National Cancer Institute®
Last Modified: October 1, 2002
UI - 12006245
AU - Nasu Y; Kusaka N; Saika T; Tsushima T; Kumon H
TI - Suicide gene therapy for urogenital cancer: current outcome and prospects.
SO - Mol Urol 2000 Summer;4(2):67-71
AD - Department of Urology, Okayama University Medical School, Shikata, Okayama, Japan. firstname.lastname@example.org
Viral-mediated transfer of the herpes simplex virus thymidine kinase (HSV-tk) gene has been demonstrated by several investigators to confer sensitivity to nucleoside analogs such as ganciclovir (GCV) in a variety of tumor cells including brain, prostate, bladder, kidney, ovary, head and neck, lung, pancreas, and liver cancers. Fourteen suicide gene clinical protocols using adenovirus vectors have been conducted, including four in prostate cancer. Two additional protocols for prostate cancer are in preparation in Japan and the Netherlands. A study conducted at Baylor College of Medicine was the first to demonstrate the safety of HSV-tk plus GCV therapy for human prostate cancer and the anticancer activity of gene therapy in this disease. However, it is still in the early stage of its development, with a number of problems to be overcome. Systemic delivery, specific introduction, and specific expression of the target gene are the major issues to be managed in order to establish a clinically relevant treatment strategy.
UI - 12175394
AU - Mansson A; Davidsson T; Hunt S; Mansson W
TI - The quality of life in men after radical cystectomy with a continent cutaneous diversion or orthotopic bladder substitution: is there a difference?
SO - BJU Int 2002 Sep;90(4):386-90
AD - Department of nursing, Lund University, University Hospital, Lund, Sweden. email@example.com
OBJECTIVE: To compare the quality of life (QoL) in men after radical cystectomy who had either a continent cutaneous diversion or orthotopic bladder substitution. PATIENTS AND METHODS: Eighty men with at least 6 months of follow-up and with no signs of recurrent disease after radical cystectomy for bladder carcinoma, and who had either a continent cutaneous diversion or orthotopic bladder substitution, were sent two types of questionnaire, the Functional Assessment of Cancer Therapy-Bladder Cancer (FACT-Bl) and the Hospital Anxiety and Depression Scale (HADS), to determine their QoL. RESULTS: The FACT-Bl and HADS questionnaires were returned by 90% and 71% of the patients, respectively (P < 0.05). In the replies to the generic version of FACT-Bl there were no differences between the groups in any domain, the scores being high in all. In questions covering intestinal, urinary and sexual items, patients with continent diversion had less trouble controlling urine (P < 0.0001), had to empty less often (P < 0.001), and had fewer symptoms when emptying (P < 0.05). Patients with neobladders had a better appreciation of appearance and better preserved erectile function (both P < 0.05). In the answers to the HADS, the mean scores were low (within the normal ranges) and did not differ between the groups. CONCLUSION: Using two instruments tested for validity and reliability, there were no differences between patients with continent diversion and those with orthotopic substitution.
UI - 12175395
AU - Gupta NP; Gill IS; Fergany A; Nabi G
TI - Laparoscopic radical cystectomy with intracorporeal ileal conduit diversion: five cases with a 2-year follow-up.
SO - BJU Int 2002 Sep;90(4):391-6
AD - Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
OBJECTIVE: To assess the feasibility and intermediate-term outcome of laparoscopic radical cystectomy (LRC) with ileal conduit urinary diversion in patients with organ-confined muscle-invasive carcinoma of the urinary bladder, the entire procedure undertaken intracorporeally only using laparoscopic techniques. PATIENTS AND METHODS: Five patients (four men and one woman) underwent LRC with intracorporeal ileal conduit LRC, ileal conduit exclusion, restoration of ileo-ileal continuity, and bilateral stented uretero-ileal anastomoses were completed intracorporeally in all patients. The follow-up data up to 2 years are reported. RESULTS: All procedures were completed laparoscopically with no open conversion or intraoperative complications. The mean duration of surgery was 7.5 h; the blood loss was 360 mL and no patient required perioperative blood transfusion. The mean (range) hospital stay was 7 (6-22) days; the specimen weight was 225-400 g. The surgical margins of the bladder specimen were negative in each patient. One patient developed intestinal obstruction after surgery, requiring a diverting ileostomy for 12 weeks. At a follow-up of 2 years, two patients died, both from unrelated causes (myocardial infarction and septicaemia from pulmonary infection in one each). The three surviving patients are asymptomatic with normal upper tracts and no evidence of local recurrence or metastatic disease. CONCLUSION: LRC with ileal conduit diversion undertaken completely intracorporeally is a feasible option for muscle-invasive organ-confined carcinoma of the urinary bladder, with good outcomes over a 2-year follow-up.
UI - 12175396
AU - Soulie M; Seguin P; Martel P; Vazzoler N; Mouly P; Plante P
TI - A modified intussuscepted nipple in the Kock pouch urinary diversion: assessment of perioperative complications and functional results.
