National Cancer Institute®
Last Modified: August 1, 2002
UI - 12118019
AU - Rodel C; Grabenbauer GG; Kuhn R; Papadopoulos T; Dunst J; Meyer M;
TI - Schrott KM; Sauer R Combined-modality treatment and selective organ preservation in invasive bladder cancer: long-term results.
SO - J Clin Oncol 2002 Jul 15;20(14):3061-71
AD - Department of Radiation Oncology, Institute of Pathology, University of Erlangen, Germany. email@example.com
PURPOSE: To evaluate our long-term experience with combined modality treatment and selective bladder preservation and to identify factors that may predict treatment response, risk of relapse, and survival. PATIENTS AND METHODS: Between 1982 and 2000, 415 patients with bladder cancer (high-risk T1, n = 89; T2 to T4, n = 326) were treated with radiotherapy (RT; n = 126) or radiochemotherapy (RCT; n = 289) after transurethral resection (TUR) of the tumor. Six weeks after RT/RCT, response was evaluated by restaging-TUR. In case of complete response (CR), patients were observed at regular intervals. In case of persistent or recurrent invasive tumor, salvage-cystectomy was recommended. Median follow-up was 60 months (range, 6 to 199 months). RESULTS: CR was achieved in 72% of patients. Local control after CR without muscle-invasive relapse was maintained in 64% of patients at 10 years. Distant metastases were diagnosed in 98 patients with an actuarial rate of 35% at 10 years. Ten-year disease-specific survival was 42%, and more than 80% of survivors preserved their bladder. Early tumor stage and a complete TUR were the most important factors predicting CR and survival. RCT was more effective than RT alone in terms of CR and survival. Salvage cystectomy for local failure was associated with a 45% disease-specific survival rate at 10 years. Cystectomy because of a contracted bladder was restricted to 2% of patients. CONCLUSION: TUR with RCT is a reasonable option for patients seeking an alternative to radical cystectomy. Ideal candidates are those with early-stage and unifocal tumors, in whom a complete TUR is accomplished.
UI - 11842741
AU - Gschwend JE
TI - Outcome of patients undergoing radical cystectomy for invasive bladder cancer.
SO - Front Radiat Ther Oncol 2002;36():106-17
AD - Department of Urology, University of Ulm, Germany. firstname.lastname@example.org
UI - 11842742
AU - Rodel C; Grabenbauer GG; Kuhn R; Dunst J; Papadopoulos T; Schrott KM;
TI - Sauer R Invasive bladder cancer: organ preservation by radiochemotherapy.
SO - Front Radiat Ther Oncol 2002;36():118-30
AD - Department of Radiation Oncology, University of Erlangen, Germany. email@example.com
UI - 11842743
AU - Zietman AL
TI - Radiation, chemotherapy and transurethral surgery: an organ-sparing alternative to the radical cystectomy.
SO - Front Radiat Ther Oncol 2002;36():131-46
AD - Massachusetts General Hospital, Harvard Medical School, Boston, Mass., USA.
UI - 11842744
AU - Miller K
TI - T1G3 bladder cancer--the case for TUR and BCG.
SO - Front Radiat Ther Oncol 2002;36():147-50
AD - Department of Urology, University Medical Center Benjamin Franklin, Berlin, Germany. firstname.lastname@example.org
UI - 11842745
AU - Dunst J; Rodel C; Diestelhorst A; Heynemann H; Schrott KM; Sauer R
TI - Radiochemotherapy for T1G3 bladder cancer.
SO - Front Radiat Ther Oncol 2002;36():151-8
AD - Department of Radiotherapy, University of Halle, Germany. email@example.com
UI - 12137851
AU - Pu YS; Hour TC; Chen J; Huang CY; Guan JY; Lu SH
TI - Cytotoxicity of arsenic trioxide to transitional carcinoma cells.
SO - Urology 2002 Aug;60(2):346-50
AD - Department of Urology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, Republic of China.
