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NCI CANCERLIT^® Search: Therapy of Bladder Cancer - September 2001

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Last Modified: November 1, 2001

• [Carcinoma in situ in the urinary bladder]

• Gemcitabine/carboplatin in advanced urothelial cancer.

• [Minimally invasive therapy for bladder and prostate cancer]

• Molecular determination of perivesical and lymph node metastasis after radical cystectomy for urothelial carcinoma of the bladder.

• Fluid consumption and the risk of bladder cancer: results of a multicenter case-control study.

• Gemcitabine-containing regimens in bladder cancer: A new standard of care.

• Prediction of scattered dose to the testes in abdominopelvic radiotherapy.

• The use of valrubicin for the chemoresection of superficial bladder cancer -- a marker lesion study.

• Diagnosis and management of superficial bladder cancer.

• Muscle-invasive transitional cell carcinoma of the urinary bladder: a population-based study of patterns of care and prognostic factors.

• [Long-term outcome of radical cystectomy in urinary bladder carcinoma]

CancerMail from the National Cancer Institute

1
UI - 20503133
AU - Katusin D; Poka Z; Mlinac-Lucijanic M; Kriz M; Klaric-Vucinic S; Ilijanic J
TI - [Carcinoma in situ in the urinary bladder]
SO - Lijec Vjesn 2000 Jul-Aug;122(7-8):177-9
In this paper we have presented seven patients with carcinoma in situ of the urinary bladder, a rare intraepithelial form of transitional cell carcinoma of the urinary bladder, described first in 1952. In all patients malignant cells were detected in urine sediment, and the diagnosis was proven histopathologicaly by random biopsies of the urinary bladder. In five patients carcinoma in situ was associated with papillary bladder tumor, while two patients had primary carcinoma in situ. We have emphasized a high rate of irritative urinary symptoms, that can lead to diagnostic mistakes. Three patients had reduced bladder capacity. In all patients a complete response was achieved after local immunotherapy or local chemotherapy. After a follow-up lasting from 23 to 61 months in one patient a recurrent carcinoma in situ was diagnosed, while six patients show no signs of recurrent disease.

2
UI - 21401137
AU - Carles J; Nogue M
TI - Gemcitabine/carboplatin in advanced urothelial cancer.
SO - Semin Oncol 2001 Jun;28(3 Suppl 10):19-24
AD - Oncology Unit, Hospital del Mar, Universitat Autonoma de Barcelona, Passeig Maritim 25-29, 08003-Barcelona, Catalonia, Spain.
Transitional cell carcinoma of the urothelium is a highly chemosensitive tumor. Combination chemotherapy can provide both palliation and a modest survival advantage in patients with advanced disease. As shown in a recent phase III trial, the new gold standard should be considered gemcitabine/cisplatin, although toxicity remains important. Bladder cancer is a common tumor in our population (Spain), usually affecting elderly patients with comorbid diseases and renal impairment. Thus, most of these patients may not benefit from cisplatin-based regimens. The development of new combinations for treating such patients is, therefore, of vital importance. The identification of new active agents against transitional cell carcinoma, such as taxanes and gemcitabine, is promising. We believe that the combination of gemcitabine plus carboplatin could also be useful in this subset of patients. On this basis, we treated bladder cancer patients in two trials using gemcitabine 1,000 mg/m(2) on days 1 and 8, and carboplatin (area under the curve 5) on day 1, every 21 days. The overall response rate for evaluable patients with and without renal impairment was 60%, with a 95% confidence interval of 40% to 72%. The potential clinical benefit of this new doublet in the treatment of transitional cell carcinoma warrants testing in future phase III studies. Semin Oncol 28 (suppl 10):19-24. Copyright 2001 by W.B. Saunders Company.

3
UI - 21416729
AU - Uchida T; Ohori M; Egawa S
TI - [Minimally invasive therapy for bladder and prostate cancer]
SO - Gan To Kagaku Ryoho 2001 Aug;28(8):1094-8
AD - Dept. of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara, Kanagawa 228-8555, Japan.
Recently, minimally invasive therapy has been a key word in the medical field. Many new therapies have been developed in the field of urology. In this area, bacillus Calmette-Guerin (BCG) instillation therapy, transurethral resection of the bladder tumor and intra-arterial infusion with irradiation therapy are noted as minimally invasive therapies for bladder cancer. Laparoscopic prostatectomy, brachytherapy, three-dimensional conformal radiotherapy (3D-CRT) and high-intensity focused ultrasound (HIFU) have also been developed as minimally invasive therapies for prostate cancer. Though the establishment of the validity of each treatment will still take time, the best treatment for each patient should be chosen case by case, including considerations of postoperative quality of life and economic efficiency.

