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Proposal for changes in cystoscopic follow up of patients with bladder cancer and adjuvant intravesical chemotherapy

Created: 20/5/2006
Updated: 13/11/2006

 

Proposal for changes in cystoscopic follow up of patients with bladder cancer and adjuvant intravesical chemotherapy
R R Hall, M K B Parmar, A B Richards, P H Smith
BMJ 1994;308:257-260 (22 January)

Introduction

  • At initial diagnosis most bladder tumours are either Ta or T1
  • Intravesical chemotherapy has been shown to reduce the frequency of tumour recurrence by 30%-50%
  • The proposals in the current paper are based on three studies:
    • An analysis of prognostic factors in patients with Ta and T1 bladder cancer treated in two Medical Research Council trials (1)
    • A trial of a single instillation of epirubicin by the European Organisation for Research and Treatment of Cancer (2)
    • MRC trial of one or five instillations of mitomycin in patients with solitary or newly diagnosed Ta and T1 bladder cancer (3,4)

Prognostic factors

Group 1 - solitary tumour at presentation and no tumours at 3 month cystoscopy

  • These patients account for approx 60% of all new patients presenting with Ta and T1 bladder cancer
  • They have a low risk of recurrence (20% at one year) and could be followed safely by flexible cystoscopy at annual intervals only

Group 2 - solitary tumour at presentation and tumour recurrence at 3 months or multiple tumours at presentation and no tumours at 3 months

  • 30% of all new cases
  • 40% risk of recurrence at one year and 60% at two years

Group 3 - multiple tumours at presentation and recurrence at 3 months.

  • Patients have worst prognosis
  • Account for approx 10% of all patients with Ta and T1 tumours at initial diagnosis
  • 50% are likely to have recurrence by six months and 90% by one to two years

NB. pT1G3 Tumours

  • In the first MRC trial 14 of the 379 patients were considered by the local pathologist to have pT1G3 tumours (1)
  • 7 were in group 1, six in group 2, and one in group 3
  • 29% (4/14) of the pT1G3 tumours progressed to muscle invasion, metastasis, or cancer death within five years compared with only 3% of the remaining 365 patients
  • Patients should be excluded at the outset from the recommended plan of management


References:

1) Parmar MKB, Freedman LS, Hargreave TB, Tolley DA. Prognostic factors for recurrence and follow up policies in the treatment of superficial bladder cancer: report from the British Medical Research Council subgroup on superficial bladder cancer (Urological Cancer Working Party). J Urol 1989;142:284-8

2) Oosterlinck W, Kurth KH, Schroder F, Bultinck J, Hammond B, Sylvester R, et al. A prospective European Organisation for Research and Treatment of Cancer Genitourinary Group randomised trial comparing transurethral resection followed by a single intravesical instillation of epirubicin or water in single stage Ta, T1 papillary carcinoma of the bladder. J Urol 1993;149:749-52.

3) Tolley DA, Hargreave TB, Smith PH, Williams JL, Grigor KM, Parmar MKB, et al. Effects of intravesical mitomycin C on recurrence of newly diagnosed superficial bladder cancer: interim report from the Medical Research Council Subgroup on Superficial Bladder Cancer (Urological Cancer Working Party). BMJ 1988;296:1759-61.

4) Tolley DA, Parmar MKB. MRC Working Party on Urological Cancer. The effect of mitomycin-C on the recurrence of newly diagnosed superficial bladder cancer - final report of a randomised MRC study. In: 49th annual meeting of the British Association of Urological Surgeons, Harrogate 1993. London: British Association of Urological Surgeons, 1993:46.


ArticleDate:20060520
SiteSection: Article
 
   
    
                                            



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