SO - BJU Int 2002 Sep;90(4):397-402
AD - Department of Urologic Surgery and Andrology, Rangueil University Hospital, Institut Cludius Regaud, Toulouse, France. firstname.lastname@example.org
OBJECTIVE: To assess the complications and continence of a modified intussuscepted nipple in Kock pouch urinary diversions. PATIENTS AND years, range 21-74) with bladder cancer (24), gynaecological tumours (eight) or previous lower tract reconstructive surgery (eight) underwent cystectomy and cutaneous continent urinary diversion using the Kock pouch procedure. The first 23 procedures (group I) used Henriet's technique, whereas a modified fixation of the intussuscepted efferent limb was applied in the last 17 (group II). Complications and functional results (focused on continence and the upper urinary tract) were reviewed. RESULTS: The median (range) follow-up was 47.6 (10-124) months; one patient died 4 weeks after surgery. Early complications occurred in 11 (28%) and re-operation was required in two (5%). Of the late complications reported (38%), extussusception (8%) and efferent nipple prolapse (3%) only occurred in group I and required surgical revision. Late complications were minor (15%) including two asymptomatic refluxes and four with stoma sclerosis. The continence rate at 6 months in groups I and II were 78% and 94%, respectively (P = 0.13). CONCLUSION: Efferent limb prolapse and extussusception of the Kock pouch were the main complications requiring surgical revision. Applying the modified nipple fixation the complications can be reduced and reservoir continence improved.
UI - 12077814
AU - Komiakov BK; Gorelov SI; Novikov AI; Gorelov AI; Guliev BG; Idrisov ShN;
TI - Kagan OF; Sergeev AV; Fadeev VA [Short-term outcomes of radical surgery for bladder cancer]
SO - Urologiia 2002 Mar-Apr;(2):16-9
A total of 102 radical cystectomies have been conducted for 1996-2001 (94 males, 8 females, age 37-78 years, mean age 57.5 years). Most of the patients (81.4%) were diagnosed to have transitional cell carcinoma. Supravesical urine derivation was made by means of ureterocutaneostomy and transureteroureteronephrostomy in 7(6.9) patients, ureterosigmoanastomosis--in 41(40.2%), Sigma-rectumpouch--in 1(0.9%) patients, ileocystoplasty, largely by Hautmann and Studer was carried out in 52(51%) patients. Postoperative complications developed in 25(24.5%) patients who often had adhesive ileus. Four patients died: 2 of pulmonary artery thromboembolism, 1 of acute cardiac failure and 1 of sepsis. Methods of continence urine derivation were preferred, such as ureterosigmoanastomosis by Mainz-Pouch II and creation of orthotopic bladder of the ileum.
UI - 12201939
AU - Stavropoulos NE; Hastazeris K; Filiadis I; Mihailidis I; Ioachim E;
TI - Liamis Z; Kalomiris P Intravesical instillations of interferon gamma in the prophylaxis of high risk superficial bladder cancer--results of a controlled prospective study.
SO - Scand J Urol Nephrol 2002;36(3):218-22
AD - Department of Urology, G. Hatzikosta General Hospital, Ioannina, Greece. email@example.com
OBJECTIVE: To determine if intravesically administered recombinant interferon (IFN) gamma may serve as adjuvant first line treatment in prophylaxis of superficial bladder cancer by reducing its risk for recurrence, in the short term. MATERIAL AND METHODS: A total of 54 patients (43 males and 11 females) with superficial bladder tumours (Ta/T1) initially treated with transurethral resection for their tumors were randomized into two groups: Twenty-eight patients were left untreated after the transurethral resection (controls) whereas 26 patients received intravesical IFN gamma adjuvantly, at a dosage of 0.7 mg per week for 8 weeks. Patients with G1 tumors and carcinoma in situ were excluded. The follow up had a mean time of 12.1 months. Recurrence or progression, as terminal events of the study, were recorded. The comparison of the recurrences between the two groups was performed by estimating: (a) the simple recurrence rate, and (b) the interval to tumor recurrence in each group. RESULTS: Tumor recurrence was detected in 24 controls (86%) and in 16 (62%) patients of the IFN gamma group (p = 0.043). The comparison of the Kaplan-Meier disease-free survival curves between the two groups of patients indicated that intravesical instillations of IFN gamma exerted a continuous protective effect to those who received the agent, in the follow up period (p = 0.0237). No serious side-effects were noted. CONCLUSIONS: Intravesically administered IFN gamma has a demonstrable protective role as first line adjuvant treatment in superficial bladder cancer. This role is mainly focused on prevention of recurrences in the short term. Further prospective studies with longer follow up are required, in order to define the exact place of the drug in the urologist's armamentarium.
UI - 12216074
AU - Kassem HSh; Sangar V; Cowan R; Clarke N; Margison GP
TI - A potential role of heat shock proteins and nicotinamide N-methyl transferase in predicting response to radiation in bladder cancer.
SO - Int J Cancer 2002 Oct 10;101(5):454-60
AD - Cancer Research UK Carcinogenesis Group, Paterson Institute for Cancer Research, Manchester, UK.
