups (12% and 13% for Group A and B, respectively). One patient with complete local control and late distant metastatic disease was observed in each group (3 and 1 year posttreatment for the Group A and B patients, respectively). The two groups differed significantly in terms of the observed side-effects. In Group B patients side-effects were more frequent and of the late complications a serious problem was the development of severe fibrous changes leading to microcystis and necessitating cystectomy in one of the Group B patients. The severity and rate of the side-effects in Group B patients were higher than those reported in the literature describing patients having received the same scheme of treatment. We believe that this difference could be attributed to the radiotherapy equipment used. Side-effects observed in Group A patients were attributable to chemotherapy and intravesical BCG, and were milder compared to side-effects of Group B patients. The percentage of nonresponders in both groups raises the question of patient selection eligible for organpreserving treatment. This question is of utmost significance, both for treatment results and for its introduction as a routine method in clinical practice. To date, no sufficient data exist for a reliable and universally accepted methodology for patient selection [13,14]. Based on our experience and the literature data, we suggest that, until sufficient methods are worked out in the field of molecular diagnosis for selecting patients eligible for organ-sparing treatment, two basic parameters can be used: the clinical stage of the disease, and the presence of chemosensitivity after the initial two chemotherapy courses. In conclusion, both methods of organ-sparing treatment of patients with invasive bladder carcinoma showed identical efficiency in about 70% or more of the cases. Search for reliable criteria for patient selection eligible for such treatments is of great importance. Although organ-sparing therapy unequivocally contributes to improved quality of life, it remains to be proven whether its impact on survival does not differ significantly compared to other more radical therapeutic approaches. Future randomized trials could well provide a reliable answer. References 1. Vogelzang N, Scardino P, Shipley W, Coffey D (eds). Comprehensive Textbook of Genitourinary Oncology. Bladder-preserving treatments. Williams & Wilkins, Baltimore, Maryland, 1996, pp Sternberg C, Yagoda A, Sher H et al. M-VAC for advanced transitional cell carcinoma of the urothelium. Cancer 1989; 64: Logothetis C. Optimal delivery of perioperative chemotherapy; preliminary results of a randomized, prospective, comparative trial of preoperative and postoperative chemotherapy for invasive bladder carcinoma. J Urol 1996; 188: Kaufman D, Shipley D, Griffen P et al. Selective bladder preservation by combination treatment of invasive bladder cancer. N Engl J Med 1993; 329: Crawford E, Das S, Smith J. Preoperative radiation therapy in the treatment of bladder cancer. Urol Clin North Am 1987; 14: Shipley W, Prout G, Einstein A et al. Treatment of invasive bladder cancer by cisplatin and radiation in patients unsuited for surgery. JAMA 1987; 258: Damyanov C, Patrashkov T, Petkov Z, Tabakov V, Tsingilev
5 245 B. Bladder preservation in patients with invasive transitional cell carcinoma of the bladder treated with immunochemotherapy. J BUON 1998; 2: Damyanov C, Terziev T, Koleva P. Combined immunochemotherapy (CEP, M-VEP, BCG) in the treatment of invasive bladder tumors..anticancer Drugs 1994; 5: Tester W, Porter A, Heaney J. Neoadjuvant combined modality therapy with possible organ preservation for invasive bladder cancer.j Clin Oncol 1996; 14: Housset M, Maulard C, Chretien Y. Combined radiation and chemotherapy for invasive transitional-cell carcinoma of the bladder. J Clin Oncol 1993; 11: Rodel C, Grabenbauer G, Kuhn R. Prognostic factors in 400 patients with invasive bladder cancer treated by a combined modality bladder-sparing protocol.int J Radiat Oncol Biol Phys 2000; 48: Shipley W, Kaufmann D, Heney N. An update of combined modality therapy for patients with muscle invading bladder cancer. J Urol 1999; 162: Kaufmann D, Raghavan D, Carducci M et al. Phase 2 trial of gemcitabine plus cisplatin in patients with metastatic urothelial cancer.j Clin Oncol 2000; 18: Scher H, Herr H, Sternberg C. Neoadjuvant chemotherapy for bladder cancer; experience with M-VAC regimen. Br J Urol 1989; 64:
MUSCLE - INVASIVE AND METASTATIC BLADDER CANCER
10 MUSCLE - INVASIVE AND METASTATIC BLADDER CANCER Recommendations from the EAU Working Party on Muscle Invasive and Metastatic Bladder Cancer G. Jakse (chairman), F. Algaba, S. Fossa, A. Stenzl, C. Sternberg
More informationBladder Preservation Protocols in the Treatment of Muscle-Invasive Bladder Cancer
Bladder-preserving therapy is a safe and effective alternative to cystectomy for carefully selected patients with bladder cancer. Michael Mahany. Trumpeter Swans on Byer s Lake. Photograph. Denali National
More informationMUSCLE-INVASIVE AND METASTATIC BLADDER CANCER
MUSCLE-INVASIVE AND METASTATIC BLADDER CANCER (Text update March 2008) A. Stenzl (chairman), N.C. Cowan, M. De Santis, G. Jakse, M. Kuczyk, A.S. Merseburger, M.J. Ribal, A. Sherif, J.A. Witjes Introduction
More informationNeo-adjuvant chemotherapy and bladder preservation in locally advanced transitional cell carcinoma of the bladder
Annals of Oncology : -5. 999. 999 Klimer Academic Publishers. Printed in the Netherlands. Original article Neo-adjuvant chemotherapy and bladder preservation in locally advanced transitional cell carcinoma
More informationImpact of Gemcitabine and Cisplatin with Radiotherapy in locally Advanced or Metastatic Transitional Cell Carcinoma of Urinary Bladder
Impact of Gemcitabine and Cisplatin with Radiotherapy in locally Advanced or Metastatic Transitional Cell Carcinoma of Urinary Bladder J. A. Mallick, S. A. Ali, N. Siddiqui, A. Fareed Department of Oncology,
More informationCollection of Recorded Radiotherapy Seminars
IAEA Human Health Campus Collection of Recorded Radiotherapy Seminars http://humanhealth.iaea.org Conservative Treatment of Invasive Bladder Cancer Luis Souhami, MD Professor Department of Radiation Oncology
More informationPartial Cystectomy for Invasive Bladder Cancer
European Urology Supplements European Urology Supplements 4 (2005) 67 71 Partial Cystectomy for Invasive Bladder Cancer Gerald H. Mickisch* Center of Operative Urology Bremen, Academic Hospital Bremen
More informationRadiochemotherapy after Transurethral Resection is an Effective Treatment Method in T1G3 Bladder Cancer
Radiochemotherapy after Transurethral Resection is an Effective Treatment Method in T1G3 Bladder Cancer Z. AKÇETIN 1, J. TODOROV 1, E. TÜZEL 1, D.G. ENGEHAUSEN 1, F.S. KRAUSE 1, R. SAUER 2, K.M. SCHROTT
More informationBladder-sparing, Combined-modality Approach for Muscle-invasive Bladder Cancer
75 Bladder-sparing, Combined-modality Approach for Muscle-invasive Bladder Cancer A Multi-institutional, Long-term Experience Sisto Perdona, MD 1 Riccardo Autorino, MD, PhD 2 Rocco Damiano, MD 3 Marco
More informationGUIDELINES ON NON-MUSCLE- INVASIVE BLADDER CANCER
GUIDELINES ON NON-MUSCLE- INVASIVE BLADDER CANCER (Limited text update December 21) M. Babjuk, W. Oosterlinck, R. Sylvester, E. Kaasinen, A. Böhle, J. Palou, M. Rouprêt Eur Urol 211 Apr;59(4):584-94 Introduction
More information5/26/16: CT scan of the abdomen showed a multinodular liver disease highly suspicious for metastasis and hydronephrosis of the right kidney.
Bladder Case Scenario 1 History 5/23/16: A 52-year-old male, smoker was admitted to our hospital with a 3-month history of right pelvic pain, multiple episodes of gross hematuria, dysuria, and extreme
More informationWhen to Integrate Surgery for Metatstatic Urothelial Cancers
When to Integrate Surgery for Metatstatic Urothelial Cancers Wade J. Sexton, M.D. Senior Member and Professor Department of Genitourinary Oncology Moffitt Cancer Center Case Presentation #1 67 yo male
More informationBladder Cancer Guidelines
Bladder Cancer Guidelines Agreed by Urology CSG: October 2011 Review Date: September 2013 Bladder Cancer 1. Referral Guidelines The following patients should be considered as potentially having bladder
More informationA patient with recurrent bladder cancer presents with the following history:
MP/H Quiz A patient with recurrent bladder cancer presents with the following history: 9/23/06 TURB 1/12/07 TURB 4/1/07 TURB 7/12/07 TURB 11/14/07 Non-invasive papillary transitional cell carcinoma from
More informationNeoadjuvant Chemotherapy plus Cystectomy Compared with Cystectomy Alone for Locally Advanced Bladder Cancer
The new england journal of medicine original article Neoadjuvant Chemotherapy plus Cystectomy Compared with Cystectomy Alone for Locally Advanced Bladder Cancer H. Barton Grossman, M.D., Ronald B. Natale,
More informationBreast cancer Can I still keep my breast?
