Therapeutic Management Of Cancer Research Articles

Impact of Medical Specialties on Diagnostic and Therapeutic Management of Elderly Cancer Patients.

The management (diagnostic and therapeutic) of cancer in the geriatric population involves a number of complex difficulties. The aim of this study was to assess the impact of a medical specialty on the diagnostic and therapeutic management of elderly cancer patients. Four clinical scenarios of cancer in the geriatric population, with a dedicated survey to gather information regarding each clinical case's diagnostic and therapeutic approaches, as well as the different criteria influencing physicians' therapeutic decisions, were exposed to geriatricians, oncologists, and radiotherapists in Saint-Etienne. The surveys were filled out by 13 geriatricians, 11 oncologists, and 7 radiotherapists. There was a homogeneity of responses regarding the confirmation of cancer diagnostics in the elderly. There were strong disparities (inter- and intra-specialties) for several clinical situations regarding the therapeutic management of cancer. There were significant disparities in terms of surgical management, the implementation of a chemotherapy protocol, and the adaptation of the chemotherapy dosage. Contrary to oncologists, who primarily consider the G8 and the Karnofsky score, geriatric autonomy scores and frailty with cognitive assessment were the key factors determining diagnostic/therapeutic therapy for geriatricians. These results raise important ethical questions, requiring specific studies in geriatric populations to provide the homogenous management of elderly patients with cancer.

Head and neck tumor segmentation convolutional neural network robust to missing PET/CT modalities using channel dropout

Objective. Radiation therapy for head and neck (H&N) cancer relies on accurate segmentation of the primary tumor. A robust, accurate, and automated gross tumor volume segmentation method is warranted for H&N cancer therapeutic management. The purpose of this study is to develop a novel deep learning segmentation model for H&N cancer based on independent and combined CT and FDG-PET modalities. Approach. In this study, we developed a robust deep learning-based model leveraging information from both CT and PET. We implemented a 3D U-Net architecture with 5 levels of encoding and decoding, computing model loss through deep supervision. We used a channel dropout technique to emulate different combinations of input modalities. This technique prevents potential performance issues when only one modality is available, increasing model robustness. We implemented ensemble modeling by combining two types of convolutions with differing receptive fields, conventional and dilated, to improve capture of both fine details and global information. Main Results. Our proposed methods yielded promising results, with a Dice similarity coefficient (DSC) of 0.802 when deployed on combined CT and PET, DSC of 0.610 when deployed on CT, and DSC of 0.750 when deployed on PET. Significance. Application of a channel dropout method allowed for a single model to achieve high performance when deployed on either single modality images (CT or PET) or combined modality images (CT and PET). The presented segmentation techniques are clinically relevant to applications where images from a certain modality might not always be available.

Antitumor effects of NK cells expanded by activation pre‑processing of autologous feeder cells before irradiation in colorectal cancer.

Natural killer (NK) cells play a crucial role in early immune defenses against transformed cells and are used in the therapeutic management of cancer. However, it is difficult to sufficiently obtain high purity activated NK cells for clinical application. The function of NK cells is dependent on the balance of activating and inhibitory signals. Strong and diverse stimuli are required to increase the function of NK cells. Radiotherapy modulates the expression of various immunomodulatory molecules that recruit and activate NK cells. NK cell-mediated antibody-dependent cellular cytotoxicity is one of the most potent cytotoxic effects of NK cells against target cancer cells. To generate activated and irradiated autologous peripheral blood mononuclear cells (PBMCs), cytokine and monoclonal antibody stimulation followed by ionizing radiation was performed in the present study. The expanded NK cells were cultured for 21 days using activated/irradiated autologous PBMCs. Colorectal cancer cells (SW480 and HT-29) were used to analyze the expression of NK group 2D ligands and EGFR by radiation. The cytotoxicity of radiation plus NK cell-based targeted therapy against colorectal cancer cell lines was analyzed using flow cytometry. Activated and irradiated PBMCs exhibited significantly increased expression of various activating ligands that stimulated NK cells. In total, >10,000-fold high-purity activated NK cells were obtained, with negligible T-cell contamination. To confirm the antitumor activity of the NK cells expanded by this method, the expanded NK cells were treated with cetuximab, radiotherapy, or a combination of cetuximab and radiotherapy in the presence of human colorectal cancer cells. Expanded NK cells were effective at targeting human colorectal cancer cells, particularly when combined with cetuximab and radiotherapy. Thus, in the present study, a novel method for high-purity activated NK cell expansion was developed using activated and irradiated PBMCs. In addition, combined radiotherapy and antibody-based immunotherapy with expanded NK cells may be an effective strategy to enhance the efficiency of treatment against colorectal cancer.