OBJECTIVES: To explore the therapeutic efficacy of arsenic trioxide (As2O3) in human transitional cell carcinomas, we investigated the potential use of the compound as a chemotherapeutic agent and the possible cross-resistance with cisplatin in this malignancy. METHODS: Three bladder transitional carcinoma cell lines, NTUB1, NTUB1/P (cisplatin-resistant), and NTUB1/As (As2O3-resistant), were used. The chemosensitivity of the three cell lines to cisplatin and As2O3 was determined by the microculture tetrazolium assay. The modulatory effect of buthionine sulfoximine (BSO) on As2O3 cytotoxicity was studied by combining the two agents simultaneously or sequentially and evaluated using the median-effect analysis. Cellular glutathione contents were determined using a biochemical method. RESULTS: There was evident cross-resistance between cisplatin and As2O3 in the cell model used. BSO significantly enhanced As2O3 cytotoxicity in the three cell lines, indicating synergism in combination. In the presence of 3 microM BSO, the sensitivity of NTUB1, NTUB1/P, and NTUB1/As to As2O3 was increased 3, 7.4, and 8.4-fold, respectively. Among the three different combination schedules, greater cytotoxic effects were obtained by concurrent exposure to both agents. A significant dose-response relationship was found between the BSO concentrations and glutathione contents in NTUB1 (P = 0.007) and NTUB1/As (P = 0.05) but not NTUB1/P (P = 0.1) cells. CONCLUSIONS: As2O3 in the presence of BSO may be an active agent against transitional cell carcinoma. Our results have clinical implications and warrant further investigation.
UI - 11798787
AU - Xu A; Wang X; Yu M
TI - [Clinical study on super-selective camptothecin microsphere's embolization of internal iliac artery for bladder carcinoma]
SO - Zhonghua Yi Xue Za Zhi 2000 May;80(5):358-9
AD - Department of Urology, General Hospital of PLA, Beijing 100853, China.
OBJECTIVE: To evaluate the efficacy of camptothecin microsphere's embolization of the internal iliac artery for bladder carcinoma. METHODS: Eighteen patients with inoperable and advanced bladder carcinoma were treated with camptothecin microsphere's super-selective embolization of the internal iliac artery. RESULTS: Tumor size was reduced significantly, and tumor cells were damaged to various degrees in 17 patients. Adverse effects were not found. CONCLUSION: Camptothecin microsphere's embolization of the internal iliac artery is a safe and effective therapy for inoperable and advanced bladder carcinoma.
UI - 12131291
AU - Kriegmair M; Zaak D; Rothenberger KH; Rassweiler J; Jocham D;
TI - Eisenberger F; Tauber R; Stenzl A; Hofstetter A Transurethral resection for bladder cancer using 5-aminolevulinic acid induced fluorescence endoscopy versus white light endoscopy.
SO - J Urol 2002 Aug;168(2):475-8
AD - Department of Urology, Clinic Ebersberg and Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Munich, Austria.
PURPOSE: Endoscopy done under fluorescence induced by 5-aminolevulinic acid has proved to be a procedure with high sensitivity for detecting transitional cell carcinoma of the bladder. In this multicenter, parallel group, phase III study we compared 5-aminolevulinic acid fluorescence endoscopy guided transurethral bladder resection with transurethral bladder resection done using only white light endoscopy. The proportion of tumor-free resected cases in the 2 groups was evaluated. MATERIALS AND METHODS: After patient stratification according to participating centers and European Organization for the Research and Treatment of Cancer risk score 65 and 64 were randomized to the 5-aminolevulinic acid fluorescence and white light endoscopy groups, respectively. Residual tumor was evaluated in the 2 groups by repeat transurethral resection 10 to 14 days later. Analysis was performed according to the intent to treat principle with all patients randomized, followed by per protocol analysis. RESULTS: Intent to treat analysis revealed that in the white light endoscopy group 40.6% of cases were resected tumor-free at primary resection, whereas with 5-aminolevulinic acid fluorescence endoscopy guided transurethral resection 61.5% were resected tumor-free (p <0014). On protocol analysis 46.9% patients in the white light and 67.3% in the 5-aminolevulinic acid fluorescence endoscopy groups were resected tumor-free (p <0.031). No difference was noted in the 2 groups in regard to side effects or laboratory findings. CONCLUSIONS: The risk of residual tumor after transurethral resection of transitional cell carcinoma is significantly decreased by 5-aminolevulinic acid fluorescence endoscopy.
UI - 12131315
AU - Ali-El-Dein B; Gomha M; Ghoneim MA
TI - Critical evaluation of the problem of chronic urinary retention after orthotopic bladder substitution in women.