The use of definitive radiotherapy for treatment of invasive bladder cancer has the advantage of preserving bladder function, but tumour regression is only achieved in approximately 40-50% of patients. Knowledge of the molecular basis of sensitivity to ionizing radiation and identification of potential molecular predictors will provide useful information regarding patient response and thus help clinicians to individualize treatment. The recent application of cDNA expression array technology provides a useful tool to investigate hundreds or even thousands of genes in a single experiment. In our study, we have used the Atlas human stress cDNA array trade mark to investigate the expression profile of stress-related and DNA repair genes in a radioresistant bladder carcinoma cell line (MGH-U1) and its radiosensitive subclone (S40b). This provides an ideal situation to study genes related to radiation because the genotypes of both cell lines are basically similar and differential changes detected are likely to be related to the different radiosensitivity phenotype. Of 234 genes blotted on the array, 3 genes (Heat shock protein 90, Heat shock protein 27 and Nicotinamide N-methyl transferase) showed consistent downregulation in the radiosensitive clone in 2 independent experiments. These results were further confirmed for HSP27 and NNMT using Sybr Green I-based real-time QRT-PCR. The role of heat shock proteins (HSPs) in response to radiation remains to be determined; however, the results of our present work suggest a possible role of HSP27 in determining radiosensitivity. Our study also opens avenues for the investigation of genes, such as NNMT, which has not previously been linked to response to radiation. Copyright 2002 Wiley-Liss, Inc.
UI - 12355941
AU - Hinotsu S; Akaza H
TI - [Urology]
SO - Gan To Kagaku Ryoho 2002 Sep;29(9):1549-69
AD - Department of Urology, Institute of Clinical Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan.
We reviewed comparative clinical studies for prostate cancer and bladder cancer performed in Japan. A systematic search was done using PubMed and Icyushi WEB to find randomized clinical trials and the result was verified. Each manuscript was summarized according to the seven items of stage, entry period, exposure, endpoint, sample size, method of randomization and result. Forty reports were found as randomized clinical trials for prostate cancer, and sixty-two reports were identified for bladder cancer. Most exposures for advanced prostate cancer were hormonal therapy involving intravesical instillation after transurethral resection for superficial bladder cancer. At minimum, we have clarified that large scale randomized trials have been conducted in Japan for both prostate cancer and bladder cancer.
UI - 12031868
AU - Raghavan D; Quinn D; Skinner DG; Stein JP
TI - Surgery and adjunctive chemotherapy for invasive bladder cancer.
SO - Surg Oncol 2002 Jun;11(1-2):55-63
AD - Division of Medical Oncology, USC Norris Comprehensive Cancer Center, Room 3446, Los Angeles, CA 90033, USA. firstname.lastname@example.org
Invasive bladder cancer has a predilection for early, occult metastasis. Despite effective local control from radiotherapy or cystectomy, approximately 50% of the patients with clinically localized, invasive bladder cancer ultimately die of their disease. Over the past 25 years, systemic chemotherapy has been combined with definitive local treatment in an attempt to improve cure rates. Non-randomized phase I-II trials have shown promising results, with significant tumor down-staging. However, many randomized trials have failed to show a statistically significant survival benefit from adjunctive systemic chemotherapy. Recently, two intergroup randomized trials have shown a survival benefit from neoadjuvant combination chemotherapy, although the differences between the arms have not been dramatic. Adjuvant chemotherapy trials to date have failed to show statistically improved survival, although most published studies have been methodologically flawed. This review analyzes the results of published data and constructs a practical paradigm for patient management.
UI - 12031869
AU - Bhojwani AG; Mellon JK
TI - Contemporary cystectomy combined with ileal conduit or bladder substitution.
SO - Surg Oncol 2002 Jun;11(1-2):65-75
AD - Division of Urology, University of Leicester, Clinical Sciences Unit, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK.
Radical cystectomy remains one of the mainstay treatments for organ-confined invasive bladder cancer. Components of this surgery including the extent of pelvic lymph node dissection, the assessment of ureteric margins and the indications for bladder reconstruction as opposed to the simpler ileal conduit urinary diversion continue to provoke debate. This review provides a broad overview of radical cystectomy and summarises the options for bladder reconstruction. Special emphasis is given to data concerning the role of pelvic lymphadenectomy in the patient staged pre-operatively as N0M0.
UI - 12031870
AU - Bassi P
TI - BCG (Bacillus of Calmette Guerin) therapy of high-risk superficial bladder cancer.
SO - Surg Oncol 2002 Jun;11(1-2):77-83
AD - Department of Urology, University of Padova Medical School, Monoblocco Ospedaliero 2, Via Giustiniani, 35100 Padova, Italy. email@example.com
BCG (Bacillus of Calmette Guerin) has been used for more than 20 years and is currently the most active agent for superficial bladder cancer therapy. Intravesical BCG therapy is effective in prophylaxis after transurethral resection of papillary tumours and in the treatment of carcinoma in situ (cis). In most series BCG is more effective than intravesical chemotherapy, although it is more toxic. There is some evidence that BCG therapy improves survival and progression rates of patients with high-risk superficial bladder cancer decreasing the proportion who require radical cystectomy. A review of the current information on BCG therapy of high-risk superficial bladder cancer is reported.