4
UI - 21303169
AU - Seraj MJ; Thomas AR; Chin JL; Theodorescu D
TI - Molecular determination of perivesical and lymph node metastasis after radical cystectomy for urothelial carcinoma of the bladder.
SO - Clin Cancer Res 2001 Jun;7(6):1516-22
AD - Department of Urology, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA.
PURPOSE: Current methods used to determine the pathological stage of the primary tumor and associated lymphatics after radical cystectomy are tedious, costly, and may lack the sensitivity afforded by molecular approaches such as reverse transcription-PCR (RT-PCR) for markers specific for urothelial tissue such as the uroplakin II (UPII) gene. Thus, we sought to evaluate an objective and sensitive molecular approach for the assessment of perivesical extension and lymph node status after radical cystectomy, based on the detection of UPII expression using RT-PCR and compare this assay to standard clinical and pathological examination. EXPERIMENTAL DESIGN: From November 1999 to September 2000, 27 patients with clinical T(a)-T(3)N(0)M(0) urothelial bladder cancer underwent radical cystectomy, 19 (70%) of which also had pelvic lymphadenectomy. At the completion of cystectomy, systematic biopsies of the external surface of the bladder specimen as well as from the largest palpable lymph node found at lymphadenectomy were obtained for molecular analysis. RT-PCR analysis for UPII mRNA was carried out on these biopsy specimens, and results were compared with data obtained from conventional pathological examination. RESULTS: Pathologically organ-confined tumors had a 42% (5 of 12) incidence of positive signals in the perivesical tissues and 17% (1 of 7) in the lymph nodes. Corresponding percentages for pT(3a)N(0) and pT(3b)-T(4)N(0) lesions were 67% (4 of 6)/25% (1 of 4) and 67% (4 of 6)/33% (2 of 6), respectively. Overall, pathologically node-negative cancers had a perivesical positivity rate of 54% (13 of 24) and a lymph node positivity rate of 25% (4 of 16). All patients with pathologically positive nodes had positive UPII signals in the lymph node sample. CONCLUSIONS: This molecular assay aimed at assessing perivesical extension and lymph node status after radical cystectomy appears to identify patients that may harbor residual disease not appreciated by conventional histology. Larger studies with 5-7-year follow-up will be required to determine the prognostic significance of such molecular information.

5
UI - 21409941
AU - Geoffroy-Perez B; Cordier S
TI - Fluid consumption and the risk of bladder cancer: results of a multicenter case-control study.
SO - Int J Cancer 2001 Sep15;93(6):880-7
AD - U 170 National Institute of Health and Medical Research (INSERM), Batiment Inserm, Villejuif Cedex, France.
A number of studies suggest a relation between fluid consumption and the risk of bladder cancer but results are contradictory. Different theories involving the quantity or the type of fluid consumed have been put forward to explain these relations but mechanisms remain unclear. We conducted a multicenter case-control study in several hospitals in France including 765 cases and 765 matched controls. Information collected by face-to-face interview included quantity and type of beverages consumed from the age of 18 until age at diagnosis, as well as smoking habits. Among men, we observed a slight non-significant increased risk of bladder cancer associated with total fluid intake, irrespectively of tobacco use. This was essentially due to intake of non-alcoholic drinks, coffee and bottled juice or water. Relative risks greater than 1 were observed in relation with coffee consumption. On the other hand, alcohol consumption, especially wine, was associated with relative risks less than unity. No relation could be identified between bladder cancer risk and fluid consumption among women. Our results do not support an association between total fluid consumption and bladder cancer risk. The role of the different types of fluid consumed, confounding factors and bias in the present analysis are discussed. Copyright 2001 Wiley-Liss, Inc.

6
UI - 21401133
AU - von der Maase H
TI - Gemcitabine-containing regimens in bladder cancer: A new standard of care.
SO - Semin Oncol 2001 Jun;28(3 Suppl 10):1-3
AD - Department of Oncology, Aarhus University Hospital, DK 8000 Aarhus C, Denmark.

