Adjuvant Chemotherapy for Superficial Transitional Cell Bladder Carcinoma: Long-term Results of a European Organization for Research and Treatment of Cancer Randomized Trial Comparing Doxorubicin, Ethoglucid and Transurethral Resection Alone

Kurth, K. H.; Tunn, U.; Ay, Reginald; Schröder, Fritz H.; Pavone‐Macaluso, M.; Debruyne, F.M.J.; Kate, Fiebo Ten; Pauw, M. De; Sylvester, Richard

doi:10.1016/s0022-5347(01)64484-7

Cited by 62 publications

(24 citation statements)

References 13 publications

(2 reference statements)

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“…Different chemotherapeutic agents have been used for adjuvant treatment after TUR [3][4][5][6]. MMC, an alkylating cytostatic drug, was used for the first time in the treatment of superficial bladder cancer by Shida [16] in 1967.…”

Section: Discussionmentioning

confidence: 99%

“…Such a selected subset of patients is not often described. A control group with TUR alone was not included because adjuvant treatment is generally considered to be indicated in these patients [2,4,14,15].…”

Section: Discussionmentioning

confidence: 99%

“…Intravesical chemotherapy has been used for almost three decades with the aim of reducing recurrence and progression rates. Several drugs have given encouraging results in the prevention of recurrences [3][4][5][6] but uncertainty persists about the effect of prophylactic chemotherapy on disease progression [7,8]. Mitomycin C (MMC) significantly reduces the recurrence rate of superficial bladder cancer [6,9].…”

Section: Introductionmentioning

confidence: 99%

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Intravesical Instillation of Mitomycin-C in 242 Patients with Superficial Bladder Cancer at High Risk of Recurrence: Long-Term Results

Hurle¹,

Manzetti²,

Losa³

et al. 1998

Urol Int

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Objective: The present study evaluated the long-term results of intravesical mitomycin C (MMC) instillation after transurethral resection (TUR) in 242 consecutive patients with superficial bladder cancer at high risk of recurrence (stage Ta, grade 1–3, or stage T1, grade 1 and 2, primary multiple or recurrent tumor). Materials and Methods: 242 patients were treated with weekly instillations of 40 mg MMC for 8 weeks after TUR. Tumor-free patients then followed a maintenance course with monthly instillations for 3 months. Results: Median follow-up of disease-free patients is 43.5 (range 23–112) months. The incidence of first recurrence is 59.5% (144/242 patients) with a median time to first recurrence of 29 months. 95 patients (39.3%) remained disease-free. Three had disease progression as the first event. The risk of recurrence was significantly higher for multifocal tumors (p = 0.0023, hazard ratio 1.79, 95% CI 1.23–2.59). Overall, patients have been followed for a median time of 57 (range 10–114) months. During this period the recurrence rate was 4.9. Eleven more patients had disease progression. The progression rate is 5.8% (14/242), with a mean time to progression of 34 months. At present 209 patients are alive, 6 have died of bladder cancer, 16 of causes unrelated to the disease and 11 (4.5%) have been lost to follow-up. Thus the crude survival rate is 86.4%, disease-specific mortality 2.5%, and non-disease-specific mortality 6.6%. Conclusions: Patients with multiple tumors seem to benefit the least from MMC instillation. Probably recurrent disease could be better prevented with intravesical bacillus Calmette-Guérin.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Intravesical Instillation of Mitomycin-C in 242 Patients with Superficial Bladder Cancer at High Risk of Recurrence: Long-Term Results

Hurle¹,

Manzetti²,

Losa³

et al. 1998

Urol Int

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“…In large studies comparing different chemotherapeutic agents, none of the chemotherapeutic agents turned out to be superior [10][11][12][13] (table 1). There is no accordance in dose, treatment schedule, time to start and dura tion of instillation therapy, all schemes are mainly empirical.…”

Section: Mitomycin C (Mmc) Adriamycin (Adm)/epirubicin (Ep1)mentioning

confidence: 99%

Current Insights in the Treatment of Superficial Transitional Cell Carcinoma of the Bladder

Reijke¹,

Kurth²,

Boer³

et al. 1996

Oncol Res Treat

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Patients with superficial transitional cell carcinoma of the bladder (Ta, Tl, Tis) can nowadays be subdivided in different risk groups for tumor recurrence and progression, based on prognostic factors, which have been obtained from the results of clinical Phase III trials. For adjuvant therapy a choice can be made between intravesical instillations with chemotherapeutic or immunotherapeutic agents. The optimal treatment schedule and time to start intravesical therapy is not known. None of the investigated chemotherapeutic agents turned out to be superior in delaying tumor recurrence. Intravesical immunotherapy, using bacillus Calmette Guérin (BCG), seems to be as effective and maybe superior in high-risk groups in delaying tumor recurrence compared to chemotherapeutic agents. The side effects, however, are a disadvantage. The exact working mechanism of BCG and its antitumor effect is not known. In the field of recognizing patients at risk for recurrence or progressive disease, biological markers have been identified. In daily practice these markers cannot be used yet. Using all these different treatment options, it is important to obtain information on the impact of these treatment schedules on the quality of life, especially if the treatment results do not differ. A start has been made to imply questionnaires in superficial bladder cancer studies.

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“…These tumours demonstrate a higher tendency to recur either at the same stage and grade or as deeply invasive tumours after initial surgical resection (Hurle et al, 1996;Lamm and Torti, 1996;Esrig et al, 1997). This biological behaviour constitutes a common clinical dilemma as far as an optimal management and points to the need for an effective prophylactic treatment of these tumours (Carballido et al, 1990a;Kurth, 1997;Kurth et al, 1997;Molt-et al, 1997;Witjes, 1997) after their transurethral resection of the tumor (Patard et al, 1993;Molto et al, 1995).…”

mentioning

confidence: 99%

The association between CD2+ peripheral blood lymphocyte subsets and the relapse of bladder cancer in prophylactically BCG-treated patients

et al. 1999

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SummaryWe investigated the potential existence of differences in the distribution of T-lymphocyte subsets and in the proliferative response of these CD2+ cells to polyclonal mitogens in patients with transitional cell bladder carcinoma (SBTCC) treated with prophylactic intracavitary instillations of bacillus Calmette-Guérin (BCG) according to their clinical response to this treatment. Before BCG treatment, different subset distribution (CD8+ and CD3+ CD56+), activation antigen expression (CD3+ HLA-DR+) and proliferative response to mitogenic signals were found in CD2+ cells from SBTCC patients prophylactically treated with BCG who remained free of disease or those who had recurrence of tumour. Otherwise, the prophylactic intracavitary BCG instillations in SBTCC patients are associated with a transitory variation of T-lymphocyte subset distribution (CD4 and CD8) and activation antigens expression (CD25).

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Adjuvant Chemotherapy for Superficial Transitional Cell Bladder Carcinoma: Long-term Results of a European Organization for Research and Treatment of Cancer Randomized Trial Comparing Doxorubicin, Ethoglucid and Transurethral Resection Alone

Cited by 62 publications

References 13 publications

Intravesical Instillation of Mitomycin-C in 242 Patients with Superficial Bladder Cancer at High Risk of Recurrence: Long-Term Results

Intravesical Instillation of Mitomycin-C in 242 Patients with Superficial Bladder Cancer at High Risk of Recurrence: Long-Term Results

Current Insights in the Treatment of Superficial Transitional Cell Carcinoma of the Bladder

The association between CD2+ peripheral blood lymphocyte subsets and the relapse of bladder cancer in prophylactically BCG-treated patients

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