Chemoresection in Ta-T1 Bladder Cancer

Bono, A; Rr, Hall; Denis, L.; Ja, Lovisolo; Sylvester, Richard

doi:10.1159/000473784

Cited by 53 publications

(15 citation statements)

References 8 publications

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“…But there are no randomized trials directly comparing MMC with epirubicin. Two small phase 2 chemoresection studies showed similar response rates on epirubicin and MMC [16]. There was no suggestion that epirubicin might be less effective than MMC when given as a single immediate postoperative instillation [17].…”

Section: Discussionmentioning

confidence: 99%

Long-Term Efficacy Results of EORTC Genito-Urinary Group Randomized Phase 3 Study 30911 Comparing Intravesical Instillations of Epirubicin, Bacillus Calmette-Guérin, and Bacillus Calmette-Guérin plus Isoniazid in Patients with Intermediate- and High-Risk Stage Ta T1 Urothelial Carcinoma of the Bladder

Brausi²,

et al. 2010

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Abstract© 2009 European Association of Urology. Published by Elsevier B.V. All rights reserved. * Corresponding author: EORTC Headquarters, 83 avenue E Mounier, Bte 11, 1200 Brussels, Belgium, Tel. +322.774.1613, Fax: +322.772.3545, richard.sylvester@eortc.be. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Financial disclosures: I certify that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/ affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: None. Intervention-Patients received six weekly instillations of epirubicin, BCG, or BCG plus isoniazid (INH) followed by three weekly maintenance instillations at months 3, 6, 12, 18, 24, 30, and 36. NIH Public AccessAuthor Manuscript Eur Urol. Author manuscript; available in PMC 2011 May 1.Measurements-End points were time to recurrence, progression, distant metastases, overall survival, and disease-specific survival.Results and limitations-With 837 eligible patients and a median follow-up of 9.2 yr, time to first recurrence (p < 0.001), distant metastases (p = 0.046), overall survival (p = 0.023), and diseasespecific survival (p = 0.026) were significantly longer in the two BCG arms combined as compared with epirubicin; however, there was no difference for progression.

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Section: Discussionmentioning

confidence: 99%

Long-Term Efficacy Results of EORTC Genito-Urinary Group Randomized Phase 3 Study 30911 Comparing Intravesical Instillations of Epirubicin, Bacillus Calmette-Guérin, and Bacillus Calmette-Guérin plus Isoniazid in Patients with Intermediate- and High-Risk Stage Ta T1 Urothelial Carcinoma of the Bladder

Brausi²,

et al. 2010

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“…For this reason, the marker lesion model is an important experimental tool in evaluating a new therapeutic model. (7) Furthermore, completion of resection of any residual tumor (marker lesion) at a later date does not appear to be associated with higher recurrence or progression. (8) The objectives of this study were, therefore, to investigate the ablative or reductive activity of intravesical administration of GM-CSF on the marker lesion, together with its efficacy to increase activate the monocyte/macrophage population.…”

Section: Discussionmentioning

confidence: 99%

“…(9) The treatment caused disappearance of the marker lesion in 55% of patients, indicating that it is an effective treatment for at least some TCC. Bono et al, (7) who used a TCC marker lesion to test mitomycin and epirubicin, noted that the complete response rate of the marker lesion was 57.3% with mitomycin and 66.7% with epirubicin.…”

Section: Discussionmentioning

confidence: 99%

A New Approach in the Management of Urothelial Tumors Using GM-CSF on Marker Lesions: An Ultrastructural and Immunohistochemical Study on the Macrophage Population in Bladder Mucosa

