Treatment of carcinoma in situ with intravesical bacillus calmette-guerin without maintenance.

Griffiths, T.R.L.; Charlton, Mary E.; Neal, D E; Powell, P. H.

doi:10.1016/s1078-1439(02)00290-9

Cited by 18 publications

(21 citation statements)

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“…found that only patient age was significantly associated with tumor recurrence after BCG therapy 12 . However, two other studies found that age was not a risk factor for progression after BCG treatment 13,14 . Some investigators have shown that the prognosis of patients with primary CIS is good, whereas others have found that it is similar to that of patients with secondary CIS 9,15,16 .…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of bacillus Calmette‐Guérin instillation therapy for carcinoma in situ of urinary bladder

et al. 2008

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Objectives:We analyzed the clinical outcomes of instillation therapy with Bacillus Calmette-Guerin (BCG) to treat carcinoma in situ (CIS) and searched for prognostic factors that could predict disease progression. Methods: Between January 1995 and January 2001, 185 patients (male, 155; female, 30) diagnosed with bladder CIS underwent weekly BCG instillations (80 mg of Tokyo 172 strain) for eight weeks. Primary, concomitant, and secondary CIS was found in 62 (33.5%), 60 (32.4%) and 63 (34.1%), patients, respectively. Seventy-five (40.5%) and 64 (34.6%) patients had limited and extensive CIS, respectively. The median follow up period was 37.5 months (range 4-95 months). Results: The overall complete response rate was 86.5%. The five-year progression-free survival rate was 78.5%. Several factors, such as age (<60 or Ն60 years), gender, previous transurethral resection, type of CIS, and CIS extension (three or more positive sites out of four to six biopsy sites was defined as extensive), were examined by multivariate analysis to predict progression. The extension of CIS was the only independent prognostic factor. The five-year recurrence-free rate of complete responders (n = 160) was 66.0%. Radical cystectomy was performed in 10 patients (6.3%) during follow up incomplete responders, of whom seven had invasive bladder cancer. Extravesical involvement was identified in 30 patients (16.2%) among whom, 21 (11.3%) had upper urinary tract recurrence and nine (4.9%) had prostatic involvement. Conclusion: Therapy with BCG is effective against CIS, the extent of which might be a prognostic factor. Disease progression including extravesical involvement should be carefully monitored over the long-term after BCG therapy.

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Section: Discussionmentioning

confidence: 99%

Clinical outcomes of bacillus Calmette‐Guérin instillation therapy for carcinoma in situ of urinary bladder

et al. 2008

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“…There are, to our knowledge, only two reports during the last 15 years where a shorter dwell‐time was used in association with BCG treatment [10,11]. Lockyer et al [10] and Griffiths et al [11] used a dwell‐time of 1 h for all patients but did not explain why this was done. Lockyer et al did not report side‐effects but Griffiths et al reported side‐effects that seem to conform to those in other reports.…”

Section: Discussionmentioning

confidence: 99%

Intravesical bacillus Calmette‐Guèrin therapy: experience with a reduced dwell‐time in patients with pronounced side‐effects

2005

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patients self-reported side-effects after each instillation in a questionnaire. RESULTSAfter reducing the BCG dwell-time, fever, chills, dysuria and the overall time-torecovery were significantly reduced but frequency and haematuria were not influenced. Patients with carcinoma in situ had significantly less dysuria than patients with papillary tumours. There was no difference in the treatment results between patients who had a normal dwell-time and a reduced dwell-time, determined at the first and second follow-up cystoscopy.

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“…There is, however, consensus that immediate radical cystectomy should be considered for patients with high‐risk NMIBC where the risk of tumour progression is especially high, or concomitant superficial urethral TCC is present, or where the patient requests it in preference to intravesical BCG. Added risk factors for progression in high‐grade T1 disease include associated CIS (80), multifocality, tumour size > 3 cm and persistent T1 disease at repeat resection (81,82). If more than one of these risk factors is present, then radical cystectomy should be strongly considered.…”

Section: Pivotal Considerations In the Management Of Nmibc (Tcc)mentioning

confidence: 99%

Current perspectives in bladder cancer management

Griffiths

2012

International Journal of Clinical Practice

108

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Summary More than 350,000 new cases of bladder cancer are diagnosed worldwide each year; the vast majority (> 90%) of these are transitional cell carcinomas (TCC). The most important risk factors for the development of bladder cancer are smoking and occupational exposure to toxic chemicals. Painless visible haematuria is the most common presenting symptom of bladder cancer; significant haematuria requires referral to a specialist urology service. Cystoscopy and urine cytology are currently the recommended tools for diagnosis of bladder cancer. Excluding muscle invasion is an important diagnostic step, as outcomes for patients with muscle invasive TCC are less favourable. For non‐muscle invasive bladder cancer, transurethral resection followed by intravesical chemotherapy (typically Mitomycin C or epirubicin) or immunotherapy [bacillus Calmette‐Guérin (BCG)] is the current standard of care. For patients failing BCG therapy, cystectomy is recommended; for patients unsuitable for surgery, the choice of treatment options is currently limited. However, novel interventions, such as chemohyperthermia and electromotive drug administration, enhance the effects of conventional chemotherapeutic agents and are being evaluated in Phase III trials. Radical cystectomy (with pelvic lymphadenectomy and urinary diversion) or radical radiotherapy are the current established treatments for muscle invasive TCC. Neoadjuvant chemotherapy is recommended before definitive treatment of muscle invasive TCC; cisplatin‐containing combination chemotherapy is the recommended regimen. Palliative chemotherapy is the first‐choice treatment in metastatic TCC.

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Treatment of carcinoma in situ with intravesical bacillus calmette-guerin without maintenance.

Cited by 18 publications

References 0 publications

Clinical outcomes of bacillus Calmette‐Guérin instillation therapy for carcinoma in situ of urinary bladder

Clinical outcomes of bacillus Calmette‐Guérin instillation therapy for carcinoma in situ of urinary bladder

Intravesical bacillus Calmette‐Guèrin therapy: experience with a reduced dwell‐time in patients with pronounced side‐effects

Current perspectives in bladder cancer management

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