Bladder Cancer Organ-Sparing Approaches SAMO Interdisciplinary Workshop on Urogenital Tumors September 15, 2012 Daniel R. Zwahlen, MD Radiation Oncology Breast cancer Can I still keep my breast? History
More informationTrimodality Therapy for Muscle Invasive Bladder Cancer
Trimodality Therapy for Muscle Invasive Bladder Cancer Brita Danielson, MD, FRCPC Radiation Oncologist, Cross Cancer Institute Assistant Professor, Department of Oncology University of Alberta Edmonton,
More informationGuidelines for the Management of Bladder Cancer West Midlands Expert Advisory Group for Urological Cancer
Guidelines for the Management of Bladder Cancer West Midlands Expert Advisory Group for Urological Cancer West Midlands Clinical Networks and Clinical Senate Coversheet for Network Expert Advisory Group
More informationBACKGROUND. Many patients with invasive urothelial cell cancer are poor candidates
2181 Treatment Options for Muscle-invasive Urothelial Cancer for Patients Who Were Not Eligible for Cystectomy or Neoadjuvant Chemotherapy With Methotrexate, Vinblastine, Doxorubicin, and Cisplatin Report
More informationBladder Sparing Treatment of Muscle Invasive Bladder Cancer
Bladder Sparing Treatment of Muscle Invasive Bladder Cancer Pr Alexandre de la Taille CHU Mondor, Créteil INSERMU955Eq07 adelataille@hotmail.com High-Risk Invasive and Muscle-Invasive BCa Radical cystectomy
More informationPoint-Counterpoint: Radiation & Bladder Cancer
Radiation Plays a Major Role in Certain Stages of Bladder Cancer ~ David C. Beyer, MD Radiation Therapy; no role in management of bladder cancer Robert E. Donohue M.D. Denver VAMC University of Colorado
More informationTREATMENT OF INVASIVE bladder cancer remains a
Combined-Modality Treatment and Selective Organ Preservation in Invasive Bladder Cancer: Long-Term Results By Claus Rödel, Gerhard G. Grabenbauer, Reinhard Kühn, Thomas Papadopoulos, Jürgen Dunst, Martin
More informationTransitional Cell Carcinoma of the Upper Ureter Metastatic to the Thoracic Spine Presenting as a Spinal Cord Compression
Case Study TheScientificWorldJOURNAL (2008) 8, 223 227 TSW Urology ISSN 1537-744X; DOI 10.1100/tsw.2008.43 Transitional Cell Carcinoma of the Upper Ureter Metastatic to the Thoracic Spine Presenting as
More informationBladder-Sparing Treatment of Invasive Bladder Cancer
Several alternatives to radical cystectomy for muscle-invasive bladder cancer have been studied. None, however, are reliably superior to operative treatment. Sidi Bou Said,Tunisia, 1999. Courtesy of J.
More informationSome Seminal Studies. Chemotherapy Alone is Inadequate. Bladder Cancer Role of Radiation in Bladder Sparing. Primary Radiation for Bladder Cancer
Bladder Cancer Role of Radiation in Bladder Sparing David C. Beyer M.D., FACR, FACRO, FASTRO Arizona Oncology Services Phoenix, Arizona Primary Radiation for Bladder Cancer No modern surgery / XRT randomized
More informationPure non-bilharzial squamous cell carcinoma: An unusual form of carcinoma of the bladder
Safini et al. 31 case Series report peer Reviewed open OPEN ACCESS Pure non-bilharzial squamous cell carcinoma: An unusual form of carcinoma of the bladder Fatima Safini, Hassan Jouhadi, Meriem Elbachiri,
More informationDr. Tareq Salah Ahmed,MD,ESMO. Lecturer of clinical oncology, Assiut faculty of medicine ESMO accreditation certificate
Dr. Tareq Salah Ahmed,MD,ESMO Lecturer of clinical oncology, Assiut faculty of medicine ESMO accreditation certificate 1 st Assiut Urology department conference,marsa Alam 3 rd February 2015 Bladder cancer
More informationBJUI. 35% had lymph node involvement at radical cystectomy or subsequent recurrence within the dissection template.