SO - J Urol 2002 Aug;168(2):587-92
AD - Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
PURPOSE: We studied the possible causes of chronic retention after radical cystectomy and orthotopic bladder substitution in women. with a mean age plus or minus standard deviation of 52 +/- 8 years underwent standard radical cystectomy and orthotopic substitution for organ confined bladder cancer. Videourodynamics, pelvic floor electromyography, pelvic floor magnetic resonance imaging and pan-endoscopy were done. In the last 37 cases some technical modifications were adopted to circumvent the development of chronic urinary retention. RESULTS: One woman died postoperatively of massive pulmonary embolism. Of the 100 patients evaluable at a mean followup of 36 months 95 were continent in the daytime, 86 were continent at night, 2 were completely incontinent and 16 were in chronic retention. Videourodynamics showed that retention was mechanical in nature due to the pouch falling back in the wide pelvic cavity, resulting in acute angulation of the posterior pouch-urethral junction. In addition, herniation of the pouch wall through the prolapsed vaginal stump was observed in most cases. Pelvic floor electromyography demonstrated complete pelvic floor silence during voiding. No abnormality of the pelvic floor or rhabdosphincter was noted on magnetic resonance imaging. Pan-endoscopy showed a normal urethra with no urethroileal stricture. A 4 mg. dose of the alpha1-adrenergic blocker doxazosin daily was ineffective, excluding the possibility that sprouting from adjacent adrenergic neurons into the denervated proximal urethral muscles may have been the cause of this problem. After omental packing behind the pouch, suturing of the peritoneum on the rectal wall to the vaginal stump, suspension of the latter by the preserved round ligaments and suspension of the pouch near its dome to the back of the rectus muscle at cystectomy the incidence of chronic retention decreased from 18.7% (14 of 75 cases) before to 8% (2 of 25) after modifications. Furthermore, after vaginal wall descent was mechanically corrected by a pessary there was significant improvement in evacuation. CONCLUSIONS: Strong evidence was provided that chronic urinary retention after orthotopic substitution is due to anatomical rather than to functional or neurogenic reasons. Modifications to increase back support of the pouch with ventral suspension near its dome and support the vaginal stump are recommended to avoid this complication.
UI - 12131337
AU - Steinberg GD; Rinker-Schaeffer CW; Sokoloff MH; Brendler CB
TI - Highlights of the Society of Urologic Oncology meeting, June 2, 2001.
SO - J Urol 2002 Aug;168(2):653-9
AD - Section of Urology, Department of Surgery, Pritzker School of Medicine, University of Chicago Hospitals, Chicago, Illinois, USA.
UI - 11993087
AU - Turk I; Davis JW; Deger S; Winkelmann B; Schonberger B; Schellhammer PF;
TI - Loening SA [Laparoscopic radical cystectomy with intracorporeal creation of a continent urinary diversion. Future or present?]
SO - Urologe A 2002 Mar;41(2):107-12
AD - Klinik fur Urologie, Universitatsklinikum Charite, Humboldt-Universitat, Schumannstrasse 20/21, 10117 Berlin. firstname.lastname@example.org
Once laparoscopic radical prostatectomy has been mastered, the step to performing a radical cystectomy is not that far. The challenge is to create the urinary diversion by laparoscopy. In this report we describe our experience with 11 laparoscopic radical cystectomies and intracorporeal construction of a continent urinary diversion (Mainz pouch II) as a treatment option in patients with muscle-invading bladder cancer. All 11 procedures could be performed successfully. A conversion to open surgery was not required in any case. The mean surgery time was 6.7 h. Except for two pouch fistulas we did not observe any intra- or postoperative complications. The functional as well as the oncological results are convincing. Less morbidity and faster recovery are the main advantages of this minimally invasive procedure. In addition, the low levels of blood loss, fluid shifts, and electrolyte loss considerably reduce cardiovascular stress. Radical cystectomy and construction of a continent urinary diversion represent the limit of technically feasible laparoscopy and should be done exclusively in specialized centers.
UI - 11993095
AU - Krege S; Hinke A; Otto T; Rubben H
TI - [Evaluation of ther complementary drug Factor AF2 as a supportive agent in management of advanced urothelial carcinoma. Prospective randomized multicenter study]
SO - Urologe A 2002 Mar;41(2):164-8
AD - Klinik fur Urologie, Universitatsklinikums Essen, Hufelandstrasse 55, 45122 Essen. email@example.com
This is a prospective randomized multicenter trial for evaluation of the biological response modifier Factor AF2 in advanced urothelial cancer treated with chemotherapy. Main aim of the study was the analysis of supportive effects. Additionally patients were examined with regard to tumor response, time to progression and survival. 106 patients with advanced urothelial cancer received chemotherapy with cisplatin and methotrexate. They were randomized for additional Factor AF2 (500 mg i.v., given at days 0-3, 7-10 and 11-14). Myelotoxicity was more common and severe in the group without Factor AF2 reaching statistical significance. Gastrointestinal side effects occurred in both groups, though grade III to IV toxicity was more common without Factor AF2. Overall remission rate was 38%, median survival 33 weeks, mean time to progression 20 weeks. There was no significant difference between the two groups with or without Factor AF2.
