Canadian guidelines for treatment of non-muscle invasive bladder cancer: a focus on intravesical therapy

Kassouf, Wassim; Kamat, Ashish M.; Zlotta, Alexander; Bochner, Bernard H.; Moore, Ronald B.; So, Alan; Izawa, Jonathan I.; Rendon, Ricardo; Lacombe, Louis; Aprikian, Armen

doi:10.5489/cuaj.846

Cited by 13 publications

(17 citation statements)

References 47 publications

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“…Although it is stated that approximately 30% of patients will have no recurrence after the initial transurethral resection (TURB), up to 50% of patients experience disease progression within 5 years from the initial diagnosis [2,3]. Therefore, this disease represents a therapeutic challenge for urologists and oncologists, and its treatment remains controversial with many advocating bacillus CalmetteGuerin (BCG) therapy and salvage cystectomy upon progression and others recommending upfront cystectomy due to the high progression and disease-specific mortality rates [4,5]. Numerous efforts have been made in the past to identify the subset of T1 carcinomas that carries a high risk of disease recurrence and progression.…”

Section: Introductionmentioning

confidence: 99%

Prognostic factors in T1 bladder urothelial carcinoma: the value of recording millimetric depth of invasion, diameter of invasive carcinoma, and muscularis mucosa invasion

Brimo

Zeizafoun

et al. 2013

Human Pathology

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Section: Introductionmentioning

confidence: 99%

Prognostic factors in T1 bladder urothelial carcinoma: the value of recording millimetric depth of invasion, diameter of invasive carcinoma, and muscularis mucosa invasion

Brimo

Zeizafoun

et al. 2013

Human Pathology

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“…3 Current Canadian guidelines recommend repeat transurethral resection of bladder tumour (TURBT) at 4-6 weeks, prior to the initiation of intravesical Bacillus Calmette-Guerin (BCG). 4 Repeat resection requires further operating room resources and adds further cost and risk of complications to the patient. This recommendation is based on data from major cancer centers in non-universal health care systems, which report rates of recurrence and upstaging on repeat TUR to be 45-76% and 29-40%, respectively.…”

Section: Introductionmentioning

confidence: 99%

Recurrence and upstaging rates of T1 high-grade urothelial carcinoma of the bladder on repeat resection in a Canadian, resource-limited, healthcare system

Kinnaird

Dromparis

Evans

2018

CUAJ

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Introduction: Non-muscle-invasive bladder cancer is the most expensive malignancy to treat. Current Canadian guidelines recommend repeat transurethral resection of bladder tumour (TURBT) within six weeks after initial resection of T1 high-grade (T1HG) urothelial carcinoma, prior to initiation of intravesical bacillus Calmette-Guerin treatment. This is a burden on operating room usage and adds further cost and risk of complications. Internationally, major cancer centres report significant rates of recurrence and upstaging on repeat resection, however minimal Canadian data is available. We aimed to determine the rate of recurrence and upstaging in a resource-limited, Canadian healthcare system. Methods: A retrospective review of patients receiving TURBT between November 2009 and November 2014 was performed. Patients were included if they had all three of the following: a pathological diagnosis of T1HG, adequate muscularis propria present in the specimen, and a repeat resection. Results: We reviewed 3166 patients who underwent TURBT and found 173 to meet our inclusion criteria. The overall recurrence and upstaging rates were 57.2% and 9.2%, respectively. Tumour recurrence and upstaging occurred more often in patients who had repeat resection after 12-24 weeks compared to those patients whose repeat resection occurred within 12 weeks. Conclusions: Although recurrence rates are similar, we have found upstaging rates to be three-to four-fold lower than those previously reported. Despite this, one in 10 patients will be upstaged, justifying use of this resource within our

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“…3 Similarly, the Canadian guidelines state that in patients with high-risk NMIBC with BCG failure, the option of radical cystectomy should be recommended and discussed with the patient (Grade B recommendation). 22 The guidelines also suggest that immediate cystectomy may be initially offered to patients with T1G3/T1HG and to patients with high-grade tumours with concomitant CIS or multiple recurrent high-grade tumours (Grade C recommendation). The advantage of cystectomy in superficial tumours that failed BCG treatment is obvious.…”

Section: Surgery After Bcg Failurementioning

confidence: 99%

“…22 A second induction course may achieve a 30% to 50% response rate. 23,24 A more uniform reporting mechanism to improve the definition of BCG failure in patients has been proposed as follows: 25 1) BCG-refractory disease when there is failure to achieve a disease-free state at 6 months following initial BCG therapy with either maintenance or retreatment at 3 months because of persistent or rapidly recurrent tumour; 2) BCG-resistant disease when there is recurrence or persistence at 3 months following an induction cycle; 3) BCGrelapsing disease when the disease recurs after the patient is disease-free for 6 months; and 4) BCG-intolerant disease when the disease recurs following administration of a less than adequate course of therapy because of a serious adverse event or symptomatic intolerance that requires discontinuation of further BCG therapy.…”

Section: Defining Bcg Failurementioning

confidence: 99%

The management of BCG failure in non-muscle-invasive bladder cancer: an update

Zlotta

Fleshner

Jewett

2013

CUAJ

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Up to 40% of patients with non-muscle-invasive bladder cancer (NMIBC) will fail intravesical bacillus Calmette-Guérin (BCG) therapy. There is unfortunately no current gold standard for salvage intravesical therapy after appropriate BCG treatment. Indeed, outcomes are at best suboptimal. The vast majority of low-grade NMIBC are prone to recur but very rarely progress. Failure after intravesical BCG in these patients is usually superficial and lowgrade. At the other end of the spectrum, failure to respond to BCG in high-risk T1 bladder cancer and/or carcinoma in situ (CIS or TIS) is more problematic, since those tumours often have the potential to progress to muscle invasion. In these cases, radical cystectomy remains the mainstay after BCG failure. With appropriate selection, certain patients who "fail" BCG (but with favourable risk factors) can be managed with intravesical regimens, including repeated BCG, BCG plus cytokines, intravesical chemotherapy, thermochemotherapy or new immunotherapeutic modalities. In this review, reasons explaining BCG failure, how to define BCG failure, optimal risk stratification and prediction of response and management of BCG failures are discussed.

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Canadian guidelines for treatment of non-muscle invasive bladder cancer: a focus on intravesical therapy

Cited by 13 publications

References 47 publications

Prognostic factors in T1 bladder urothelial carcinoma: the value of recording millimetric depth of invasion, diameter of invasive carcinoma, and muscularis mucosa invasion

Prognostic factors in T1 bladder urothelial carcinoma: the value of recording millimetric depth of invasion, diameter of invasive carcinoma, and muscularis mucosa invasion

Recurrence and upstaging rates of T1 high-grade urothelial carcinoma of the bladder on repeat resection in a Canadian, resource-limited, healthcare system

The management of BCG failure in non-muscle-invasive bladder cancer: an update

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