[2] Neoadjuvant intravesical chemotherapy to treat extended large non-muscle-invasive bladder cancer

Objective: To report our experience with the use of neoadjuvant intravesical chemotherapy in the treatment of large exophytic bladder tumours. About 75% of bladder cancers are superficial at diagnosis. Sometimes, symptoms are mild or absent, and the tumour can grow unnoticed into a large intra-lumin...

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Autores principales:	Marco Raber, Ismail Hassan, Nashaat Hendawi, Noor Buchholz
Formato:	article
Lenguaje:	EN
Publicado:	Taylor & Francis Group 2018
Materias:	Diseases of the genitourinary system. Urology RC870-923
Acceso en línea:	https://doaj.org/article/0ac3360b28ca4a00b728104860f95059
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spelling	oai:doaj.org-article:0ac3360b28ca4a00b728104860f950592021-12-02T12:07:16Z[2] Neoadjuvant intravesical chemotherapy to treat extended large non-muscle-invasive bladder cancer2090-598X10.1016/j.aju.2018.10.049https://doaj.org/article/0ac3360b28ca4a00b728104860f950592018-11-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2090598X18301438https://doaj.org/toc/2090-598XObjective: To report our experience with the use of neoadjuvant intravesical chemotherapy in the treatment of large exophytic bladder tumours. About 75% of bladder cancers are superficial at diagnosis. Sometimes, symptoms are mild or absent, and the tumour can grow unnoticed into a large intra-luminal, bulky mass. Methods: At transurethral resection of bladder tumour (TURBT), the aim was to perform a complete resection as far as possible, or at least a reliable tumour biopsy, and to resect to the tumour base to exclude deeply invasive disease. At 15 days postoperatively, patients were started on a short and intensive schedule of intravesical bladder chemotherapy with six doses of 40 mg mitomycin (MMC). This was followed by a second TURBT with deep bladder wall biopsies to complete resection and staging. Results: In all reported cases, an initial complete resection was not possible. In seven cases (47%) T staging was inconclusive (Tx), with six of the seven cases having high-grade tumours and one a low-grade tumour. In the remaining eight of 15 cases, six (40%) were of a Ta-low grade, and two (13%) were of a T1-high grade. The two patients with a Ta-low grade tumour refused the option of immediate radical cystectomy (RC) and preferred a bladder-sparing treatment option. After neoadjuvant intravesical chemotherapy, complete resection was then feasible in all patients. One patient (7%) was consequently diagnosed with a T2 tumour and underwent RC. Two patients (13%) had no muscle cells in their histology and thus remained unstaged. Conclusion: A neoadjuvant MMC schedule after initial incomplete resection of large non-muscle-invasive bladder tumours and before a second complete resection appears to be a viable and safe alternative. If done carefully and expediently, it does not delay a potentially curative early RC.Marco RaberIsmail HassanNashaat HendawiNoor BuchholzTaylor & Francis GrouparticleDiseases of the genitourinary system. UrologyRC870-923ENArab Journal of Urology, Vol 16, Iss , Pp S2-S3 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	Diseases of the genitourinary system. Urology RC870-923
spellingShingle	Diseases of the genitourinary system. Urology RC870-923 Marco Raber Ismail Hassan Nashaat Hendawi Noor Buchholz [2] Neoadjuvant intravesical chemotherapy to treat extended large non-muscle-invasive bladder cancer
description	Objective: To report our experience with the use of neoadjuvant intravesical chemotherapy in the treatment of large exophytic bladder tumours. About 75% of bladder cancers are superficial at diagnosis. Sometimes, symptoms are mild or absent, and the tumour can grow unnoticed into a large intra-luminal, bulky mass. Methods: At transurethral resection of bladder tumour (TURBT), the aim was to perform a complete resection as far as possible, or at least a reliable tumour biopsy, and to resect to the tumour base to exclude deeply invasive disease. At 15 days postoperatively, patients were started on a short and intensive schedule of intravesical bladder chemotherapy with six doses of 40 mg mitomycin (MMC). This was followed by a second TURBT with deep bladder wall biopsies to complete resection and staging. Results: In all reported cases, an initial complete resection was not possible. In seven cases (47%) T staging was inconclusive (Tx), with six of the seven cases having high-grade tumours and one a low-grade tumour. In the remaining eight of 15 cases, six (40%) were of a Ta-low grade, and two (13%) were of a T1-high grade. The two patients with a Ta-low grade tumour refused the option of immediate radical cystectomy (RC) and preferred a bladder-sparing treatment option. After neoadjuvant intravesical chemotherapy, complete resection was then feasible in all patients. One patient (7%) was consequently diagnosed with a T2 tumour and underwent RC. Two patients (13%) had no muscle cells in their histology and thus remained unstaged. Conclusion: A neoadjuvant MMC schedule after initial incomplete resection of large non-muscle-invasive bladder tumours and before a second complete resection appears to be a viable and safe alternative. If done carefully and expediently, it does not delay a potentially curative early RC.
format	article
author	Marco Raber Ismail Hassan Nashaat Hendawi Noor Buchholz
author_facet	Marco Raber Ismail Hassan Nashaat Hendawi Noor Buchholz
author_sort	Marco Raber
title	[2] Neoadjuvant intravesical chemotherapy to treat extended large non-muscle-invasive bladder cancer
title_short	[2] Neoadjuvant intravesical chemotherapy to treat extended large non-muscle-invasive bladder cancer
title_full	[2] Neoadjuvant intravesical chemotherapy to treat extended large non-muscle-invasive bladder cancer
title_fullStr	[2] Neoadjuvant intravesical chemotherapy to treat extended large non-muscle-invasive bladder cancer
title_full_unstemmed	[2] Neoadjuvant intravesical chemotherapy to treat extended large non-muscle-invasive bladder cancer
title_sort	[2] neoadjuvant intravesical chemotherapy to treat extended large non-muscle-invasive bladder cancer
publisher	Taylor & Francis Group
publishDate	2018
url	https://doaj.org/article/0ac3360b28ca4a00b728104860f95059
work_keys_str_mv	AT marcoraber 2neoadjuvantintravesicalchemotherapytotreatextendedlargenonmuscleinvasivebladdercancer AT ismailhassan 2neoadjuvantintravesicalchemotherapytotreatextendedlargenonmuscleinvasivebladdercancer AT nashaathendawi 2neoadjuvantintravesicalchemotherapytotreatextendedlargenonmuscleinvasivebladdercancer AT noorbuchholz 2neoadjuvantintravesicalchemotherapytotreatextendedlargenonmuscleinvasivebladdercancer
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[2] Neoadjuvant intravesical chemotherapy to treat extended large non-muscle-invasive bladder cancer

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