UI - 11999462
AU - Salvador-Bayarri J; Rodriguez-Villamil L; Imperatore V; Palou Redorta J;
TI - Villavicencio-Mavrich H; Vicente-Rodriguez J Bladder neoplasms after nephroureterectomy: does the surgery of the lower ureter, transurethral resection or open surgery, influence the evolution?
SO - Eur Urol 2002 Jan;41(1):30-3
AD - Departament of Urology, Fundacio Puigvert, Barcelona, Spain. firstname.lastname@example.org
OBJECTIVE: Nephroureterectomy is the treatment of choice for tumors of the upper urinary tract (UUTT). In 1952, a modified version of this technique was described, involving endoscopic detachment of the ureter followed by nephroureterectomy with a single lumbar incision. We reviewed a retrospective survey to assess whether UUTT patients treated with nephroureterectomy with no prior history of bladder tumor had different rates of incidence or different sites of bladder recurrence according to the specific technique employed. METHODS: Patients were divided into group A, 87 patients who underwent a double incision nephroureterectomy and group B with 58 patients with prior detachment of the ureter. In both groups, incidence was calculated for two variables (bladder tumor recurrences and homolaterality of such recurrences) and chi-square tested. Results: Bladder tumor was diagnosed at follow-up in 39% of patients in group A and 34.5% in group B, with no statistically significant difference (N.S.). Bladder tumor recurrences were homolateral to UUTT in 50% of group A cases and 55% of group B cases (N.S.). CONCLUSIONS: Although this is a retrospective survey of two asynchronous groups, given the similar nature of the UUTT cases in both groups and the fact that no statistically significant differences have been found, it is reasonable to conclude that nephroureterectomy with prior endoscopic detachment of the ureter is a safe and radical procedure.
UI - 11886001
AU - Pectasides D; Glotsos J; Bountouroglou N; Kouloubinis A; Mitakidis N;
TI - Karvounis N; Ziras N; Athanassiou A Weekly chemotherapy with docetaxel, gemcitabine and cisplatin in advanced transitional cell urothelial cancer: a phase II trial.
SO - Ann Oncol 2002 Feb;13(2):243-50
AD - First Department of Medical Oncology, Metaxa's Memorial Cancer Hospital, Piraeus, Greece. email@example.com
PURPOSE: To evaluate the efficacy and toxicity of a combination of weekly docetaxel, gemcitabine and cisplatin in advanced transitional cell carcinoma (TCC) of the bladder. PATIENTS AND METHODS: Thirty-five chemotherapy-naive (adjuvant and neoadjuvant chemotherapy was allowed) patients with advanced TCC received intravenous docetaxel 35 mg/m2, gemcitabine 800 mg/m2 and cisplatin 35 mg/m2, on days 1 and 8 every 3 weeks. Prophylactic granulocyte-colony stimulating factor was given from days 3 to 6 and days 10 to 15, anti-emetics were used routinely. RESULTS: Most (27) patients (77.1%) had a performance status of 0 to 1 and eight (22.9%) had received prior adjuvant or neoadjuvant cisplatin-based chemotherapy. In the intention-to-treat analysis, the objective response rate was 65.6% [23/35 patients, 95% confidence interval (CI) 47.8% to 80.9%]. Ten patients (28.5%) achieved a complete response (95% CI 14.6% to 46.3%) and 13 (37.1%) a partial response (95% CI 21.5% to 55.0%). Median survival time was 15.5 months, median duration of response was 10.2 months and median time to progression was 8.9 months. Ten patients (28.5%) developed grade 3/4 neutropenia, including five (14.3%) who experienced febrile neutropenia, which was successfully treated. Grade 3/4 anaemia and thrombocytopenia occurred in 20% and 25.7% of patients, respectively; four patients required platelet transfusions. There were no treatment-related deaths. CONCLUSIONS: Weekly docetaxel, gemcitabine plus cisplatin is a highly effective treatment for chemotherapy-naive advanced TCC, and causes only moderate toxicity. This regimen should be considered as a suitable option that deserves further prospective evaluation through randomised phase III trials.