Use of virtual reality in oncology: From the state of the art to an integrative model

Over the past 20 years, virtual reality (VR) has been the subject of growing interest in oncology. More and more researchers are studying the effects of virtual environments to contribute to current thinking on technologies likely to support patients undergoing oncological treatment. Recent research highlights how VR can divert attention while reducing anxiety in stressful healthcare situations through its multisensory and participative nature. VR appears to be a promising tool capable of reducing cancer-related anxiety symptoms, improving treatment adherence, and increasing satisfaction with oncology care. While the literature reports these positive effects in the therapeutic management of cancer, few studies have focused on theoretical models capable of explaining the psychological benefits of virtual immersion. This literature review provides a theoretical framework combining results from all relevant empirical work in oncology. The review can help researchers identify the optimal conditions for using VR in oncology and bridge the gap between divergent devices, modalities, and practices (e.g., headmounted displays, environments, interactivity, immersion time).

A Review on Nanocarrier Mediated Treatment and Management of Triple Negative Breast Cancer: A Saudi Arabian Scenario

People have continued to be petrified by the devastating effects of cancer for decades and thus a pursuit for developing anticancer agents have seen an ever-increasing trend in the past few decades. Globally, breast cancer is the most common malignancy in women and the second most common cause of cancer-related deaths. In Saudi Arabia, breast cancer is the most common type of cancer among women, constituting almost 14.2% of the total cancer burden. Triple-negative breast cancer (TNBC) is a subtype of breast cancer, which is a pathologically diverse disease of higher grade characterized by the absence of the estrogen receptor (ER), the progesterone receptor (PR), and the human epidermal growth factor receptor 2 (HER2) expressions. Despite the considerable advancements achieved in the therapeutic management of cancer, TNBC remains an unbeatable challenge, which requires immediate attention as it lacks conventional targets for treatment, leading to a poor clinical prognosis. The present research goals are directed toward the development and implementation of treatment regimens with enhanced bioavailability, targetability, minimized systemic toxicity, and improved outcomes of treatment options. The present treatment and management scenario of TNBC continues to provoke oncologists as well as nanomedical scientists to develop novel and efficient nanotherapies. Lately, scientific endeavors have addressed the importance of enhanced availability and targeted cellular uptake with minimal toxicity, which are achieved by the application of nano drug-carriers. This review intends to summarize the incidence rates of TNBC patients, the importance of nanotherapeutic options for patients suffering from TNBC, the identification of promising molecular targets, and challenges associated with the development of targeted nanotherapeutics with special reference to the Saudi Arabian context.

The Pattern of Second Primary Tumours in Postmenopausal Women with Prior Breast Cancer in Western Romania: A Retrospective, Single-Institution Study.