7
UI - 21268250
AU - Budgell GJ; Cowan RA; Hounsell AR
TI - Prediction of scattered dose to the testes in abdominopelvic radiotherapy.
SO - Clin Oncol (R Coll Radiol) 2001;13(2):120-5
AD - Christie Hospital NHS Trust, Manchester, UK.
Radical abdominal radiotherapy in men runs the risk of impairing their fertility owing to scattered dose to the testes, outside of the treated volume. In patients for whom this is a concern it is important to be able to predict the dose to the testes before treatment in order to determine whether semen cryopreservation should be undertaken and testicular shielding performed during treatment. Measurements have been made on an anthropomorphic phantom to determine the magnitude of these doses for a four-field treatment consisting of an anterior-posterior parallel pair and a lateral parallel pair. A dataset is presented, which, together with a correction for patients size, allows an estimate of testicular dose to be made given only the photon energy, interfield distances and the distance from the testes to the nearest beam edge. Thermoluminescent dosimetry has been carried out in 17 patients to validate the use of the data tables. The results indicate that testicular doses may be estimated with a standard deviation corresponding to 1%-2% of the tumour dose, which is sufficient for the purpose of determining whether fertility is threatened by a planned treatment.

8
UI - 21356615
AU - Newling DW; Hetherington J; Sundaram SK; Robinson MR; Kisbenedek L
TI - The use of valrubicin for the chemoresection of superficial bladder cancer -- a marker lesion study.
SO - Eur Urol 2001 Jun;39(6):643-7
AD - Academisch Ziekenhuis der Vrije Universiteit, Amsterdam, The Netherlands. urol@azvu.nl
OBJECTIVES: To assess the effect and tolerance of a 6-week course of intravesical valrubicin on a tumour intentionally left in the bladder (marker lesion) following incomplete transurethral resection of the bladder (TURBT). PATIENTS AND METHODS: In a prospective phase II study, 40 patients with refractory superficial transitional cell carcinoma (TCC), with or without carcinoma in situ, underwent TURBT at which a tumour <1 cm in diameter was deliberately left in the bladder. They were then treated with six instillations of 800 mg valrubicin at weekly intervals. Patients were assessed three months after the initial TURBT by cystoscopy and biopsy. Patients remaining clear of disease underwent repeat cystoscopies at 3-monthly intervals until recurrence or for up 2 years. RESULTS: 21/39 (54%) of patients were found to be clinically clear of disease upon cystoscopic examination at 3 months. 18/39 (46%) of patients were considered histologically clear of bladder disease. The current estimate of the mean time to recurrence is 248 days. CONCLUSIONS:A 6-week course of intravesical valrubicin has proved effective in ablating a marker tumour left in the bladder after incomplete TURBT and in preventing or delaying recurrence of further tumours in a group of patients with previously treated superficial TCC.

9
UI - 21405429
AU - Amling CL
TI - Diagnosis and management of superficial bladder cancer.
SO - Curr Probl Cancer 2001 Jul-Aug;25(4):219-78
AD - Department of Urology, Naval Medical Center, San Diego, California, USA.
Bladder cancer is the fourth leading cause of cancer in American men, accounting for more than 12,000 deaths annually. It was one of the first malignancies in which carcinogens were recognized as an important factor in its cause. Currently, cigarette smoking is by far the most common cause of bladder cancer, although occupational exposure to arylamines has been implicated in the past. Gross or microscopic hematuria is the most common sign at presentation. Initial radiologic evaluation usually includes the excretory urography (intravenous pyelography), although further evaluation of the renal parenchyma with ultrasound or computed tomography scanning has been advocated by some. These radiologic studies are unable to provide adequate bladder imaging, and thus cystoscopy is required for the diagnosis of bladder cancer. Most bladder cancers present as "superficial" disease, confined to the bladder mucosa or submucosal layer, without muscle invasion. Superficial tumors consist of papillary tumors that are mucosally confined (Ta), papillary or sessile tumors extending into the lamina propria (T1), and carcinoma in situ, which occurs as "flat" mucosal dysplasia, which can be focal, diffuse, or associated with a papillary or sessile tumor. The natural history of these pathologic subtypes differ significantly. Most superficial tumors (60% to 70%) have a propensity for recurrence after transurethral resection. Some (15% to 25%) are at high risk for progression to muscle invasion. Most superficial tumors can be stratified into high- or low-risk groups depending on tumor stage, grade, size, number, and recurrence pattern. It is important to identify those tumors at risk for recurrence or progression so that adjuvant intravesical therapies can be instituted. Many intravesical chemotherapeutic agents have been shown to reduce tumor recurrence when used in conjunction with transurethral tumor resection. Unfortunately, however, none of these agents have proved to be of benefit in preventing disease progression. Most are given intravesically on a weekly basis, although many studies suggest that a single instillation immediately after transurethral resection may be as good as a longer course of therapy. Although all of these drugs have toxicity, they usually are well tolerated. Intravesical bacille Calmette-Guerin (BCG) is an immunotherapeutic agent that when given intravesically is very effective in the treatment of superficial transitional cell carcinoma. Compared with controls, BCG has a 43% advantage in preventing tumor recurrence, a significantly better rate than the 16% to 21% advantage of intravesical chemotherapy. In addition, BCG is particularly effective in the treatment of carcinoma in situ, eradicating it in more than 80% of cases. In contrast to intravesical chemotherapy, BCG has also been shown to decrease the risk of tumor progression. The optimal course of BCG appears to be a 6-week course of weekly instillations, followed by a 3-week course at 3 months in those tumors that do not respond. In high-risk cancers, maintenance BCG administered for 3 weeks every 6 months may be optimal in limiting recurrence and preventing progression. Unfortunately, adverse effects associated with this prolonged therapy may limit its widespread applicability. In those patients at high risk in whom BCG therapy fails, intravesical interferon-alpha with or without BCG may be beneficial in some. Photodynamic therapy has also been used but is limited by its toxicity. In patients who progress or do not respond to intravesical therapies, cystectomy should be considered. With the development of orthotopic lower urinary tract reconstruction to the native urethra, the quality of life impact of radical cystectomy has been lessened.