UI - 12237912
AU - Ricci S; Galli L; Chioni A; Iannopollo M; Antonuzzo A; Francesca F;
TI - Vocaturo V; Selli C; Orlandini C; Conte P Gemcitabine plus epirubicin in patients with advanced urothelial carcinoma who are not eligible for platinum-based regimens.
SO - Cancer 2002 Oct 1;95(7):1444-50
AD - Division of Medical Oncology, Department of Oncology, S. Chiara University Hospital, Pisa, Italy. firstname.lastname@example.org
BACKGROUND: The objective of this study was to evaluate the efficacy and toxicity of gemcitabine plus epirubicin in previously untreated patients with advanced urothelial carcinoma who were not eligible for cisplatin-based regimens. METHODS: Patients with advanced urothelial carcinoma and at least one of the following characteristics were eligible: impaired renal function (creatinine clearance < 60 mL per minute), an Eastern Cooperative Oncology Group performance status (PS) >or= 2, and age >or= 75 years. The treatment included epirubicin 70 mg/m(2) as an intravenous bolus on Day 1 and gemcitabine 1000 mg/m(2) over 30 minutes on Days 1 and 8 of a 21-day cycle. RESULTS: Thirty-eight patients entered the study, and a total of 152 cycles were administered, with a median of 4 cycles per patient (range, 1-6 cycles per patient). The following Grade 3-4 hematologic toxicities were reported (percent of cycles): neutropenia, 22.4%; anemia, 11.2%; and thrombocytopenia, 6.5%. No cardiac, renal, or hepatic toxicities were observed. Dose intensities of epirubicin and gemcitabine were 19.6 mg/m(2) per week (84%) and 532.2 mg/m(2) per week (80%), respectively. There were 2 complete responses (5.3%), 13 partial responses (34.2%), 11 patients with stable disease (28.9%), and 12 patients with progressive disease (31.6%), for an overall response rate of 39.5% (95% confidence interval, 25.1-55.1). The median progression free survival (PFS) and overall survival (OS) rates were 4.8 months and 8.0 months, respectively. The 1-year survival rate was 38%, and the median PFS and OS were 6.4 months and 16.4 months, respectively, in patients with PS 0-1. Thirty patients were symptomatic: Seventeen patients (56.7%) achieved a complete response, and 5 patients (16.7%) achieved a partial symptomatic response. CONCLUSIONS: At the doses given in this study, gemcitabine and epirubicin had a good tolerability profile with interesting activity in patients with advanced urothelial carcinoma who were not fit for cisplatin-based regimens. Copyright 2002 American Cancer Society.DOI 10.1002/cncr.10860
UI - 12002357
AU - Turkolmez K; Baltaci S; Beduk Y; Muftuoglu YZ; Gogus O
TI - DNA ploidy and S-phase fraction as predictive factors of response and outcome following neoadjuvant methotrexate, vinblastine, epirubicin and cisplatin (M-VEC) chemotherapy for invasive bladder cancer.
SO - Scand J Urol Nephrol 2002 Feb;36(1):46-51
AD - Department of Urology, University of Ankara, School of Medicine, Turkey.
OBJECTIVE: To investigate the value of DNA ploidy and S-phase fraction (SPF) as factors that could predict response and outcome of invasive transitional cell carcinoma (TCC) of the bladder to neoadjuvant methotrexate, vinblastine, epirubicin and cisplatin (MVEC) chemotherapy. MATERIALS AND METHODS: Twenty-four patients with localized invasive TCC of the bladder (stages T3 to T4a, NoMo) were treated with neoadjuvant MVEC chemotherapy. DNA flow cytometry was performed in paraffin-embedded tissue obtained by transurethral resection before chemotherapy. Radical cystectomy specimens were utilized for complete pathologic staging. The tumors were subdivided into high- and low-SPF tumors according to their SPF value. DNA ploidy status was evaluated into two groups (diploidy and nondiploidy). RESULTS: DNA ploidy was not correlated to the response to chemotherapy (p = 0.67), and overall or disease-free survival (p = 0.27 and p = 0.69, respectively). Major response (pathologic complete response and partial response) was more often found in the high SPF group than among tumors with low SPF (p = 0.02). High SPF tumors were significantly associated with increased overall and disease-free survival (p = 0.0056 and p = 0.0059, respectively). CONCLUSION: A high SPF, but not DNA ploidy, may be helpful to identify patient likely to respond and survive longer following neoadjuvant MVEC chemotherapy in the treatment of invasive bladder cancer.
UI - 12002360
AU - El-Abbady AA; Shoukry MS; Hanno AG; Younis LK; Abdel-Rahman M
TI - Repeated transurethral resection of recurrent superficial bladder tumors--does it affect the spread and stage of the tumor?
SO - Scand J Urol Nephrol 2002 Feb;36(1):60-4
AD - Department of Urology, Alexandria School of Medicine, Alexandria University, Egypt.
