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Clinical Scenario: Recurrent Ta Tumor

73-year-old woman with multiple, recurrent high-grade Ta tumors who has received perioperative mitomycin chemotherapy and has significant lower urinary tract symptoms

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Management of Bladder Cancer

Abstract

Under the rubric of non-muscle invasive bladder cancer (NMIBC) there is a variegated spectrum of disease. In this chapter, we will adhere narrowly to a single type of patient: a patient with NMIBC at high risk for recurrence and a significant potential for disease progression. Throughout this chapter we will discuss the nuances of treating a patient where, often, indications become equivocal and guidelines less than guiding.

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References

  1. Jakse G, Algaba F, Malmström PU, Oosterlinck W. A second-look TUR in T1 transitional cell carcinoma: why? Eur Urol. 2004;45:539–46.

    Article  PubMed  Google Scholar 

  2. Larsson P, Wijkström H, Thorstenson A, Adolfsson J, Norming U, Wiklund P, Onelöv E, Steineck G. A population-based study of 538 patients with newly detected urinary bladder neoplasms followed during 5 years. Scand J Urol Nephrol. 2003;37:195–201.

    Article  PubMed  Google Scholar 

  3. Haukaas S, Daehlin L, Maartmann-Moe H, Ulvik NM. The long-term outcome in patients with superficial transitional cell carcinoma of the bladder: a single-institutional experience. BJU Int. 1999;83:957–63.

    Article  CAS  PubMed  Google Scholar 

  4. Kikuchi E, Fujimoto H, Mizutani Y, Okajima E, Koga H, Hinotsu S, Shinohara N, Oya M, Miki T, Cancer Registration Committee of the Japanese Urological Association. Clinical outcome of tumor recurrence for Ta, T1 non-muscle invasive bladder cancer from the data on registered bladder cancer patients in Japan: 1999-2001 report from the Japanese Urological Association. Int J Urol. 2009;16:279–86.

    Article  PubMed  Google Scholar 

  5. Sylvester RJ, van der Meijden A, Witjes JA, Jakse G, Nonomura N, Cheng C, Torres A, Watson R, Kurth KH. High-grade Ta urothelial carcinoma and carcinoma in situ of the bladder. Urology. 2005;66:90–107.

    Article  PubMed  Google Scholar 

  6. Ranasinghe W, Persad R. The changing incidence of carcinoma in-situ of the bladder worldwide, advances in the scientific evaluation of bladder cancer and molecular basis for diagnosis and treatment. ISBN: 978-953-51-1142-9, InTech. doi:10.5772/53929. Available from http://www.intechopen.com/books/advances-in-the-scientific-evaluation-of-bladder-cancer-and-molecular-basis-for-diagnosis-and-treatment/the-changing-incidence-of-carcinoma-in-situ-of-the-bladder-worldwide

  7. Sylvester RJ, van der Meijden AP, Oosterlinck W, Witjes JA, Bouffioux C, Denis L, Newling DW, Kurth K. Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials. Eur Urol. 2006;49:466–7.

    Article  PubMed  Google Scholar 

  8. Fradet Y, Grossman HB, Gomella L, Lerner S, Cookson M, Albala D, Droller MJ, PC B302/01 Study Group. A comparison of hexaminolevulinate fluorescence cystoscopy and white light cystoscopy for the detection of carcinoma in situ in patients with bladder cancer: a phase III, multicenter study. J Urol. 2007;178:68–73.

    Article  PubMed  Google Scholar 

  9. Babjuk M, Oosterlinck W, Sylvester R, Kaasinen E, Bohle A, Redorta-Palou J, Roupret M. EAU guidelines on nonmuscle-invasive urothelial carcinoma of the bladder, the 2011 update. Eur Urol. 2011;59:997–1008.