2010 THE AUTHORS; 2010 Urological Oncology LYMPH NODE STATUS IN PT0 BLADDER CANCER KAAG ET AL. BJUI Regional lymph node status in patients with bladder cancer found to be pathological stage T0 at radical
More informationOptimal sequencing in treatment muscle invasive bladder cancer : oncologists. Phichai Chansriwong, MD Ramathibodi Hospital, Mahidol University
Optimal sequencing in treatment muscle invasive bladder cancer : oncologists Phichai Chansriwong, MD Ramathibodi Hospital, Mahidol University Slide 2 Presented By Andrea Apolo at 2018 Genitourinary Cancers
More informationBladder Cancer Canada November 21st, Bladder Cancer 2018: A brighter light at the end of the cystoscope
Bladder Cancer Canada November 21st, 2018 Bladder Cancer 2018: A brighter light at the end of the cystoscope Chris Morash MD FRCSC Associate Professor, University of Ottawa Head, Urological Oncology Bladder
More informationUpper Egypt experience in bladder preservation using concurrent chemoradiotherapy
Maklad et al. International Archives of Medicine 2013, 6:21 ORIGINAL RESEARCH Open Access Upper Egypt experience in bladder preservation using concurrent chemoradiotherapy Ahmed M Maklad 1*, Elsayed M
More informationSubject Index. Androgen antiandrogen therapy, see Hormone ablation therapy, prostate cancer synthesis and metabolism 49
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOO Subject Index Androgen antiandrogen therapy, see Hormone ablation therapy, synthesis and metabolism 49 Bacillus Calmette-Guérin adjunct therapy with transurethral resection
More informationBLADDER CANCER: PATIENT INFORMATION
BLADDER CANCER: PATIENT INFORMATION The bladder is the balloon like organ located in the pelvis that stores and empties urine. Urine is produced by the kidneys, is conducted to the bladder by the ureters,
More informationInformation for Patients. Primary urethral cancer. English
Information for Patients Primary urethral cancer English Table of contents What is primary urethral cancer?... 3 Risk factors... 3 Symptoms... 4 Diagnosis... 4 Clinical examination... 4 Urinary cytology...
More informationUROTHELIAL CELL CANCER
UROTHELIAL CELL CANCER Indications and regimens for neoadjuvant systemic treatment Astrid A. M. van der Veldt, MD, PhD, medical oncologist Department of Medical Oncology Erasmus Medical Center Cancer Institute
More informationChemotherapy and Bladder Cancer. Blayne Welk UBC Urology Grand Rounds June 4, 2008
Chemotherapy and Bladder Cancer Blayne Welk UBC Urology Grand Rounds June 4, 2008 Outline Review of Incidence and Impact of bladder cancer Neoadjuvant chemotherapy Adjuvant chemotherapy Bladder preservation
More informationsymposium article introduction symposium article
Annals of Oncology 17 (Supplement 5): v118 v122, 2006 doi:10.1093/annonc/mdj965 Long-term survival results of a randomized trial comparing gemcitabine/cisplatin and methotrexate/ vinblastine/doxorubicin/cisplatin
More informationJoseph H. Williams, MD Idaho Urologic Institute St. Alphonsus Regional Medical Center September 22, 2016
BLADDER CANCER Joseph H. Williams, MD Idaho Urologic Institute St. Alphonsus Regional Medical Center September 22, 2016 BLADDER CANCER = UROTHELIAL CANCER Antiquated term is Transitional Cell Carcinoma
More informationeuropean urology 55 (2009)
european urology 55 (2009) 911 921 available at www.sciencedirect.com journal homepage: www.europeanurology.com Bladder Cancer Bladder Preservation in Selected Patients with Muscle-Invasive Bladder Cancer
More informationInformation for Patients. Bladder Cancer. English
Information for Patients Bladder Cancer English Table of contents What is the function of the bladder?... 3 What is bladder cancer?... 3 What causes bladder cancer?... 3 Stages of the disease... 3 Risk
More informationClinical problems in advanced bladder cancer
Journal of BUON 9: 121-126, 2004 2004 Zerbinis Medical Publications. Printed in Greece. CONTINUING EDUCATION IN ONCOLOGY Clinical problems in advanced bladder cancer years [2]. It is appropriate to focus
More informationCould salvage surgery after chemotherapy have clinical impact on cancer survival of patients with
Could salvage surgery after chemotherapy have clinical impact on cancer survival of patients with metastatic urothelial carcinoma? Kensuke Bekku, Takashi Saika, Yasuyuki Kobayashi, Ryo Kioshimoto, Taiki
More informationResearch Article Partial Cystectomy after Neoadjuvant Chemotherapy: Memorial Sloan Kettering Cancer Center Contemporary Experience
International Scholarly Research Notices, Article ID 702653, 6 pages http://dx.doi.org/10.1155/2014/702653 Research Article Partial Cystectomy after Neoadjuvant Chemotherapy: Memorial Sloan Kettering Cancer
More informationM-VAC (methotrexate, vinblastine, d Titlefor poor prognosis patients with ur dose intensity Author(s) HIBI, Hatsuki; OKAMURA, Kikuo; TAKA SHIMOJI, Toshio; MIYAKE, Koji Citation 泌尿器科紀要 (1997), 43(2): 89-96
More informationPart II: Treatment. A Woman-to-Woman Talk with Dr. Armine Smith. Wednesday, March 8, Presented by
Women & Bladder Cancer A Woman-to-Woman Talk with Dr. Armine Smith Wednesday, March 8, 2017 Part II: Treatment Presented by Dr. Smith is an Assistant Professor of Urology at Johns Hopkins University and
More informationGlossary of Terms Primary Urethral Cancer
Patient Information English Glossary of Terms Primary Urethral Cancer Advanced cancer A tumour that grows into deeper layers of tissue, adjacent organs, or surrounding muscles. Anaesthesia (general, spinal,
More informationIndex. Surg Oncol Clin N Am 14 (2005) Note: Page numbers of article titles are in boldface type.