OBJECTIVES: This prospective study was done to demonstrate the effect of repeated resection of superficial bladder tumors (TURT) on deep malignant cell infiltration in bladder wall. MATERIAL AND METHODS: Thirty-six patients underwent radical cystectomy for invasive bladder cancer, 16 patients originally had superficial cancer that became invasive after repeated TURT (group I) and the other 20 patients (group II) presented with invasive bladder cancer from the start. Each cystectomy specimen was subjected to a thorough histopathological study. RESULTS: There was a statistically significant difference in pattern of local spread of malignant cells between the two groups. Isolated clusters of malignant cells in-between normal bladder muscle fibers, isolated subserosal malignant deposits as well as cells reaching the adjacent cervix uteri were found only in group I. Intravesical pressure was measured in another 10 patients during TURT and was found to be high reaching up to 80 cm H2O. CONCLUSIONS: We conclude that some malignant cells penetrate through the denuded urothelium during TURT by the effect of high intravesical pressure. This may be responsible, among other factors, for tumor recurrence with deeper stages.
UI - 12228754
AU - Carrion R; Seigne J
TI - Surgical management of bladder carcinoma.
SO - Cancer Control 2002 Jul-Aug;9(4):284-92
AD - Division of Urology, University of South Florida, Tampa, 33620, USA.
BACKGROUND: Despite advances in medical oncology, radiation therapy, and molecular and cell biology, the mainstay in the management of bladder cancer continues to be surgery. METHODS: The authors reviewed the literature regarding the endoscopic diagnosis and management of bladder cancer as well the role of partial and radical cystectomy. RESULTS: Cystoscopy and transurethral resection are required to diagnose and stage bladder cancer. The indications for random bladder biopsies, prostatic urethral biopsy, and re-resection of the tumor bed are examined. The results and complications of endoscopic resection in the management of Ta, T1, and T2 or greater bladder cancer are reported. The roles of partial cystectomy, radical cystectomy, extent of lymphadenectomy, and indications for urethrectomy are also examined. The results and complications of radical cystectomy for the management of T2, T3, T4, and N+ bladder cancer are reported. CONCLUSIONS: Surgery remains a critical element in the management of bladder cancer. Improvements in surgical technique, urinary reconstruction, and multimodal therapy continue to improve the prognosis and quality of life of patients with transitional cell cancer of the bladder.
UI - 12352414
AU - Chang SS; Cole E; Cookson MS; Peterson M; Smith JA Jr
TI - Preservation of the anterior vaginal wall during female radical cystectomy with orthotopic urinary diversion: technique and results.
SO - J Urol 2002 Oct;168(4 Pt 1):1442-5
AD - Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
PURPOSE: Orthotopic urinary reconstruction has been shown to be a viable option in women undergoing radical cystectomy. However, due to anatomical differences and technical considerations orthotopic diversion has been performed in a relatively small number of patients. We examined our technique of vaginal wall preservation during female radical cystectomy and orthotopic neobladder construction. MATERIALS AND METHODS: We reviewed the records of all patients who underwent radical we identified 94 females, of whom 25 (27%) underwent orthotopic neobladder substitution. We reviewed perioperative major and minor complications, postoperative care, followup and pathological results. RESULTS: Overall 21 of the 25 patients (84%) underwent anterior vaginal wall sparing. Five patients (24%) had minor complications, there were no major perioperative complications and no patients required transfusion. Median estimated blood loss in this group was 575 ml. (range 200 to 1,250). A single neobladder-vaginal fistula developed in a patient early in our series in whom the anterior vaginal wall was incised and repaired during dissection. Of the 21 patients 15 (72%) were continent. Pathological specimens revealed a negative posterior bladder wall and urethral margins in all cases. At a median followup of 12 months 1 patient had local recurrence. CONCLUSIONS: Anterior vaginal wall preservation in female radical cystectomy with orthotopic neobladder substitution is technically feasible, maintains vaginal length and support, has an acceptable complication rate and can achieve negative margins. Prospective evaluation is needed to assess the long-term impact on functional outcomes and cancer control.
UI - 12352422
AU - Chiu W; Radhakrishnan V; Lin CH; Huan SK; Wu MP
TI - Internal bladder retractor for laparoscopic cystectomy in the female patient.
SO - J Urol 2002 Oct;168(4 Pt 1):1479-81
AD - Division of Urology, Department of Surgery, Chi-Mei Foundation Medical Center, Tainan, Taiwan, Republic of China.
PURPOSE: To overcome difficult dissection of the vascular pedicles during laparoscopic radical cystectomy we used a novel technique of internal bladder retraction. MATERIALS AND METHODS: An internal bladder retractor was used to facilitate dissection of the vascular pedicles during laparoscopic radical cystectomy in a female patient. RESULTS: The application of the retractor is easy and it allows more precise control of the vascular pedicles and ureters. It also helps to overcome the space limitation when dissecting the perivesical structures. Laparoscopic cystectomy with hysterectomy was accomplished in 2.5 hours. CONCLUSIONS: We successfully used a novel internal bladder retractor to facilitate laparoscopic radical cystectomy in a female patient.