With improved survival, more patients with prior breast cancer are at risk of having a second primary cancer diagnosed. The pattern and impact of second primary cancers following breast cancer is important for overall breast cancer therapeutic management. Our study is a first analysis of the trend of second primary tumours over time in terms of incidence, sites with significantly elevated risks and correlation with stage, molecular subtype and therapeutic strategies conducted in Eastern Europe in postmenopausal women with breast cancer. Patients and methods: Our study population included 28 patients with prior breast cancer (BC) and second primary tumours, which were diagnosed and treated in our Institution between 2004 and 2017. The criteria for selection were based on the completeness of the documentation of the first treatment for breast cancer, stage of disease, molecular subtype, the site of origin of the second tumours and the survival data. Results: An increased risk of second primary cancer was associated with the 51–60 years age group (53.6%), with the greater prevalence in patients living in urban environments (82.1%). The use of chemotherapy increased the risk of the occurrence of gynecological second malignancies (75%). Our study is a first analysis of the trend of second primary tumours over time in terms of identifying sites with significantly elevated risks and correlation with therapeutic strategies conducted in Eastern Europe in postmenopausal women with breast cancer. Conclusions: Our study is a first analysis of the trend of second primary tumours over time in terms of correlation with luminal subtype and stage at diagnosis of primary cancer sites with significantly elevated risks and correlation with therapeutic strategies in postmenopausal women with breast cancer conducted in Eastern Europe. The reported time from primary to second primary malignancy onset, with a significantly higher rate for postmenopausal breast cancer patients, was less than one year (50%). With the advances and wider availability of genetic testing (e.g., gene panels), patients diagnosed with multiple primaries should be increasingly investigated for an underlying cancer predisposition. Postmenopausal women with breast cancer may benefit from increased surveillance and advice to avoid second malignancies.

Impact of the COVID-19 pandemic on patients with cancer and cancer survivors: A narrative review

The coronavirus disease-2019 (COVID-19) pandemic has impacted the healthcare system. Patients with cancer have been severely affected by the pandemic and have not been able to utilize the required healthcare services in a timely manner. This review is aimed at assessing the clinical and psychological impact of the COVID-19 pandemic on patients with cancer and cancer survivors. A comprehensive literature search was performed for this review in the PubMed database and Google Scholar database using the keywords, “COVID-19,” “cancer,” and “impact” in the title. Of a total of 30 relevant studies, 27 articles were included in the review. In addition, the World Health Organization website was extensively searched for relevant information. For patients with cancer who are affected by COVID-19, it has been advocated that post recovery from COVID-19, the therapeutic management of cancer should resume at the earliest to minimize cancer-related mortality. The COVID-19 pandemic has caused massive disruptions in the prevention, screening, diagnosis, and management of cancer. Therefore, minimizing the effect of the COVID-19 infection and improving the healthcare services offered to the patients with cancer by strengthening the healthcare system is the need of the hour.

An HPTLC densitometric method for simultaneous quantification of sorafenib tosylate and chrysin: Analytical method development, validation and applications

Since decades, the plant bioactives have shown tremendous promise in the therapeutic management of cancer. Lately, many synthetic drugs and natural bioactive molecules have been used in combination for potential synergism in cancer therapeutics. Sorafenib (SFN) and chrysin (CHR) form one of such promising combinations with definitive synergistic potential in cancer therapy. This has, however, given rise to analytical challenges, as it becomes quite difficult to identify and quantify two or more active moieties simultaneously in the presence of each other. Herein, we report the development and validation of an HPTLC densitometric method for analysis of SFN and CHR, in combination, followed by studying the effect of biological matrix (i.e., plasma), on the assay of both the molecules. Solvent system, comprising of toluene: n-hexane: isopropyl alcohol (7:2:1), was employed for chromatographic separation with Rf values of 0.3 and 0.5, for SFN and CHR, respectively. Validation studies established linearity for the concentrations ranging from 20 to 800 ng/band for each of the molecules, along with high degree of accuracy, precision (intra- and inter-day), ruggedness, robustness, and sensitivity of the liquid chromatographic method. Specificity studies using plasma as the biological matrix, exhibited well-resolved peaks of both the molecules, coupled with high recovery values too. The aforesaid method was finally applied to the estimation of real plasma levels in Wistar rats, following co-administration of SFN and CHR as a suspension. In a nutshell, the validated analytical method can be productively applied for simultaneous estimation of SFN and CHR, for routine analysis, in drug formulations and in biological matrices like plasma.