Surg Oncol Clin N Am 14 (2005) 433 439 Index Note: Page numbers of article titles are in boldface type. A Abdominosacral resection, of recurrent rectal cancer, 202 215 Ablative techniques, image-guided,
More informationQ&A. Fabulous Prizes. Collecting Cancer Data: Bladder, Renal Pelvis, and Ureter 5/2/13. NAACCR Webinar Series
Collecting Cancer Data Bladder & Renal Pelvis NAACCR 2012 2013 Webinar Series Q&A Please submit all questions concerning webinar content through the Q&A panel. Reminder: If you have participants watching
More informationCitation International journal of urology (2. Right which has been published in final f
Title Novel constant-pressure irrigation of renal pelvic tumors after ipsila Nakamura, Kenji; Terada, Naoki; Sug Author(s) Toshinori; Matsui, Yoshiyuki; Imamu Kazutoshi; Kamba, Tomomi; Yoshimura Citation
More informationStaging and Grading Last Updated Friday, 14 November 2008
Staging and Grading Last Updated Friday, 14 November 2008 There is a staging graph below Blood in the urine is the most common indication that something is wrong. Often one will experience pain or difficulty
More informationThe Efficacy of Adjuvant Chemotherapy for Locally Advanced Upper Tract Urothelial Cell Carcinoma
Ivyspring International Publisher Research Paper 686 Journal of Cancer 2013; 4(8): 686-690. doi: 10.7150/jca.7326 The Efficacy of Adjuvant Chemotherapy for Locally Advanced Upper Tract Urothelial Cell
More informationManagement of High Grade, T1 Bladder Cancer Douglas S. Scherr, M.D.
Management of High Grade, T1 Bladder Cancer Douglas S. Scherr, M.D. Assistant Professor of Urology Clinical Director, Urologic Oncology Weill Medical College-Cornell University Estimated new cancer cases.
More informationGUIDELINES ON RENAL CELL CANCER
20 G. Mickisch (chairman), J. Carballido, S. Hellsten, H. Schulze, H. Mensink Eur Urol 2001;40(3):252-255 Introduction is characterised by a constant rise in incidence over the last 50 years, with a predominance
More information3.1 Investigations for Patients Presenting with Haematuria Table 1
3.1 Investigations for Patients Presenting with Haematuria Table 1 Patients at risk of bacterial endocarditis should be given antibiotic prophylaxis as per local guidelines. Patients with heart valve replacements
More informationEAU GUIDELINES ON NON-MUSCLE INVASIVE (TaT1, CIS) BLADDER CANCER
EU GUIDELINES ON NON-MUSLE INVSIVE (TaT1, IS) LDDER NER (Limited text update March 2017) M. abjuk (hair), M. urger (Vice-hair), E. ompérat, P. Gontero,.H. Mostafid, J. Palou,.W.G. van Rhijn, M. Rouprêt,
More informationNeodjuvant chemotherapy
Neodjuvant chemotherapy Dr Robert Huddart Senior Lecturer and Honorary Consultant in Clinical Oncology Royal Marsden Hospital and Institute of Cancer Research Why consider neo-adjuvant chemotherapy? Loco-regional
More informationAnalysis of Intravesical Recurrence After Bladder-preserving Therapy for Muscle-invasive Bladder Cancer
Original Article Japanese Journal of Clinical Oncology Advance Access published July 10, 2012 Jpn J Clin Oncol 2012 doi:10.1093/jjco/hys105 Analysis of Intravesical Recurrence After Bladder-preserving
More informationBLADDER CANCER CONTENT CREATED BY. Learn more at
BLADDER CANCER CONTENT CREATED BY Learn more at www.health.harvard.edu TALK TO YOUR DOCTOR Table of Contents WHAT IS BLADDER CANCER? 4 TYPES OF BLADDER CANCER 5 GRADING AND STAGING 8 TREATMENT OVERVIEW
More informationTHORACIC MALIGNANCIES
THORACIC MALIGNANCIES Summary for Malignant Malignancies. Lung Ca 1 Lung Cancer Non-Small Cell Lung Cancer Diagnostic Evaluation for Non-Small Lung Cancer 1. History and Physical examination. 2. CBCDE,
More informationSeptember 10, Dear Dr. Clark,
September 10, 2015 Peter E. Clark, MD Chair, NCCN Bladder Cancer Guidelines (Version 2.2015) Associate Professor of Urologic Surgery Vanderbilt Ingram Cancer Center Nashville, TN 37232 Dear Dr. Clark,
More informationOpen clinical uro-oncology trials in Canada
Open clinical uro-oncology trials in Canada George Rodrigues, MD, Eric Winquist, MD, Mary J. Mackenzie, MD London Health Sciences Centre, London, Ontario, Canada ADRENOCORTICAL MALIGNANCIES CISPLATIN-BASED
More informationShould We Screen for Bladder Cancer in a High Risk Population: A Cost per Life-Year Saved Analysis?