UI - 12196897
AU - Lehmann J; Retz M; Stockle M
TI - Chemotherapy in the post-MVAC era: the case for adjuvant chemotherapy.
SO - World J Urol 2002 Aug;20(3):144-50
AD - Department of Urology and Pediatric Urology, Saarland University, Kirrberger Strasse, 66421 Homburg/Saar, Germany. email@example.com
Radical cystectomy for muscle invasive and locally advanced bladder cancer is the standard treatment modality in most of the Western industrialised countries. Rates of perioperative mortality from radical cystectomy have decreased to less than 2% over the past two decades due to advances in surgical technique and perioperative care. However, at least 40% of patients with pT3 bladder cancer and 70% of patients with lymph node-positive disease develop tumour recurrence after radical treatment within the first 5 years when treated with radical cystectomy alone. After the efficacy of combination chemotherapy for metastatic urothelial cancer using methotrexate, vinblastine, adriamycin and cisplatin (MVAC) was first described in 1985, several cisplatin-based systemic regimens have been investigated as adjunctive treatment before or after therapy for locally advanced bladder cancer by radical surgery or radiation therapy. Three randomised studies have reported superior results of postoperative adjuvant systemic chemotherapy compared to radical cystectomy alone for locally advanced bladder cancer. All three studies demonstrated a significant survival benefit for bladder cancer patients receiving adjuvant combination therapy. Studies have been criticised for small patient numbers and statistical shortcomings. New effective antineoplastic agents, such as paclitaxel and gemcitabine, have evolved during the past decade as promising substances for the treatment of urothelial cancer. This article reviews adjuvant studies from the era of MVAC combination chemotherapy, as well as contemporary studies that discuss new antineoplastic agents for systemic adjuvant chemotherapy of locally advanced bladder cancer.
UI - 12196898
AU - Madersbacher S; Studer UE
TI - Contemporary cystectomy and urinary diversion.
SO - World J Urol 2002 Aug;20(3):151-7
AD - Department of Urology, University of Berne, Anna-Seiler Haus, 3010 Berne, Switzerland. firstname.lastname@example.org
Radical cystectomy has emerged as the standard therapy for patients with invasive bladder cancer. Controversy is related to the indication, i.e. a low or high threshold. Meticulous pelvic lymphadenectomy can cure 20%-30% of patients with lymph node metastases, particularly those with limited node involvement. Unilateral nerve-sparing surgery is feasible in most patients without compromising oncological outcome and, besides erectile function, has an impact on the continence status after orthotopic bladder substitution. The excellent local control rates following radical cystectomy indicate that the weight of the problem in the future lies in reducing distant metastases. Orthotopic bladder substitution with a low-pressure ileal reservoir is currently the preferred method to reconstruct the lower urinary tract for both sexes following cystectomy. Long-term experience with follow-ups exceeding 10 years demonstrates a sustained favourable voiding outcome with slightly increasing incontinence rates as patients age.
UI - 12196900
AU - Bradley BA; Wajsman Z
TI - The role of chemotherapy and radiation in organ-preservation strategies for muscle-invasive bladder cancer.
SO - World J Urol 2002 Aug;20(3):167-74
AD - University of Florida College of Medicine, Division of Urology, P.O. Box 100247, Gainesville, FL 32610-0247, USA. email@example.com
Radical cystectomy with pelvic lymph node dissection has been accepted as the standard treatment for muscle-invasive bladder cancer. Radiation therapy and chemotherapy are increasingly being implemented in bladder-preservation protocols to provide an alternative treatment to cystectomy. We review experience with radiation and chemotherapy in treating bladder cancer and their use in bladder-preservation protocols. Multimodality organ-sparing treatment strategies offer overall survival rates comparable to radical cystectomy and pelvic lymph node dissection in selected cases. However, bladder-preservation techniques risk local recurrence of potentially aggressive tumors whose long-term effect on cancer-specific survival has not been fully characterized. No improvement in quality of life has clearly been demonstrated with bladder-preservation regimens. Bladder-preservation protocols are costly and require precise coordination of multiple specialists as well as strict, life-long patient compliance. Bladder-preservation protocols should only be performed at tertiary care centers with experience in their administration and be limited to patients desiring an alternative cystectomy or who are not surgical candidates.
UI - 12196901
AU - Syed S; Weiss GR
TI - Management of locally advanced bladder cancer: early vs deferred chemotherapy.
SO - World J Urol 2002 Aug;20(3):175-82
AD - The University of Texas Health Science Center at San Antonio, South Texas Veterans Health Care System, San Antonio, TX 78284-6200, USA.
Locally advanced bladder cancer is associated with a high risk of local recurrence and distant metastases. Clinical and pathologic variables have been useful in predicting outcome in patients with muscle-invasive bladder cancer. Recently, a number of molecular prognostic markers have been identified that help predict tumor aggressiveness, response to chemotherapy, and survival. Transitional cell carcinoma is a chemosensitive tumor. The early use of chemotherapy to reduce the risk of recurrence and improve survival has been the focus of many randomized clinical trials. Unfortunately, the majority of studies have failed to show a survival advantage for chemotherapy-treated patients. Well-designed prospective trials that target high-risk patients, defined by clinical, pathological, and molecular features, and incorporate new more tolerable chemotherapeutic agents are needed to clarify the benefit of early chemotherapy.