PENGARUH TINGKAT STRES TERHADAP MEKANISME KOPING PASIEN KANKER BERBASIS MANAJEMEN TERAPI KANKER

The management of cancer therapy is useful to improve the survival of cancer patients, but it has a physical impact on various functions of the body's organs. It can lead to stress and affect individual coping mechanisms. The aim of this study was to analyze the effect of stress levels on coping mechanisms of cancer patients based on cancer therapeutic management. This study used a mix method design and sequential explanatory approach. The population was cancer patients at the Indonesian Cancer Foundation, East Java Branch, Surabaya. The number of sample were 32 patients taken by total sampling method. The instrument used perceived stress scale and coping strategies inventory short form. The result of ordinal regression test and nagelkerle's pseudo R-Square in chemotherapy group 0.013 and R 0.621, in radiation group 0.016 and R 0.597, in chemoradiotherapy group 0.010 and R 0.737. It means that stress levels has a significant effect on individual coping mechanisms in all cancer therapeutic management groups. On the qualitative results showed that stress and maladaptive coping mechanisms caused by side effects of therapy, financial, relationships with caregiver was less harmonious, less able to think positively. The complexity of therapeutic stressors and the presence of poorly managed of external factors made respondents more likely to have maladaptive coping mechanisms.

Variety of clinical trial enrollment by actionable tumor suppressor genotype.

e15674 Background: In the last decade, genomics has been increasingly used for therapeutic management of cancer. In precision oncology, genes that can be directly or indirectly targeted with therapeutic agents are considered “actionable”. However, not all alterations affect gene function and alterations in tumor suppressor genes are especially challenging to interpret. The objective of this study was to determine frequency of trial enrollment in patients with “actionable” tumor suppressor alterations and determine whether this varied by genotype and tumor type. Methods: A single-institution retrospective review was performed on patients with metastatic, advanced, or recurrent solid tumors perceived to likely benefit from genomic profiling. Between 1/2015 and 1/2020, the top 5 tumor suppressor alterations CDKN2A, BRCA1/2, PTEN, ATM and NF1 were considered most common “actionable” tumor suppressor genes among patients reviewed by MD Anderson Precision Oncology Decision Support system. Once literature-based or inferred actionability of the tumor-suppressor alteration was determined, a clinical record review was performed to assess an institution-specific annotation detailing trial availability. This annotation matches somatic genomic alteration based on therapeutic significance and availability of matched investigative therapy based on available literature at the time. From here, patient demographics and trial enrollment was extracted from the electronic medical record. Results: 424 patients were categorized as having actionable alterations that had a trial available for enrollment based on genomic characteristics. Of these, 61 patients (14%) enrolled in a matched trial. Primary reasons for non-enrollment for a specific alteration were: enrollment in non-targeted therapeutic trial (39%), treatment with another stand of care therapy (32%), or enrollment in another genomically matched trial targeting another genomic alteration (14%). There was variability in enrollment by disease type approaching statistical significance (p = 0.073). CDKN2A alterations were the most common while BRCA1/2 had the highest rate of matched enrollment (39.5%). Conclusions: In this cohort of patients, the presence of an actionable tumor-suppressor alteration was associated with trial enrollment varying by genotype. Further work is needed to determine the impact of decision support on trial enrollment as well as strategies to increase actionability by building genomically-driven combination therapy trials.

GC-MS Analysis of Bioactive Compounds of Artemesia annua and Assessment of its anti-proliferative activity against Human Cancer Cell Lines

