Optimum Management Of The T1 High Grade Bladder Cancer

2020 ◽  
Vol 16 (1) ◽  
pp. 26-32
Author(s):  
Md Abul Hossain ◽  
Md Waliul Islam ◽  
Md Nurul Hooda ◽  
Md Fazal Naser ◽  
Md Shafiqul Azam
Keyword(s):  
Bladder Cancer ◽  
Cancer Treatment ◽  
Treatment Option ◽  
Conservative Therapy ◽  
Invasive Bladder Cancer ◽  
Intravesical Therapy ◽  
High Grade ◽  
Muscle Invasive Bladder Cancer ◽  
Optimum Treatment ◽  
Muscle Invasive

Objectives: To determine the optimum treatment option for patients with superficial high grade (T1Hg) bladder cancer. Introduction: Controversy exists about the most appropriate treatment for superficial high grade (T1Hg) bladder cancer. Immediate cystectomy offers the best chance for survival but associated with an impaired quality of life compared with conservative therapy. In case of conservative therapy lifelong surveillance is required and there is a high rate of recurrence and risk of disease progression. So optimum treatment option should be determined to treat the disease optimistically. Methods: A comprehensive and systemic search of the pubmed database for English Language articles was performed using the following medical subject Heading (MeSH): Bladder cancer, treatment of superficial high grade (T1Hg) bladder cancer, treatment options for bladder cancer, natural history of T1Hg bladder cancer, newer Intravesical agents, cystectomy and in addition reference of relevant articles were searched for additional references. Results: Approximately 70% of all newly diagnosed bladder tumors are non-muscle invasive bladder cancer. The management of these patients entails transurethral resection with or without adjuvant intravesical therapy. After review of obtained articles it is evident that the conservative treatment of T1Hg bladder cancer should be ended when there is systemic or local toxicity from intravesical therapy or patient is not complaint or persistence of tumor or tumor progression despite therapy. Conclusion : The management of T1Hg is highly variable due to several factors including divergence in treatment related evidence. The efficacy of treatments must be balanced with their toxicity, so that single treatment option cannot be considered superior across all Non-Muscle Invasive Bladder Cancer (NMIBC). Immediate radical cystectomy may be offered upfront in patients with T1Hg tumors with concomitant CIS or multiple recurrent high grade tumors. Bangladesh Journal of Urology, Vol. 16, No. 1, Jan 2013 p.26-32

scholarly journals Oncological outcomes of high-grade T1 non-muscle-invasive bladder cancer treatment in octogenarians

2021 ◽  
Author(s):  
Aleksander Ślusarczyk ◽  
Karolina Garbas ◽  
Piotr Zapała ◽  
Łukasz Zapała ◽  
Piotr Radziszewski
Keyword(s):  
Bladder Cancer ◽  
Cancer Treatment ◽  
Charlson Comorbidity Index ◽  
Invasive Bladder Cancer ◽  
High Grade ◽  
Muscle Invasive Bladder Cancer ◽  
Oncological Outcomes ◽  
Bcg Therapy ◽  
Comorbidity Index ◽  
Muscle Invasive

Abstract Purpose To evaluate the outcomes of high-grade T1 non-muscle-invasive bladder cancer treatment (NMIBC) in elderly patients over 80 years of age. Methods This is a retrospective single tertiary-centre study. Medical records of patients with T1 high-grade NMIBC treated with transurethral resection of the bladder tumour (TURBT) were reviewed. Among 269 patients with high-grade T1 NMIBC, 74 individuals were over 80 years of age at the time of surgery. Finally, 67 patients met the inclusion criteria. Results Only 47.8% of patients (N = 32) received at least five of the six instillations of the BCG immunotherapy induction course. Oncological outcomes were compared between patients who received at least the induction course of BCG and non-BCG-treated patients matched to each other based on age and Charlson comorbidity index. Thirty case–control pairs were included in the final analysis. Rates of disease recurrence (80% vs. 53%) and cancer-specific mortality (40% vs. 10%) were significantly higher in the group of patients who did not receive BCG. BCG therapy, Charlson comorbidity index, haemoglobin concentration and the number of tumours > 3 in TURBT constituted independent prognostic factors for cancer-specific survival (CSS). Conclusion BCG should be strongly recommended to patients with T1HG NMIBC despite advanced age and comorbidities. Already BCG induction improves CSS and reduces the recurrence rate in octogenarians with T1HG bladder cancer.

scholarly journals Effectivity of intravescical thermo-chemotherapy prophylaxis for patients with high recurrence and progression risk for non-muscle invasive bladder cancer