UI - 12196902
AU - Kuczyk M; Machtens S; Bokemeyer C; Kollmannsberger C; Hartmann J; Kondoh
TI - M; Merseburger A; Jonas U Surgical bladder preserving strategies in the treatment of muscle-invasive bladder cancer.
SO - World J Urol 2002 Aug;20(3):183-9
AD - Department of Urology, Hanover University Medical School, Carl-Neuberg-Str. 1, 30625 Hanover, Germany.
Single modality bladder-sparing therapy for muscle-invasive bladder cancer, including transurethral resection (TUR), partial cystectomy, systemic chemotherapy or radiotherapy, have been demonstrated to result in insufficient local control of the primary tumour, as well as decreased long-term survival in the patients when compared to radical cystectomy. Therefore, multimodality treatment protocols that aim at bladder preservation and involve all of the aforementioned approaches have been established. Arguments for combining systemic chemotherapy with radiation are to sensitise tumour tissue to radiotherapy and to eradicate occult metastases that have already developed in as many as 50% of patients at the time of first diagnosis. It has been shown that the clinical outcome observed with this approach approximates that after radical cystectomy. Additionally, a substantial number of patients survive with an intact bladder. However, bladder-sparing approaches are costly, and require close co-operation between different clinical specialists as well as careful follow-up. The good long-term results that are observed after cystectomy and the creation of an orthotopic neobladder make the substantial advantage of a bladder preservation strategy questionable when the patient's quality of life is addressed. Additionally, bladder-sparing therapy-related side effects might result in an increased morbidity and mortality in those patients who need to undergo surgery due to recurrent or progressive disease. Multimodality bladder-sparing treatment is a therapeutic option that can be offered to the patient at centres that have a dedicated multidisciplinary team at their disposal. However, radical cystectomy remains the standard of care for muscle-invasive bladder cancer.
UI - 12074781
AU - Patard JJ; Rodriguez A; Leray E; Rioux-Leclercq N; Guille F; Lobel B
TI - Intravesical Bacillus Calmette-Guerin treatment improves patient survival in T1G3 bladder tumours.
SO - Eur Urol 2002 Jun;41(6):635-41; discussion 642
AD - Department of Urology, CHU, Rennes, France. firstname.lastname@example.org
OBJECTIVE: To study the clinical and pathological factors that affect recurrence, progression and survival in pT1G3 bladder tumours treated 1996, 80 patients were conservatively treated for pT1G3 bladder tumours. All patients were studied for potential prognostic factors such as: age, sex, previous tumour recurrence, tumour size, multiple tumours, carcinoma in situ, and intravesical instillations. A longitudinal, retrospective, observational and analytical study was conducted to evaluate four different types of events: recurrence, progression, overall survival, and disease-specific survival. The chi(2) (Fischer exact test) and student t tests were used to assess the prognostic value of the qualitative and quantitative variables. Estimations of the survival distributions were calculated according to the Kaplan-Meier method and compared with the Log rank test. Multivariate analysis of the data was performed with Cox proportional hazard models. RESULTS: Among the 80 patients, 67 (84%) were men and 13 (16%) were women, with median age of 65.5 years. The median tumour size was 20 mm, most had single tumour (58.8%) and carcinoma in situ was found in six patients (7.5%). Thirty patients were treated with transurethral resection (TUR) of the bladder tumour and 50 patients were treated with TUR followed by BCG. The two groups of patients were comparable and followed up during a median time of 61 and 65 months, respectively (p=0.454). Kaplan-Meier estimators and Log rank tests demonstrated that patients with TUR alone recurred (p<0.0001), progressed (p<0.040) and died (overall survival: p<0.009; disease-specific p<0.040) earlier than patients who received intravesical instillations of BCG. The results were confirmed with Cox models and odds-ratios are presented. CONCLUSION: In this study, BCG adjuvant immunotherapy was the only factor affecting recurrence, progression and survival. Conservative treatment using TUR followed by BCG may improve disease-specific survival.
UI - 12230616
AU - Kulkarni JN; Gupta R
TI - Recurrence and progression in stage T1G3 bladder tumour with intravesical bacille Calmette-Guerin (Danish 1331 strain).
SO - BJU Int 2002 Oct;90(6):554-7
AD - Department of Urology, Tata Memorial Hospital, Mumbai, India. email@example.com
OBJECTIVE: To report recurrence and progression rates in patients with T1G3 superficial bladder carcinoma treated with intravesical bacille Calmette-Guerin (BCG, Danish 1331 strain) after complete transurethral resection. PATIENTS AND METHODS: Data from the records of 111 patients 1999 were analysed for recurrence, progression, salvage therapy and survival. RESULTS: Of the 111 patients with T1G3 bladder tumours, 69 had intravesical BCG therapy, 20 radical cystectomy and 22 only transurethral resection (TUR). Of the 69 patients receiving BCG therapy 37 (54%) had no recurrence, and 24 (35%) had a recurrence that was not muscle-invasive (Ta/T1) and were treated with TUR only. The remaining eight (12%) progressed to muscle invasion and had salvage cystectomy. During the follow-up six patients died, four from disease and three from other causes, while the remaining 63 are alive and well. Of the other 42 patients, 15 are alive after radical cystectomy and 18 after TUR. CONCLUSION: 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.
