Delayed cystectomy for T1G3 transitional cell carcinoma (TCC) of the urinary bladder, NCI retrospective case series
Joint Authors
Salamah, Asma
Fakhr, Ibrahim
al-Husayni, Hisham
Source
Journal of the Egyptian National Cancer Institute
Issue
Vol. 20, Issue 4 (31 Dec. 2008), pp.387-394, 8 p.
Publisher
Cairo University National Cancer Institute
Publication Date
2008-12-31
Country of Publication
Egypt
No. of Pages
8
Main Subjects
Topics
Abstract EN
Aim : We aim to evaluate the National Cancer Institute (NCI) treatment protocol and its outcome regarding recurrence, progression and survival in patients with T1G3 urinary bladder transitional cell carcinoma.
Patients and Methods: In a retrospective study, between January 2001 and December 2007, all 34 patients with T1G3 bladder transitional cell carcinoma (TCC), after complete transurethral resection (TURBT), received intravesical BCG as adjuvant therapy.
A conservative approach was adopted, whereby those with superficial recurrences were eligible to TURBT, with delayed cystectomy for progression to muscle invasion.
Overall, recurrence, and progression-free survival were analyzed.
Results : Thirty-three patients were included, 29 were males and 4 were females.
The mean age was 61 years (range 35-89 years).
Final analysis was made at median follow-up of 15 months (Range of 3-68 months, mean 18 months) for survival.
Eleven (33.3%) patients had multifocal tumors.
Associated schistosomiasis was present in 12 (36.6%) patients.
Twenty-two (66.67%) patients showed recurrence.
Eleven out of these 22 (50.0%) patients progressed to muscle invasion and underwent radical cystectomy.
Ten out of 34 (30.3%) patients received postcystectomy radiotherapy.
Two (20.0%) of them, were staged as TNM stage II, 6 (60.0%) as TNM stage III and 2 (20.0%) patients were TNM stage IV.
Eight (72.7%) of these 11 patients had post-cystectomy radiotherapy alone; while the 2 (6.0%) other patients with stage IV had adjuvant concomitant Cisplatin and Gemcitabine chemotherapy.
Five (14%) patients of those cystectomy patients died of TCC.
Three (60%) patients died from metastatic disease (to lung, liver and bone), one patient died from advanced locoregional disease and another patient died from postoperative complications.
Among those patients who received radiotherapy alone, 62.5% are alive.
Although, we report a biologically more aggressive behavior of T1G3 than that reported by some authors, for this conservative approach, the overall survival (OS) was (84.4%) and the recurrence-free survival (RFS) was (41.3%), at 18 months; which are comparable to those reported in the literature for the delayed cystectomy approach.
Conclusion : Adjuvant intravesical therapy with BCG with repeated cystoscopies, and delayed radical cystectomy until progression to the invasive disease carries a significant risk of mortality from invasive disease.
This treatment policy may be acceptable for T1G3 bladder TCC, without concomitant carcinoma in situ (CIS), who don’t recur after intravesical BCG, however, patients who progress to invasive disease may skip stage II disease and present with stage III or IV, with consequent poor survival.
Therefore, due to the aggressive biologic behavior of T1G3 cancer, a determination of a cutoff number for recurrence(s) or better evaluation parameters are needed, to proceed with cystectomy without awaiting muscle invasion.
American Psychological Association (APA)
Fakhr, Ibrahim& al-Husayni, Hisham& Salamah, Asma. 2008. Delayed cystectomy for T1G3 transitional cell carcinoma (TCC) of the urinary bladder, NCI retrospective case series. Journal of the Egyptian National Cancer Institute،Vol. 20, no. 4, pp.387-394.
https://search.emarefa.net/detail/BIM-355989
Modern Language Association (MLA)
Fakhr, Ibrahim…[et al.]. Delayed cystectomy for T1G3 transitional cell carcinoma (TCC) of the urinary bladder, NCI retrospective case series. Journal of the Egyptian National Cancer Institute Vol. 20, no. 4 (Dec. 2008), pp.387-394.
https://search.emarefa.net/detail/BIM-355989
American Medical Association (AMA)
Fakhr, Ibrahim& al-Husayni, Hisham& Salamah, Asma. Delayed cystectomy for T1G3 transitional cell carcinoma (TCC) of the urinary bladder, NCI retrospective case series. Journal of the Egyptian National Cancer Institute. 2008. Vol. 20, no. 4, pp.387-394.
https://search.emarefa.net/detail/BIM-355989
Data Type
Journal Articles
Language
English
Notes
Includes bibliographical references : p. 392-394
Record ID
BIM-355989