Oncological Outcomes of Different Patterns of Tumor Recurrence at First Evaluation After Bacillus Calmette-Guérin Induction Therapy for Intermediate and High Risk Non Muscle Invasive Bladder Cancer
Study Details
Study Description
Brief Summary
This retrospective study aimed at assessment of different patterns (morphological and pathological) of tumor recurrence found at first evaluation after BCG induction therapy (3 months cystoscopy) for intermediate and high-risk NMIBC and its prognostic implications at a tertiary referral center.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
Bladder cancer (BCa) is the second most common genitourinary malignancy with approximately 75-85% of all patients with BCa present at diagnosis a non-muscle invasive bladder cancer (NMIBC) (Ta, T1 and Tis). Although NMIBC usually carries a favorable prognosis, there is a high risk of disease recurrence and a 10% to 20% risk of progression to muscle-invasive disease.
The common treatment for intermediate- and high-risk patients is a transurethral resection followed by intravesical therapy with bacillus Calmette-Guerin (BCG), a non-specific immunotherapy that has remained the gold standard for 40 years. Over the last decades, several studies have confirmed the superiority of BCG over the combination of epirubicin and interferon, mitomycin C or epirubicin alone for prevention of tumor recurrence, in intermediate- and high-risk tumors.
Despite wide acceptance of BCG intravesical therapy in intermediate and high risk NMIBC, there is still a controversy regarding the optimal protocol of administration. However, most of the guidelines have recommended an induction regimen of six weekly BCG instillations followed by maintenance instillation for at least 1 year.
Complete response (CR) rates after an induction course of BCG for intermediate and high risk NMIBC are high and range from 50-70%. Tumor recurrence at first evaluation (3-months cystoscopy) after BCG induction therapy has been defined as a poor prognostic indicator in those groups of patients with an increased potential risk of disease recurrence and /or progression.
Different patterns of tumor recurrence may be encountered at 3-mo cystoscopy during first evaluation after induction therapy either morphological (single tumor vs. multiple, <3 cm or more, site (? bladder neck involvement), papillary or non papillary) or histopathological (Ta vs. T1, concurrent CIS or not, tumor grade). To determine how to optimally manage those heterogeneous groups of patients, studying of the specific impact of different tumor characteristics on oncological outcomes is warranted.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: intermediate and high risk non muscle invasive bladder cancer
|
Drug: induction regimen of intravesical BCG
intravesical instillation of 6 weekly doses of BCG
|
Outcome Measures
Primary Outcome Measures
- one year Recurrence rate [one year]
recurrence rate at 1 year after induction BCG
- one year progression rate [one year]
progression rate at 1 year after induction BCG
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Patients for who complete TURBT, was carried out
-
Intermediate and high risk NMIBC.
-
Patients who received full induction BCG regimen (6 weekly doses).
-
Patients completed at least 12 months follow up after 3 months cystoscopy.
Exclusion Criteria:
-
Patients who received incomplete induction BCG regimen (less than 6 weekly doses)
-
Patients with incomplete (less than 12 months) follow up.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Urology and Nephrology Center | Mansoura | Egypt | 35516 |
Sponsors and Collaborators
- Mansoura University
Investigators
- Principal Investigator: Amr A Elsawy, Urology and Nephrology Center
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- AE 20320