UI - 12109342
AU - Kamat AM; Lamm DL
TI - Chemoprevention of bladder cancer.
SO - Urol Clin North Am 2002 Feb;29(1):157-68
AD - Department of Urology, UT MD Anderson Cancer Center, Houston, TX 77030, USA. firstname.lastname@example.org
The data presented herein, although highly supportive for a protective role of various nutrients against bladder cancer, are far from definitive. Many authorities question the validity of current recommendations for nutritional chemoprevention against bladder cancer. The reason for the wide variations reported in epidemiologic studies lies in the nature of observational studies. Dietary studies are limited in their conclusions because the protection afforded by the consumption of a particular nutrient may be multifactorial, with different components of the food exerting potential chemopreventive effects. Furthermore, measuring levels of nutrients in the food intake of populations is confounded by factors that might affect these levels and also the incidence of cancer. For example, vitamin A can come from animal or vegetarian sources. Because animal fat has been identified as a potential carcinogen in man, depending on the source of the vitamin, varying levels of protection might be deduced. In addition, chemoprevention studies using dietary supplements are expected to have mild effects, and large studies would be required to confirm statistical significance. Even with agents such as intravesical chemotherapy, only half the studies achieve statistical significance . Prospective randomized trials with a large sample size, longer follow-up, and an extended duration of treatment are needed to clarify the association between micronutrients and cancer protection. With these caveats in mind, several recommendations can be made. Simple measures, such as drinking more fluids (especially water), can have a profound impact on the incidence of bladder cancer. Vitamins are being extensively studied in chemopreventive trials for different cancers. There is strong evidence for a chemoprotective effect of vitamin A in bladder cancer. The authors recommend 32,000 IU/day of vitamin A initially, with lower doses (24,000 IU) for persons less than 50 kg. Because liver toxicity is a possibility with long-term administration, the dose should be decreased to 16,000 IU after 3 years. High doses of beta-carotene should be avoided based on a large clinical trial reporting a 25% increase in the number of cases of prostate cancer and a statistically significant increase in the incidence of lung cancer. Vitamin B6 has been studied in several clinical trials in bladder cancer. The US-based Veterans Administration cooperative study found benefit for vitamin B6 when given as a single agent. Data for vitamins C and E are insufficient to recommend either agent as stand-alone treatment. Nonetheless, each of these vitamins is known to have beneficial effects, including improved function of the immune system. It is possible that only a small percentage of patients with bladder cancer respond to vitamins B6, C, or E, yet each is safe, nontoxic, and inexpensive. In an effort to pool the efficacy of individual agents and to increase the power of study, the authors evaluated the combination of vitamins A, B6, C, and E in a double-blind trial. The observed 50% 5-year reduction in tumor recurrence was highly significant and greater than would be expected for any of the individual ingredients and suggests that combinations of nutritional agents may be most appropriate. A large-volume study along similar lines is being conducted. Among the numerous other compounds and dietary substances purported to have chemopreventive effect, soybeans, garlic, and green tea stand out as having the greatest promise and can freely be recommended to patients. For synthetically synthesized agents such as celecoxib, piroxicam, or DFMO, recommendations must be deferred until the results of clinical trials are conclusively in favor of their use. Many of the dietary factors found to be protective against bladder cancer are being investigated in other cancers and are beneficial to general health. Although naturally occurring nutrients are ideal, especially because the delicate balance of various micronutrients might be impossible to synthesize in the laboratory, the general population finds it easier to take vitamin supplements. Unfortunately, dietary changes such as decreasing fat and increasing fruit and vegetable intake are more difficult to initiate. There is a mistaken notion that simply because an agent is naturally occurring, it cannot be as beneficial as taking a substance synthesized in the laboratory. Even in a high-risk group such as nuclear-bomb survivors in Japan, high consumption of vegetables and fruit is protective against bladder cancer . Encouraging patients to follow an essentially healthy food habit lifestyle will be a significant contribution in the fight against cancer.
UI - 12109354
AU - Moyad MA
TI - Potential lifestyle and dietary supplement options for the prevention and postdiagnosis of bladder cancer.