Should We Screen for Bladder Cancer in a High Risk Population: A Cost per Life-Year Saved Analysis? Yair Lotan, Robert S. Svatek, Arthur I. Sagalowsky Should We Screen? Prevalence 5 th most common cancer
More informationKoji Ichihara Hiroshi Kitamura Naoya Masumori Fumimasa Fukuta Taiji Tsukamoto
Int J Clin Oncol (2013) 18:75 80 DOI 10.1007/s10147-011-0346-8 ORIGINAL ARTICLE Transurethral prostate biopsy before radical cystectomy remains clinically relevant for decision-making on urethrectomy in
More informationEfficacy of Bladder-Preserving Therapy for Patients with T3b, T4a, and T4b Transitional Cell Carcinoma of the Bladder
www.kjurology.org DOI:10.4111/kju.2010.51.8.525 Urological Oncology Efficacy of Bladder-Preserving Therapy for Patients with T3b, T4a, and T4b Transitional Cell Carcinoma of the Bladder Jaewoo Cheon, Hyunchul
More informationCancer Biology 2015;5(4)
Bladder preservation by neoadjuvant chemotherapy followed by gemcitabine as radiosensitizer for muscleinvasive transitional cell carcinoma of the urinary bladder after maximal TURBT Alaa fayed, M.D. 1,
More informationBLADDER TUMOURS A REVIEW OF 150 PATIENTS TREATED AT THE INSTITUTE OF UROLOGY AND NEPHROLOGY GENERAL HOSPITAL KUALA LUMPUR
Med. J. Malaysia Vol. 38. No. I March 1983. BLADDER TUMOURS A REVIEW OF 150 PATIENTS TREATED AT THE INSTITUTE OF UROLOGY AND NEPHROLOGY GENERAL HOSPITAL KUALA LUMPUR ZAKRIYA MAHAMOOTH HUSSAIN AWANG SUMMARY
More informationof Urology, Nagoya Memorial Hospital, Nagoya, Japan Keywords: Urothelial carcinoma, cisplatin, gemcitabine, pathological complete response.
188 Journal of Analytical Oncology, 2013, 2, 188-194 Pathological Complete Response Induced by the Combination Therapy of Gemcitabine and 24-h Infusion of Cisplatin in Two Cases Initially Diagnosed as
More informationRadical Cystectomy Often Too Late? Yes, But...
