Recurrence and progression in stage T1G3 bladder tumour with intravesical bacille Calmette‐Guérin (Danish 1331 strain)

Kulkarni, Jagdeesh N.; Gupta, Roby

doi:10.1046/j.1464-410x.2002.02969.x

Cited by 32 publications

(14 citation statements)

References 27 publications

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“…Adjuvant intravesical immunotherapy with the attenuated tuberculosis vaccine BCG has proven to be effective and has become the standard adjuvant treatment for these patients [22] and a useful modality in delaying cystectomy. In a recent meta-analysis, it was clearly shown that treatment with intravesical BCG decreases tumor recurrence and progression but no effect on patient survival was documented [23]. …”

Section: Discussionmentioning

confidence: 99%

Thermochemotherapy for Non-Muscle-Invasive Bladder Cancer: Is There a Chance to Avoid Early Cystectomy?

Volpe

Racioppi²,

Bongiovanni³

et al. 2012

Urol Int

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Objectives: Non-muscle-invasive bladder cancer is characterized by a high recurrence rate after primary transurethral resection. In case of bacillus Calmette-Guérin-refractory neoplasms, cystectomy is the gold standard. In this study the effects of thermochemotherapy with mitomycin C were evaluated in high-risk bladder cancer nonresponders to previous therapy. Patients and Methods: Between January 2006 and December 2009, 30 patients were enrolled with recurrent stage carcinoma in situ, Ta and T1, grade G1 to G3 non-muscle-invasive bladder cancer refractory to chemotherapy or immunotherapy and so becoming suitable for radical cystectomy. All patients underwent endovesical thermochemotherapy: 16 patients underwent a prophylactic scheme and 14 patients underwent an ablative scheme. Results: All the patients completed the study. The mean follow-up for all the patients enrolled was 14 months. Thirteen of 30 patients (43.30%) were disease free and 17 patients (56.70%) had recurrence. In the prophylactic group, 7 of 16 patients (43.75%) were disease free and 9 patients (46.25%) had tumor recurrence; no progression was observed. In the ablative group, 3 patients (17, 64%) had progression to muscle-invasive disease. Side effects were generally mild. Conclusions: Thermochemotherapy could be considered an additional tool in patients refractory to intravesical therapies before considering early cystectomy.

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Section: Discussionmentioning

confidence: 99%

Thermochemotherapy for Non-Muscle-Invasive Bladder Cancer: Is There a Chance to Avoid Early Cystectomy?

Volpe

Racioppi²,

Bongiovanni³

et al. 2012

Urol Int

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“…In superfi cial tumors (Ta, T1), the net benefi t of BCG therapy appears to be an increase in the recurrence-free interval and a delay in cystectomy. Thus, it is possible to preserve the bladder in up to 88% of patients after BCG therapy [9] . T1G3 tumors treated by TUR alone had a recurrence rate of 50-80% and progressed in 25-50% of the cases [15] .…”

Section: Discussionmentioning

confidence: 99%

“…Nine of these patients had muscle-invasive disease and 1 patient (multilocular stage pT1, grade 3) had radical cystectomy after a 24-month followup. After a second course of BCG 1 patient, who was not (24) disease-free (39) pT1G1 ( 27) pT1G1 (36) disease-free (48) pT1G1 multiple (15) pT1G2 (30) disease-free (54) pT1G1 multiple (9) TUR-BT pT1G1 (24) (18) pT1G2 (21) pT2G3 (30) cystectomy disease-free (38) pT1G2 multiple (12) pT1G3 (27) TUR-BT+BCG pT3aG3 node+(36) cystectomy + chemotherapy alive with metastases (50) pT1G3 (15) died, other cause (33) pT1G3 (9) pT2G3 (21) After BCG instillation, signifi cant side effects were seen in 10 (20.4%) of 49 patients, including gross hematuria in 2 (4.1%), severe irritative voiding symptoms in 7 (14.3%), and decreased bladder capacity in 1 (2%).…”