10
UI - 21407944
AU - Scrimger RA; Murtha AD; Parliament MB; Venner PM; Hanson J; Houle G; Chetner M
TI - Muscle-invasive transitional cell carcinoma of the urinary bladder: a population-based study of patterns of care and prognostic factors.
SO - Int J Radiat Oncol Biol Phys 2001 Sep 1;51(1):23-30
AD - Division of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada.
PURPOSE: Population-based cancer registries can permit the study of the survivorship of all patients with a particular diagnosis regardless of patterns of referral and practice within a specific geographic distribution. The purpose of this study is to describe the patterns of care, outcome, and prognostic factors for bladder cancer in the northern region of the province of Alberta, Canada, between 1984 and 1993. METHODS AND MATERIALS: Between 1984 and 1993, 184 patients from northern Alberta were identified from the Alberta Cancer Registry as having undergone curative treatment for biopsy-proven muscle-invasive transitional cell carcinoma of the bladder. Data were obtained, by retrospective chart review, regarding the staging, pathology, treatment, and outcome of patients treated in the northern Alberta cities of Edmonton, Grande Prairie, and Red Deer, regardless of the responsible treating institution. The prognostic significance of patient-, tumor-, and treatment-related variables were tested using univariate and multivariate analysis using the Cox proportional-hazard model. RESULTS: As the primary treatment modality, 74 patients (40%) received radical radiotherapy (RT) without surgery; surgery was used alone in 81 patients (44%), and was combined with preoperative or postoperative radiotherapy in 29 patients (16%). Seventy-three (40%) patients also received concurrent, neoadjuvant, or adjuvant chemotherapy. The Kaplan-Meier estimate of median survival was 2.2 years, and the 5-year overall survival was 30%. Univariate analysis demonstrated the prognostic significance of T classification (p < 0.001), lymph node involvement (p < 0.001), complete response to RT (p = 0.001), hydronephrosis (p = 0.017), and vascular/lymphatic involvement (p = 0.035). Multivariate analysis revealed the following to have a significant association with survival: T classification (p = 0.001), lymph node involvement (p = 0.004), complete response to RT (p = 0.054), hydronephrosis (p = 0.019), and use of chemotherapy in the treatment regimen (p = 0.025). CONCLUSION: The strongest prognostic factors in this study were tumor related, and no significant differences in survival were detected between patients treated with primary surgery vs. organ-preservation approaches. A survival advantage associated with the incorporation of chemotherapy into the management schema was detected on multivariate, but not univariate, analysis. Stratification of patients based on tumor characteristics is imperative in clinical trials for invasive bladder cancer. Novel treatment approaches are required to improve survival further in patients with apparently localized disease.

11
UI - 21428487
AU - Dunst J
TI - [Long-term outcome of radical cystectomy in urinary bladder carcinoma]
SO - Strahlenther Onkol 2001 Aug;177(8):437-8