Stravoravdi

Toliou²,

Kirtsis³

et al. 1999

Journal of Interferon & Cytokine Research

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Our purpose was to investigate a new therapeutic model, GM-CSF-targeted immunomodulation on transitional cell carcinoma (TCC) marker lesions and to evaluate the immunologic response of the bladder mucosa. Eleven patients with pTa or pT1 bladder cancer were eligible for the study. All lesions were removed by transurethral resection (TUR) except for a marker lesion. All patients received 8 weekly instillations of 300 microg of GM-CSF, after which cystoscopy with bladder biopsies +/- TUR was repeated on adjacent urothelium or tumor or both. Paraffin-embedded sections were immunohistochemically stained with CD68, which labels monocytes and macrophages. The CD68+ cell population was evaluated as 1+ to 3+. Comparable specimens were routinely processed for ultrastructural analysis. Complete response was observed in 6 patients (55%), persistent tumor occurred in 4 patients (approximately 36.4%), and 1 patient (8.6%) showed recurrence. Immunohistochemically, an at least twofold increase in the number of the CD68+ cells was observed in all responders. Submicroscopically, migration of macrophages to the surface layer occurred. Macrophages showed an extensive lysosomal system and pseudopodia. This study indicates that the prophylactic treatment of TCC with GM-CSF may induce immunomodulatory effects on macrophage activities, which could be associated with the clinical evolution of the disease.

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“…Auch muss im Rahmen einer Phase-II-Untersuchung manchmal eine sogenannte ᭤Mar-ker-Läsion belassen werden, um die Wirksamkeit einer intravesikalen Therapie zu testen [4]. In beiden Fällen wird der verbliebene Tumor im Blasendiagramm hinsichtlich Größe und Lokalisation dokumentiert.…”

Section: Nach-oder Zweitresektionunclassified

Transurethrale Resektion von Blasentumoren

Kurth

2001

Der Urologe B

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Urologe [B] 5•2001 | 501Fort-und Weiterbildung Transurethrale Resektion Mit der transurethralen Resektion des Blasentumors werden 3 Ziele angestrebt: 1. die möglichst kurative Entfernung des nicht muskelinvasiven Tumors (Ta,T1), 2. die Abschätzung des klinischen Tumorstadiums durch eine endoskopische und bimanuelle Untersuchung des relaxierten Patienten und 3. die Entnahme von Gewebeproben zur Beurteilung des Tumortyps und der Ausbreitung des Tumors in den Blasenlagen. Sind in der Harnzytologie bereits Tumorzellen nachgewiesenen worden, oder besteht der Verdacht auf ein Carcinoma in situ, werden selektiv aus verschiedenen Blasengebieten und beim Mann zusätzlich aus der prostatischen Urethra Biopsien entnommen. Klinisch-endoskopischer Befund und pathohistologische Diagnose bestimmen das weitere Vorgehen. Prämisse der erfolgreichen Behandlung von Primärtumoren, die meist unifokal, in etwa 80% der Fälle nicht muskelinvasiv und ≤2 cm sind, ist die vollständige und adäquate Resektion. Bei der Nachresektion von Tumoren der Stadien Ta, T1, G2, und G3 wird in 38-76% der Fälle ein Resttumor und bei bis zu 28% ein muskelinvasiver Tumor gefunden. Die Technik der transurethralen Resektion zur Behandlung von Blasentumoren ist in den verschiedensten Monographien urologisch-chirurgischer Methoden beschrieben [3, 12, 32, 36, 45]. Im Folgenden soll auf einige Aspekte eingegangen werden, die in der täglichen Praxis unterschiedlich gehandhabt werden. Ihre Berücksichtigung ist jedoch für optimale Behandlungsresultate von Bedeutung. Nur bei Beachtung einiger pathologisch-anatomischer und chirurgischer Kriterien kann eine vollständige Resektion oberflächlicher Blasentumoren der Kategorie Ta/T1 erfolgreich verlaufen [49]. Endoskopische Diagnostik Vor der transurethralen Resektion (TUR) wird der relaxierte Patient in Narkose zystoskopiert und die Blase bimanuell palpiert. Die ᭤bimanuelle Untersuchung wird vor allem bei Verdacht auf muskelinvasive Tumoren nach der Resektion wiederholt. Soweit nicht bereits vor der TUR erfolgt, wird bei palpablem Resttumor das lokale Tumorstadium durch CT oder NMR evaluiert und nach eventuellen Metastasen in Ziel einer erfolgreichen Behandlung von Primärtumoren ist die vollständige und adäquate Resektion. ᭤ Bimanuelle Untersuchung Urologe B 2001 · 41: 501-511

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Chemoresection in Ta-T1 Bladder Cancer

Cited by 53 publications

References 8 publications

A New Approach in the Management of Urothelial Tumors Using GM-CSF on Marker Lesions: An Ultrastructural and Immunohistochemical Study on the Macrophage Population in Bladder Mucosa

Transurethrale Resektion von Blasentumoren

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