european urology 50 (2006) 1129 1138 available at www.sciencedirect.com journal homepage: www.europeanurology.com Editorial 50th Anniversary Radical Cystectomy Often Too Late? Yes, But... Urs E. Studer
More informationGuidelines for the Management of Bladder Cancer
Guidelines for the Management of Bladder Cancer Date Approved by Network Governance July 2012 Date for Review July 2015 Changes Between Version 3 and 4 Sections 5.2 and 8 updated Page 1 of 9 1. Scope of
More informationClinical Study of G3 Superficial Bladder Cancer without Concomitant CIS Treated with Conservative Therapy
Jpn J Clin Oncol 2002;32(11)461 465 Clinical Study of G3 Superficial Bladder Cancer without Concomitant CIS Treated with Conservative Therapy Takashi Saika, Tomoyasu Tsushima, Yasutomo Nasu, Ryoji Arata,
More informationAlicia K. Morgans, MD Assistant Professor of Medicine Division of Hematology/Oncology Vanderbilt University Medical Center January 24, 2015
Alicia K. Morgans, MD Assistant Professor of Medicine Division of Hematology/Oncology Vanderbilt University Medical Center January 24, 2015 Overview Background Perioperative chemotherapy in MIBC Neoadjuvant
More informationNorth of Scotland Cancer Network Clinical Management Guideline for Carcinoma of the Uterine Cervix
THIS DOCUMENT North of Scotland Cancer Network Carcinoma of the Uterine Cervix UNCONTROLLED WHEN PRINTED DOCUMENT CONTROL Prepared by A Kennedy/AG Macdonald/Others Approved by NOT APPROVED Issue date April
More informationOpen clinical uro-oncology trials in Canada
Open clinical uro-oncology trials in Canada Eric Winquist, MD, Mary J. Mackenzie, MD, George Rodrigues, MD London Health Sciences Centre, London, Ontario, Canada ADRENOCORTICAL MALIGNANCIES CISPLATIN-BASED
More informationRADIOTHERAPY IN THE MANAGEMENT OF CANCERS OF THE URINARY BLADDER
RADIOTHERAPY IN THE MANAGEMENT OF CANCERS OF THE URINARY BLADDER INTRODUCTION Incidence: Mortality: 20/100000/year (Europe) 8-9/100000/year Worldwide fourth most common cancer in men Incidence: 31.1 mortality:
More informationOpen clinical uro-oncology trials in Canada
CLINICAL TRIALS Open clinical uro-oncology trials in Canada Eric Winquist, MD, Mary J. Mackenzie, MD, George Rodrigues, MD London Health Sciences Centre, London, Ontario, Canada ADRENOCORTICAL MALIGNANCIES
More informationCHEMO-RADIOTHERAPY FOR BLADDER CANCER. Dr Darren Mitchell Consultant Clinical Oncologist Northern Ireland Cancer Centre
CHEMO-RADIOTHERAPY FOR BLADDER CANCER Dr Darren Mitchell Consultant Clinical Oncologist Northern Ireland Cancer Centre AIMS Muscle invasive disease Current Gold-Standard Rationale behind Chemo-Radiotherapy
More informationAUA Guidelines for Invasive Bladder Cancer: What s New?
AUA Guidelines for Invasive Bladder Cancer: What s New? Michael S. Cookson, MD, MMHC Professor and Chairman Department of Urology, University of Oklahoma History 1999: AUA guidelines Panel Non-muscle invasive
More informationMEDitorial March Bladder Cancer
MEDitorial March 2010 Bladder Cancer Last month, my article addressed the issue of blood in the urine ( hematuria ). A concerning cause of hematuria is bladder cancer, a variably malignant tumor starting
More informationBladder Cancer in Primary Care. Dr Penny Kehagioglou Consultant Clinical Oncologist
Bladder Cancer in Primary Care Dr Penny Kehagioglou Consultant Clinical Oncologist Objectives Patient presentation in primary care Investigating bladder cancer Management of bladder cancer Differential
More informationNeo-adjuvant and adjuvant chemotherapy of bladder cancer: Is there a role?
DOI: 10.1093/annonc/mdf670 Neo-adjuvant and adjuvant chemotherapy of bladder cancer: Is there a role? C. N. Sternberg Medical Oncology, Vincenzo Pansadoro Foundation, Clinic Pio XI, Rome, Italy Introduction
More informationIn the United States, approximately 38,000 patients were
ORIGINAL ARTICLE Multimodality Therapy Including Surgical Resection and Intraoperative Electron Radiotherapy for Recurrent or Advanced Primary Carcinoma of the Urinary Bladder or Ureter Christopher L.
More informationNMIBC. Piotr Jarzemski. Department of Urology Jan Biziel University Hospital Bydgoszcz, Poland
NMIBC Piotr Jarzemski Department of Urology Jan Biziel University Hospital Bydgoszcz, Poland 71 year old male patient was admitted to the Department of Urology First TURBT - 2 months prior to the hospitalisation.
More informationJ Clin Oncol 23: by American Society of Clinical Oncology INTRODUCTION
VOLUME 23 NUMBER 21 JULY 20 2005 JOURNAL OF CLINICAL ONCOLOGY O R I G I N A L R E P O R T Long-Term Survival Results of a Randomized Trial Comparing Gemcitabine Plus Cisplatin, With Methotrexate, Vinblastine,
More informationManagement of Superficial Bladder Cancer Douglas S. Scherr, M.D.
Management of Superficial Bladder Cancer Douglas S. Scherr, M.D. Assistant Professor of Urology Clinical Director, Urologic Oncology Weill Medical College-Cornell University Estimated new cancer cases.