    Article  PubMed  Google Scholar 

  10. Thorstenson A, Schumacher M, Wiklund N, Jonsson M, Larsson P, Wijkström H, Onelöv E, Steineck G, De Verdier P. Diagnostic random bladder biopsies: reflections from a population-based cohort of 538 patients. Scand J Urol Nephrol. 2010;44:11–9.

    Article  PubMed  Google Scholar 

  11. Naselli A, Introini C, Timossi L, Spina B, Fontana V, Pezzi R, Germinale F, Bertolotto F, Puppo P. A randomized prospective trial to assess the impact of transurethral resection in narrow band imaging modality on non-muscle-invasive bladder cancer recurrence. Eur Urol. 2012;61:908–13.

    Article  PubMed  Google Scholar 

  12. Koloszy Z. Histopathological “self control” in transurethral resection of bladder tumors. Br J Urol. 1991;67:162–4.

    Article  Google Scholar 

  13. Sylvester RJ, Oosterlinck W, van der Meijden AP. A single immediate postoperative instillation of chemotherapy decreases the risk of recurrence in patients with stage Ta T1 bladder cancer: a meta-analysis of published results of randomized clinical trials. J Urol. 2004;171:2186–90.

    Article  PubMed  Google Scholar 

  14. Sylvester RJ, Oosterlinck W, Witjes JA. The schedule and duration of intravesical chemotherapy in patients with non-muscle-invasive bladder cancer: a systematic review of the published results of randomized clinical trials. Eur Urol. 2008;53:709–19.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Barocas DA, Liu A, Burks FN, Suh RS, Shuster TG, Bradford T, Moylan, DA, Knapp, PM, Murtagh DS, Morris D, Dunn RL, Montie JE, Miller DC. Practice-base collaboration to imprvoe the use of immediate intravesical therapy after resection for non-muscle-invasive bladder cancer. J Urol. 2013. pii: S0022-5347(13)04620-X. doi:10.1016/j.juro.2013.06.025. [Epub ahead of print].

  16. Montgomery JS, Miller DC, Weizer AZ. Quality indicators in the management of bladder cancer. J Natl Compr Canc Netw. 2013;11:492–500.

    CAS  PubMed  Google Scholar 

  17. Sylvester RJ, van der MA, Lamm DL. Intravesical bacillus Calmette-Guerin reduces the risk of progression in patients with superficial bladder cancer: a meta-analysis of the published results of randomized clinical trials. J Urol. 2002;168:1964–70.

    Article  CAS  PubMed  Google Scholar 

  18. Gudjonsson S, Adell L, Merdasa F, Olsson R, Larsson B, Davidsson T, Richthoff J, Hagberg G, Grabe M, Bendahl PO, Mansson W, Liedberg F. Should all patients with non-muscle-invasive bladder cancer receive early intravesical chemotherapy after transurethral resection? The results of a prospective randomised multicentre study. Eur Urol. 2009;55:773–80.

    Article  PubMed  Google Scholar 

  19. Kaasinen E, Rintala E, Hellström P, Viitanen J, Juusela H, Rajala P, Korhonen H, Liukkonen T, FinnBladder Group. Factors explaining recurrence in patients undergoing chemoimmunotherapy regimens for frequently recurring superficial bladder carcinoma. Eur Urol. 2002;42:167–74.

    Article  PubMed  Google Scholar 

  20. Hall MC, Chang SS, Dalbagni G, Pruthi RS, Seigne JD, Skinner EC, Wolf Jr JS, Schellhammer PF. Guideline for the management of nonmuscle invasive bladder cancer (stages Ta, T1, and Tis): 2007 update. J Urol. 2007;178:2314–30.

    Article  PubMed  Google Scholar 

  21. Han RF, Pan JG. Can intravesical bacillus Calmette-Guérin reduce recurrence in patients with superficial bladder cancer? A meta-analysis of randomized trials. Urology. 2006;67:1216–23.