SO - Urol Clin North Am 2002 Feb;29(1):31-48, viii
AD - Department of Urology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0330, USA. email@example.com
Apart from smoking, certain occupational exposures, and schistosomiasis, little is known about other potential lifestyle risk factors for bladder cancer. Other investigations thus far have also been important because of the large number of individuals who are diagnosed with this cancer that apparently have no known risk factors. Preventing the recurrence of bladder cancer has generated some interest because several preliminary trials have found that a combination dietary supplement of vitamins and minerals or a probiotic agent (Lactobacillus casei) may impact this outcome favorably. Advising patients on some of these lifestyle modifications is currently recommended because the majority of them are also currently recommended for cardiovascular disease reduction.
UI - 11947931
AU - Magno C; Melloni D; Gali A; Mucciardi G; Nicocia G; Morandi B; Melioli
TI - G; Ferlazzo G The anti-tumor activity of bacillus Calmette-Guerin in bladder cancer is associated with an increase in the circulating level of interleukin-2.
SO - Immunol Lett 2002 May 1;81(3):235-8
AD - Unita di Urologia, Universita' degli Studi di Messina, Messina, Italy.
Bacillus Calmette-Guerin (BCG) is currently employed in the treatment of superficial bladder cancer but, despite its recognized effectiveness in preventing recurrences and progression, the immune mechanisms behind its antitumor activity remain to be delineated. In this study we provide evidence that a prolonged increase in the plasma levels of IL-2, but not IL-1beta, IL-4, IL-10, IL-2R or TNF-alpha occured in patients affected by bladder cancer following effective BCG treatment. Conversely, a drop in circulating IL-2 was consistently associated with tumor relapse. The level of IL-2 was elevated even further 15 days after the last BCG administration in patients who did not experience tumor recurrence, suggesting a prolonged T cell-mediated response against antigens other than BCG. Our results indicate that a specific type 1 immune response plays a major role in the anti-cancer activity of BCG. In addition, monitoring IL-2 plasma levels may offer a useful tool for predicting tumor recurrences.
UI - 11769081
AU - Gattegno B; Ciofu C; Chopin D; Association Francaise d'Urologie
TI - [Survey on superficial bladder tumors with members of the French Association of Urology]
SO - Prog Urol 2001 Nov;11(5):1177-90
UI - 12070550
AU - Al-Ali MA; Kashmoula DM; Haddad LF
TI - Surgically treated transitional cell carcinomas of the bladder. The role of radical surgery.
SO - Saudi Med J 2002 Jun;23(6):695-9
AD - Department of Urology, The Royal Hospitals of St Bartholomew and The London, United Kingdom. firstname.lastname@example.org
OBJECTIVE: To assess the treatment outcome and differentiate between the individual behavior of the tumor stages that were studied (Ta, T1, and T2a) with special reference to T2a tumors. METHODS: This study was carried out at Al-Rasheed Military Hospital, Baghdad, Iraq, during a 12 year period. Fifty-six patients with Ta, T1, and T2a (superficial invasion of muscularis propria) transitional cell carcinomas of the bladder, have been retrospectively analyzed. They were treated surgically with either transurethral of the bladder tumor (N=45) or radical surgery (N=11). Tumors with frequent recurrences or mulifocal or extending to the ureter or vesical outlet were treated with radical surgery. No adjuvant intraveiscal chemotherapy or bacillus calmette-guerin therapy was practiced. RESULTS: All Ta tumors were controlled by transurethral of the bladder tumor treatment. Seventy-five percent of T1 tumors were controlled by transurethral of the bladder treatment and 25% qualified for radical surgery according to our criteria. Sixty percent of T2a tumors were controlled by transurethral of the bladder treatment and 40% warranted radical surgery. No stage progression occurred in Ta and T1 lesions, but 27% of T2a lesions (superficial invasion of muscularis propria) progressed to T2b (deep invasion of muscularis propria). All grade 2a lesions of all stages under study were controlled by transurethral of the bladder treatment. Of 6 patients with T2a grades 2b and 3 tumors, 5 patients (83%) qualified for radical surgery. No distant metastasis occurred during the observation period, which ranged from 4 months to 12 years (mean 51 months). Seventy-five percent of all patients, 78% of the transurethral of the bladder treatment group and 64% of the radical surgery group are alive and free of disease for 5 years or more. CONCLUSION: Radical surgery is indicated for T1 and T2a bladder carcinomas if they were multifocal, or extending to the ureter or the vesical outlet or frequently recurring within the first year, specially if they were T1 tumors of grade 3 or T2a tumors of grades 2b and 3. Transurethral resection is justifiable for grades 1 and 2a, low risk T2a tumors.
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