PROGNOSIS OF PATIENTS WITH MODERATE AND HIGH-RISK NON-MUSCLE-INVASIVE BLADDER CANCER TREATED WITH INTRAVESICAL INSTILLATIONS OF MITOMYCIN C DURING UNAVAILABILITY OF BCG VACCINE
Authors:
Michael Pešl 1; Otakar Čapoun 1; Zuzana Vaľová 1; Roman Sobotka 1; Pavel Dundr 2; Tomáš Hanuš 1; Viktor Soukup 1
Authors place of work:
Urologická klinika VFN a 1. LF UK, Univerzita Karlova, Praha
1; Ústav patologie VFN a 1. LF UK, Univerzita Karlova, Praha
2
Published in the journal:
Ces Urol 2016; 20(4): 302-308
Category:
Original Articles
Summary
Purpose:
The aim of this study is to evaluate the prognosis in patients with moderate and highrisk non–muscle-invasive bladder cancer treated with intravesical instillations of mitomycin C (MMC) during a period of unavailability of the BCG vaccine.
Method:
We retrospectively evaluated a total of 66 patients with primary detection or recurrence of urothelial bladder cancer who had been diagnosed with Ta/T1 urothelial carcinoma between January 2012 and September 2014 and who had subsequently received intravesical treatment with mitomycin C. The median of follow-up was 25.5 months.
Results:
Thirty cases (45 %) had a moderate-risk and 36 cases (55 %) a high-risk tumour. In three patients, treatment was prematurely terminated due to adverse effects. In five cases, treatment with MMC was changed to intravesical immunotherapy owing to the resumption of supplies of the BCG vaccine.
We performed a comparison of the disease course in a subgroup of patients with pT1 G3 tumours treated with MMC (10 patients) with a control group (20 patients with a similar histological finding who underwent standard treatment with the BCG vaccine in the past; so-called “historical controls”).
During follow-up, recurrence occurred in 8 (27 %) patients with a moderate-risk and 13 (36 %) with a high-risk tumour; two (5.6 %) patients with a high-risk tumour were found to have progression to a muscle-invasive form of carcinoma. From a comparison with the historical controls, it was evident that patients with a pT1 G3 tumour had significantly higher recurrence rates if they were treated with adjuvant intravesical chemotherapy using mitomycin C (p = 0.0394).
Conclusion:
When treating patients with high-risk bladder cancer by means of intravesical chemotherapy, it is necessary to expect a higher recurrence risk than in those with moderate-risk tumours. The risk of progression was not evaluated. In the case of T1 G3 carcinoma, the treatment with MMC is associated with a significantly higher risk of recurrence than in patients undergoing standard treatment with the BCG vaccine.
Key words:
BCG vaccine, instillation therapy, intravesical chemotherapy, mitomycin C, bladder tumours.
Zdroje
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Štítky
Paediatric urologist Nephrology UrologyČlánok vyšiel v časopise
Czech Urology
2016 Číslo 4
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