2017 ◽  
Vol 89 (2) ◽  
pp. 102 ◽  
Author(s):  
Ali Serdar Gözen ◽  
Paolo Umari ◽  
Walter Scheitlin ◽  
Fuat Ernis Su ◽  
Yigit Akin ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
High Risk ◽  
Recurrent Disease ◽  
Bladder Wall ◽  
Invasive Bladder Cancer ◽  
Outpatient Basis ◽  
High Grade ◽  
Muscle Invasive Bladder Cancer ◽  
Muscle Invasive

Background&Aim: High grade non-muscle invasive bladder cancer (NMIBC) is common in urological practice. Most of these cancers are or become refractory to intravesical immunotherapy and chemotherapy. Here we evaluated the efficacy of combined local bladder hyperthermia and intravesical mitomycin-C (MMC) instillation in patients with high-risk recurrent NMIBC. Materials and methods: Between February 2014 and December 2015, 18 patients with high risk NMIBC were enrolled. Patients were treated in an outpatient basis with 6 weekly induction sessions followed by monthly maintenance sessions with intravesical MMC in local hyperthermia with bladder wall thermo-chemotherapy (BWT) system (PelvixTT system, Elmedical Ltd., Hod Hasharon, Israel). The follow-up regimen included cystoscopy after the induction cycle and thereafter with regular intervals. Time to disease recurrence was defined as time from the first intravesical treatment to endoscopic or histological documentation of a new bladder tumour. Adverse events were recorded according to CTC 4.0 (Common Toxicity Criteria) score system. Results: Mean age was 72 (32-87) years. 10 patients had multifocal disease, 9 had CIS, 6 had recurrent disease and 2 had highly recurrent disease (> 3 recurrences in a 24 months period). 6 patients underwent previous intravesical chemotherapy with MMC. The average number of maintenance sessions per patient was 7.6. After a mean follow-up of 433 days, 15 patients (83.3%) were recurrence-free. 3 patients had tumour recurrence after a mean period of 248 days without progression. Side effects were limited to grade 1 in 2 patients and grade 2 in 1 patient. Conclusions: BWT seems to be feasible and safe in high grade NMIBC. More studies are needed to identify the subgroup of patients who may benefit more from this treatment.

scholarly journals Does the Urinary Mast Cell Mediators Predict the Immune Response to BCG in Patients with Primary High-Grade Non-Muscle Invasive Bladder Cancer?

2020 ◽  
Author(s):  
Muhammed Fatih Simsekoglu ◽  
İslim Kaleler ◽  
Bulent Onal ◽  
Cetin Demirdag ◽  
Sinharib Citgez ◽  
...  
Keyword(s):  
Immune Response ◽  
Bladder Cancer ◽  
Mast Cell ◽  
Critical Role ◽  
Invasive Bladder Cancer ◽  
High Grade ◽  
Muscle Invasive Bladder Cancer ◽  
Muscle Invasive ◽  
Healthy Participants ◽  
Bcg Instillation

Background: Mast cells play a critical role in tumor-associated immune pathways. We aimed to determine whether the urinary mast cell mediators predict the immune response in patients with non-muscle invasive bladder cancer (NMIBC) treated with Bacillus Calmette-Guérin (BCG) immunotherapy. Methods: Nineteen patients who have received immunotherapy due to NMIBC and 19 healthy participants were enrolled. Urine samples were collected to assay N-methylhistamine, histamine, and tryptase levels immediately before the first BCG instillation, immediately after the third and sixth instillations, and four weeks after the sixth instillation in patients with NMIBC and at a single visit in healthy participants. Cystoscopic examinations were performed on the patient with NMIBC at three-month intervals for two years. The changes in urinary markers due to BCC response, BCG instillation, and the presence of NMIBC were assessed. Results: The average age was 56.1 ± 10.5 years in patients with NMIBC. Fourteen patients had high-grade Ta tumors, and 5 had high-grade T1 tumors. While 12 patients responded, 6 presented with recurrence and 1 with progression. There was no correlation between the levels of mast cell mediators and BCG response. The N-methylhistamine and histamine levels were increased significantly with the onset of immunotherapy, and N-methylhistamine levels were significantly decreased when immunotherapy was terminated. Pre-BCG estimated marginal means of N-methylhistamine were significantly higher in patients with NMIBC than healthy participants. Conclusions: Our study is the first study to identify the changes in mast cell mediators with the onset of immunotherapy and with the presence of bladder cancer. However, these mediators were not found to predict the patients’ response to immunotherapy.

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