More informationHypofractionation versus conventional radiotherapy with concurrent Gemcitabine in bladder preservation of patient with bladder carcinoma
Hypofractionation versus conventional radiotherapy with concurrent Gemcitabine in bladder preservation of patient with bladder carcinoma Abdelmalik NA ¹, Shehata SM ², Elsyed MI ¹ and Abbas H ¹ Radiotherapy
More informationOld and New Radiation for Bladder and Upper Tract Cancers. Bridget Koontz Radiation Oncology Duke Cancer Institute
Old and New Radiation for Bladder and Upper Tract Cancers Bridget Koontz Radiation Oncology Duke Cancer Institute Disclosures Janssen funded clinical research BlueEarth Diagnostics advisory board member
More informationChemotherapy Treatment Algorithms for Urology Cancer
Chemotherapy Treatment Algorithms for Urology Cancer Chemoradiation for bladder cancer; Chemotherapy algorithm for non TCC bladder cancer Squamous cell carcinoma; Chemotherapy Algorithm for Non Transitional
More informationConcurrent Vinblastine and Radiation Therapy in Bladder Cancer
2885 Concurrent Vinblastine and Radiation Therapy in Bladder Cancer B. Kragelj, M.D.,* B. Jereb, M.D.,* L. Kragelj, M.D.,? and M. Sfanonik, M.D.$ Background. Since mid-987, 29 patients with invasive transitional
More informationBone Metastases in Muscle-Invasive Bladder Cancer
Journal of the Egyptian Nat. Cancer Inst., Vol. 18, No. 3, September: 03-08, 006 AZZA N. TAHER, M.D.* and MAGDY H. KOTB, M.D.** The Departments of Radiation Oncology* and Nuclear Medicine**, National Cancer
More informationReview of Current Neoadjuvant and Adjuvant Chemotherapy in Muscle-Invasive Bladder Cancer
available at www.sciencedirect.com journal homepage: www.europeanurology.com Review of Current Neoadjuvant and Adjuvant Chemotherapy in Muscle-Invasive Bladder Cancer Nadine Houédé a,b, *, Philippe Pourquier
More informationNational Cancer Institute of Canada Clinical Trials Group (NCIC CTG) Trial design:
Open clinical uro-oncology trials in Canada Eric Winquist, MD, Mary J. Mackenzie, MD, George Rodrigues, MD London Health Sciences Centre, London, Ontario, Canada BLADDER CANCER A PHASE III STUDY OF IRESSA
More informationOptimal Timing of Radical Cystectomy for Patients with Invasive Transitional Cell Carcinoma of the Bladder
Jpn J Clin Oncol 2002;32(1)14 18 Optimal Timing of Radical Cystectomy for Patients with Invasive Transitional Cell Carcinoma of the Bladder Isao Hara, Hideaki Miyake, Shoji Hara, Akinobu Gotoh, Hiroshi
More informationAttachment #2 Overview of Follow-up
Attachment #2 Overview of Follow-up Provided below is a general overview of follow-up and this may vary based on specific patient or cancer characteristics. Of note, Labs and imaging can be performed closer
More informationInternational Journal of Health Sciences and Research ISSN:
International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Original Research Article Outcome of Open Radical Cystectomy and Ileal Conduit: A Single Center Experience Mahesh Kalloli
More informationClinical Value of C-reactive Protein and Erythrocyte Sedimentation Rate in Advanced Bladder Cancer
Original Article Research in Oncology 2018; Vol. XX, No. X: X-X. DOI: 10.21608/resoncol.2018.4152.1060 Clinical Value of C-reactive Protein and Erythrocyte Sedimentation Rate in Advanced Bladder Cancer
More information1. Introduction. Correspondence should be addressed to Franklin C. Lee; Received 5 August 2013; Accepted 24 October 2013
Advances in Urology Volume 2013, Article ID 317190, 6 pages http://dx.doi.org/10.1155/2013/317190 Research Article Pathologic Response Rates of Gemcitabine/Cisplatin versus Methotrexate/Vinblastine/Adriamycin/Cisplatin
More informationTreatment of Non-Metastatic Muscle-Invasive Bladder Cancer: AUA/ASCO/ASTRO/SUO Guideline
Treatment of Non-Metastatic Muscle-Invasive Bladder Cancer: AUA/ASCO/ASTRO/SUO Guideline Jeffrey M. Holzbeierlein, MD, FACS John W Weigel Professor & Chair Director of Urologic Oncology University of Kansas
More informationAttachment #2 Overview of Follow-up
Attachment #2 Overview of Follow-up Provided below is a general overview of follow-up and this may vary based on specific patient or cancer characteristics. Of note, Labs and imaging can be performed closer
More information