UI - 12230627
AU - Ghanem AN
TI - Experience with 'capsule sparing' cystoprostadenectomy for orthotopic bladder replacement: overcoming the problems of impotence, incontinence and difficult urethral anastomosis.
SO - BJU Int 2002 Oct;90(6):617-20
AD - Urology Department, King Khalid Hospital, Najran, Kingdom of Saudi Arabia. firstname.lastname@example.org
UI - 10614978
AU - Baniel J
TI - Bladder cancer in women.
SO - Int Urogynecol J Pelvic Floor Dysfunct 1999;10(6):399-404
AD - Head, Urology Section, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel.
In women bladder cancer usually occurs above the age of 60 and comprises 3% of all female cancers. The hallmark of presentation is hematuria, which must be investigated by radiological imaging and cystoscopy. The best prognostic indicators are grade and stage. Stage divides the disease into two separate entities, superficial and invasive disease. Approximately 70%-80% of patients will present with superficial disease, 10% will fail treatment or progress to invasive disease, and 20% present with invasive disease. Superficial disease is managed by transurethral resection and additional intravesical therapy when high-risk parameters for recurrence or progression exist. Overall survival is good and the morbidity acceptable. Invasive bladder cancer carries a worse prognosis, with an average of 50% 5-year survival. Management of invasive disease warrants extensive surgery, which is the best single treatment modality. Chemotherapy and radiotherapy are implemented in the management of progression or metastasis.
UI - 12227904
AU - Matin SF; Gill IS
TI - Laparoscopic radical cystectomy with urinary diversion: completely intracorporeal technique.
SO - J Endourol 2002 Aug;16(6):335-41; discussion 341
AD - Section of Laparoscopic and Minimally Invasive Surgery, Urological Institute, The Cleveland Clinic, Ohio 44195, USA.
Laparoscopic radical cystectomy with urinary diversion performed using intracorporeal techniques exclusively is a new development in the growing field of minimally invasive urology. This report details step by step the completely intracorporeal laparoscopic technique of cystectomy, bilateral pelvic lymphadenectomy, and urinary diversion with creation of an ileal conduit or neobladder, including the isolation of ileum, restoration of bowel continuity, retroperitoneal transfer of the left ureter to the right side, bilateral stented ureteroileal anastomoses, and urethroileal anastomosis in case of orthotopic diversion. Although at present, this is still a technique in development at high-volume medical centers, it holds promise as a minimally invasive yet appropriately radical form of treatment for patients with muscle-invasive bladder cancer. Definition of its true role awaits greater experience and long-term comparisons of the outcomes with those of traditional open surgery.
UI - 12227913
AU - Abdel-Hakim AM; Bassiouny F; Abdel Azim MS; Rady I; Mohey T; Habib I;
TI - Fathi H Laparoscopic radical cystectomy with orthotopic neobladder.
SO - J Endourol 2002 Aug;16(6):377-81
AD - Department of Urology, Faculty of Medicine, Cairo University, Egypt. email@example.com
PURPOSE: We report our technique of laparoscopic radical cystectomy in nine patients. Diversion was achieved by a modified Camey II orthotopic neobladder (the Y bladder) performed by a minilaparotomy in three cases and laparoscopically in the last six cases. PATIENTS AND METHODS: There were eight men with muscle-invasive transitional-cell carcinoma and one woman with verrucous squamous-cell carcinoma of the bladder. The age range was 41 to 65 years. The control of the posterior and lateral bladder pedicles was achieved by vascular Endo-GIA in the first three cases and by the 10-mm Harmonic Shears (Ultracision; Ethicon) in the last six cases. The operative specimen was extracted through a 3- to 5-cm muscle-splitting incision in the right iliac fossa. The detubularized pouch was prepared extracorporeally through the same incision. The urethral and ureteral anastomoses were performed using laparoscopic intracorporeal suturing in the last six cases. RESULTS: The operative time ranged from 6.5 to 12 hours (median 8.3 hours). The blood loss was 150 to 500 mL. Oral feeding was resumed on the 3rd postoperative day. The stents were usually removed on the 8th postoperative day. A pouchogram was obtained on the 10th postoperative day, and the urethral catheter was removed. The lymph nodes as well as the surgical margins were tumor free. CONCLUSION: Laparoscopic radical cystectomy and orthotopic neobladder creation is feasible, although difficult and technically demanding. The use of the Harmonic Shears in the cystectomy reduces the operative cost significantly. With growing experience, laparoscopic radical cystectomy and continent urinary diversion can be an alternative to the open technique.
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