Complete Transurethral Resection Of Bladder Tumor Research Articles

Organ-Sparing Treatment in Muscle-Invasive Bladder Cancer

Organ-sparing treatment of bladder cancer by a trimodality approach is feasible and effective. In this study, the results of a series of patients are reported, who were, in the majority, not suitable for major surgery. In the period from June 1995 through December 2003, 68 patients (64 males, four females) with urothelial bladder cancer were treated with curative intent. The median age was 68 years (range 42-82 years). Clinical T-category was 32x T2, 20x T3, and 16x T4. Transurethral resection was performed in all cases, and a complete TUR-BT (transurethral resection of bladder tumor) was attempted, if possible. Radiotherapy was administered in conventional fractionation (five fractions of 1.8 Gy per week) up to 50.4 Gy to bladder, and regional nodes and the whole bladder received a boost up to 54-59.4 Gy. 34 patients received concurrent cisplatin-based chemotherapy (25 mg/m(2) on days 1-5 and 29-33), and patients with impaired renal function were either treated with irradiation alone (n = 7) or received paclitaxel as alternative to cisplatin in a phase II protocol or on an individual decision (n = 27). The median follow-up was 34 months (range 2-104 months). A histologically confirmed complete remission (CR) on restaging cystoscopy was observed in 40/46 patients (87%) who underwent restaging cystoscopy. CR rates were not significantly correlated to T-category (CR: 24/32 T2, 9/19 T3, and 9/16 T4 tumors) or clinical nodal status. Patients with non-radical resection and macroscopic residual tumor (R2 resection) achieved a CR in only 39% (12/31); this figure was significantly lower as compared to patients with radical R0 TUR-BT (CR: 15/16, 94%, p = 0.013) Furthermore, age and preexisting anemia had no impact on response. The overall survival of the whole group was 45% after 5 years, and survival according to clinical T-category was 62% for T2, 43% for T3, and 19% for T4 (p = 0.015). In eleven patients, local disease progression or relapse was observed. So far, only one salvage cystectomy has been performed, due to contraindications to surgery in the majority of patients. The data obtained in this study confirm the high efficacy of TUR and radiochemotherapy for locally advanced bladder cancer.

Impact of transurethral resection of bladder tumor: analysis of cystectomy specimens to evaluate for residual tumor

Objectives To analyze the impact of transurethral resection of bladder tumor (TURBT) on the outcome of patients with bladder cancer who undergo subsequent cystectomy. Methods We reviewed the records of 90 patients with pathologic Stage T2 or less transitional cell carcinoma of the bladder at our institute. Before radical cystectomy, TURBT was performed for diagnostic and therapeutic purposes in all patients. We used the term “complete TURBT” in the following situations: no residual tumor endoscopically after TURBT, the presence of a muscle layer in the TURBT specimen, and no gross residual tumor in the cystectomy specimen as evaluated by a pathologist. Results No statistically significant differences in the completeness of TURBT were observed by age, sex, tumor multiplicity, shape, history of previous TURBT, tumor grade, or stage. Of 21 patients with superficial bladder tumors who had undergone incomplete resection, 14 (66.7%) had a higher stage on the cystectomy specimen; 3 (17.7%) of 17 patients had a higher stage in the complete TURBT group. Of 34 patients with an invasive tumor who underwent complete TURBT, 10 (29.4%) had an identical pathologic stage after cystectomy; the remaining patients had a lower stage. However, only 3 (16.7%) of 18 patients had a lower stage in the incomplete resection group. Of patients with Stage T2, those with pT0 stage had a better chance of survival than those with residual tumor ( P = 0.04). Conclusions Our findings indicate that the completeness of TURBT is an important aspect of patient outcome in cases of superficial or invasive bladder cancer.

Treated natural history of superficial bladder cancer.

The present study was conducted to examine the natural history of superficial bladder cancer. One hundred and forty-four patients with superficial bladder cancer who had been treated with transurethral resection of bladder tumor (TURBt) alone were analyzed. The non-recurrence rate was 64.8% at 36 months and 61.2% at 60 months after TURBt. When the non-recurrence rate after TURBt was analyzed by background variables, the rate differed significantly between the solitary tumor group and the multiple tumor group. The tumor recurrence hazard curves for the entire population had one high peak before 500 days and another slight peak around 1500 days after TURBt. These results will provide basic information useful when evaluating new regimens of intravesical instillation therapy for prophylaxis of superficial bladder cancer after our complete TURBt in the Nara Uro-Oncology Research Group.

Bladder preservation in muscle-invasive bladder cancer by conservative surgery and radiochemotherapy.

Organ preservation has been investigated in muscle-invasive bladder cancer over the past decades as an alternative to standard radical cystectomy. The results of large prospective protocols and population-based studies suggest that an organ-preserving approach is possible without deferring the survival probability. Organ preservation requires a trimodal schedule, including transurethral surgery (transurethral resection of bladder tumor (TURBT)), radiation, and chemotherapy. A complete TURBT is the most important single prognostic factor, and should be attempted. Radiotherapy, in conjunction with concurrent platinum-based chemotherapy, can control the vast majority of urothelial bladder tumors. The histologically-proven complete remission rates of macroscopic tumors (unresectable by TURBT) lie in the range of about 70%. After radiochemotherapy, a histological response evaluation with repeated TURBT is recommended. Patients with residual tumor require salvage cystectomy. In cases of complete remission, patients can maintain their bladders but they should be closely followed over years. The risk of severe late-radiation sequelae is low, in the range of less than 5%. About 75% of long-term survivors maintain a normally functioning bladder.