Section: Progressionmentioning

confidence: 99%

“…T1G3 tumors are associated with a worse outcome because of their aggressive biology [7] and hence require aggressive transurethral resection (TUR) of the bladder tumor and endovesical adjuvant therapy as primary treatment [8] . Historically, early cystectomy for T1G3 tumors has yielded good results but currently the emphasis is on bladder preservation [9] . It is now widely accepted that stage T1G3 tumors require additional therapy after TUR to reduce the local recurrence rate and progression to muscle invasive disease.…”

Section: Introductionmentioning

confidence: 99%

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Recurrence and Progression of T1G3 Transitional Cell Carcinoma of the Bladder Treated with Intravesical Bacillus Calmette-Guérin

et al. 2005

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Objective: To examine the incidence of recurrence and progression in patients with stage T1, grade-3 carcinoma of the bladder treated with endovesical bacillus Calmette-Guérin (BCG) after complete transurethral resection. Material and Methods: From May 1995 to June 2002, 937 patients with superficial bladder cancer underwent transurethral resection. 46 patients (4.9%) had T1G3 tumors. All patients received endovesical BCG therapy 2–3 weeks after transurethral resection, given in 6 sessions as weekly instillations of 120 ml Pasteur strain BCG in 50 ml saline. Success was defined by normal cytology and cystoscopy, and normal bladder biopsies. Recurrent tumors were resected and a second or third cycle of therapy was given according to pathological status. Progressive tumors were managed by radical cystectomy, radiotherapy and/or chemotherapy depending on the nature of the tumor or clinical status of the patient. Results: During follow-up 60.7% of the patients (28 of 46) remained tumor free after only 1 BCG cycle and 73.9% (34 of 46) after the third BCG cycle, and the bladder was preserved in all. Muscle-invasive progression was noted in 10 (21.7%) patients at the end of the BCG cycles. Radical cystectomy was done in 10 patients. The tumor-free survival rate of all patients including those who underwent cystectomy is 84.8% (39 of 46) with a median follow-up of 61 (range 39–118) months. Conclusion: Adjuvant immunotherapy with BCG after complete transurethral resection of the bladder tumor represents a highly effective treatment for bladder preservation in stage pT1, grade-3 carcinoma of the bladder. pT1G3 tumors with early high-grade recurrence after failed immunotherapy should be regarded as candidates for early radical cystectomy.

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“…Intravesical instillations of BCG have become the first-line treatment of such tumours. The most recent reports dealing with the results of BCG therapy in patients with T1G3 tumour are listed in Table 2 [3,[5][6][7][8][9]. These studies have reached very heterogeneous conclusions.…”

Section: Discussionmentioning

confidence: 99%

T1G3 transitional cell carcinoma of the bladder: recurrence, progression and survival

Peyromaure

Zerbib

2003

BJU International

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age. Patients treated with BCG had systematic biopsies taken at the end of the first course. Patients with residual tumour received a second course of six weekly instillations. Patients with negative biopsies received maintenance BCG therapy consisting of intravesical instillations each week for 3 weeks given 3, 6, 12, 18, 24, 30 and 36 months after the first course. RESULTSThe median follow-up was 53 months. The overall recurrence rate was 46% and the overall progression rate 19%. The rate of delayed cystectomy was 8% and that of disease-specific survival 91%. In patients who received BCG therapy, the recurrence and progression rates were 42% and 23%, respectively. In this group the rate of diseasespecific survival was 88%. CONCLUSIONThis study confirms that maintenance BCG therapy is an effective treatment for T1G3 bladder tumours, with an acceptable rate of bladder preservation.

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Recurrence and progression in stage T1G3 bladder tumour with intravesical bacille Calmette‐Guérin (Danish 1331 strain)

Abstract: This series further confirms the benefits of intravesical BCG (Danish 1331) in an adjuvant setting; furthermore, this treatment facilitates bladder preservation by reducing recurrences and delaying the progression in many patients.

Cited by 32 publications

References 27 publications

Thermochemotherapy for Non-Muscle-Invasive Bladder Cancer: Is There a Chance to Avoid Early Cystectomy?

Thermochemotherapy for Non-Muscle-Invasive Bladder Cancer: Is There a Chance to Avoid Early Cystectomy?

Recurrence and Progression of T1G3 Transitional Cell Carcinoma of the Bladder Treated with Intravesical Bacillus Calmette-Guérin

T1G3 transitional cell carcinoma of the bladder: recurrence, progression and survival

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