    Article  PubMed  Google Scholar 

  22. Shelley MD, Wilt TJ, Court J, Coles B, Kynaston H, Mason MD. Intravesical bacillus Calmette-Guerin is superior to mitomycin C in reducing tumour recurrence in high-risk superficial bladder cancer: a meta-analysis of randomized trials. BJU Int. 2004;93:485–90.

    Article  CAS  PubMed  Google Scholar 

  23. Bohle A, Jocham D, Bock PR. Intravesical bacillus Calmette-Guerin versus mitomycin C for superficial bladder cancer: a formal meta-analysis of comparative studies on recurrence and toxicity. J Urol. 2003;169:90–5.

    Article  CAS  PubMed  Google Scholar 

  24. Shelley MD, Kynaston H, Court J, Wilt TJ, Coles B, Burgon K, Mason MD. A systematic review of intravesical bacillus lmette-Guerin plus transurethral resection vs transurethral resection alone in Ta and T1 bladder cancer. BJU Int. 2001;88:209–16.

    Article  CAS  PubMed  Google Scholar 

  25. Jakse G, Hall R, Bono A, Höltl W, Carpentier P, Spaander JP, van der Meijden AP, Sylvester R. Intravesical BCG in patients with carcinoma in situ of the urinary bladder: long-term results of EORTC GU Group phase II protocol 30861. Eur Urol. 2001;40:144–50.

    Article  CAS  PubMed  Google Scholar 

  26. Takenaka A, Yamada Y, Miyake H, Hara I, Fujisawa M. Clinical outcomes of bacillus Calmette-Guerin instillation therapy for carcinoma in situ of urinary bladder. Int J Urol. 2008;15:309–13.

    Article  PubMed  Google Scholar 

  27. Lamm D, Herr H, Jakse G, Kuroda M, Mostofi FK, Okajima E, Sakamoto A, Sesterhenn I, da Silva FC. Updated concepts and treatment of carcinoma in situ. Urol Oncol. 1998;4:130–8.

    Article  CAS  PubMed  Google Scholar 

  28. Denzinger S, Fritsche H, Otto W, Blana A, Wieland W, Burger M. Early versus deferred cystectomy for initial high-risk pT1G3 urothelial carcinoma of the bladder: do risk factors define feasibility of bladder-sparing approach? Eur Urol. 2008;53:146–52.

    Article  PubMed  Google Scholar 

  29. Oddens J, Brausi M, Sylvester R, Bono A, Beek C, Ande GL, Gontero P, Hoeltl W, Turkeri L, Marreaud S, Collette S, Oosterlinck W. Final results of an EORTC-GU cancers group randomized study of maintenance bacillus Calmette-Guérin in intermediate- and high-risk Ta, T1 papillary carcinoma of the urinary bladder: one-third dose versus full dose and 1 year versus 3 years of maintenance. Eur Urol. 2013;63:462–72.

    Article  PubMed  Google Scholar 

  30. Lamm DL, Blumenstein BA, Crissman JD, Montie JE, Gottesman JE, Lowe BA, Sarosdy MF, Bohl RD, Grossman HB, Beck TM, Leimert JT, Crawford ED. Maintenance bacillus Calmette-Guérin immunotherapy for recurrent TA, T1 and carcinoma in situ transitional cell carcinoma of the bladder: a randomized Southwest Oncology Group Study. J Urol. 2000;163:1124–9.

    Article  CAS  PubMed  Google Scholar 

  31. Catalona WJ, Hudson MA, Gillen DP, Andriole GL, Ratliff TL. Risks and benefits of repeated courses of intravesical bacillus Calmette-Guerin therapy for superficial bladder cancer. J Urol. 1987;137:220–4.

    CAS  PubMed  Google Scholar 

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Correspondence to Michael A. O’Donnell M.D. .

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Gillespie, J.A., O’Donnell, M.A. (2015). Clinical Scenario: Recurrent Ta Tumor. In: Konety, B., Chang, S. (eds) Management of Bladder Cancer. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1881-2_15

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  • DOI: https://doi.org/10.1007/978-1-4939-1881-2_15

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