Plant essential oil is found to possess many beneficial effects in the field of medicine. Especially essential oil derived from different species of plants is reported to have specific activity against cancer. Artemesiaannua is an annual herb belonging to Asteraceae family has been traditionally used for treating several ailments. It is a conventional medicinal plant used in the treatment of chloroquine-resistant and cerebral malaria. The major aim of this study was to evaluate the anticancer potential of this plant against cancer cell line. Hydro distilled volatile oil obtained from aerial parts of A.annua was analysed by GCMS. The majority of the compounds derived from essential oil of Artemesiaannua are monoterpenes and sesquiterpenes. Artemisinin, the active component of Artemesiaannua is a sesquiterpenoid lactone containing unusual endoperoxide bridge that shows remarkable activity against numerous tumour growth and metastases. The pleiotropic nature of artemisinin induces oxidative stress, anti-angiogenetic effect and apoptosis triggering on cancer cells. The anti-proliferative effect of essential oil derived from Artemesiaannua on human cancer cell lines like MCF-7, HT29 and AGS was done by MTT assay. Results shows the essential oil of artemisia annua have cytotoxic potential by inhibiting cell growth in a dose dependent manner. However, further investigations in isolating active cytotoxic components and understanding its molecular mechanisms will help in therapeutic management of cancer.

Identification of high-affinity inhibitors of pyruvate dehydrogenase kinase-3: towards therapeutic management of cancer

Pyruvate dehydrogenase kinase 3 (PDK3) is a multifunctional enzyme that plays a central role in the cancer metabolic switch by blocking pyruvate catabolism in the TCA cycle. PDK3 plays a significant role in the TCA cycle and cancer cell progression, thus, considered as a novel drug target for developing effective therapeutics against varying types of cancer. Here, we employed a structure-based virtual high-throughput screening of natural compounds from the ZINC database to identify potential inhibitors of PDK3. First, the resulted hits were selected on the basis of their physicochemical and ADMET properties. Further, PAINS filter, binding affinities based on the docking analysis and interaction analysis was carried out to find safe and better hits against PDK3. Finally, we identified four natural compounds bearing admirable affinity towards PDK3. Selected compounds showed appreciable drug-like properties and preferentially interact to the residues of the ATP-binding pocket of PDK3. Binding and structural annotations made in docking analysis were supplemented by all-atom molecular dynamics simulations to evaluate the conformational dynamics, stability and interaction mechanism of PDK3 in complex with one of the identified compounds ZINC08764476. PDK3 and ZINC08764476 forming a stable complex throughout the simulation trajectory. We suggest that compound ZINC08764476 may be exploited as a promising scaffold for the development of potential inhibitors of PDK3 to combat cancer and associated diseases.Communicated by Ramaswamy H. Sarma

2017 Update on Ovarian Cancer Peritoneal Carcinomatosis Multimodal-Treatment Considerations.

Ovarian cancer peritoneal carcinomatosis requires a multimodal-treatment approach. Current treatment considerations are analyzed in this update and include the management of recurrent malignant ascites and the understanding of its pathophysiology, the role of peritoneal washing cytology in detecting peritoneal metastases, capsular invasion and ovarian cancer histologic type, interpretation of pretreatment Ca-125 levels at different time points of ovarian cancer therapeutic management, characteristics of 10-year survivors of high-grade ovarian cancer, and the role of lymphadenectomy in ovarian cancer peritoneal carcinomatosis. This update also includes current considerations on the role of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in ovarian cancer peritoneal carcinomatosis as well as relevant ongoing phase III randomized controlled trial protocols.

Drug Combination in Clinical Cancer Treatments.

The modality of anticancer drug combinations needs to be renovated from empirical into technical-supportive systems. To challenge past therapeutic routines, the new landscape may be established. Among the different areas of anticancer drug combination study, research in the fields of medical study is the most important one-including disciplinary of therapeutics in different cancer stages, modern genetic/ molecular diagnostics, cancer bioinformatics, traditional Chinese medicine, mathematical data analysis, therapeutic toxicity monitor, personalized cancer medicine and so on. This article addresses these types of cancer therapeutic management systems for clinical anticancer drug combination utilities. Future cancer drug combinational studies and clinical optimums must be implemented.

Tumor angiogenesis and vascular normalization: alternative therapeutic targets.

Tumor blood vessels are a key target for cancer therapeutic management. Tumor cells secrete high levels of pro-angiogenic factors which contribute to the creation of an abnormal vascular network characterized by disorganized, immature and permeable blood vessels, resulting in poorly perfused tumors. The hypoxic microenvironment created by impaired tumor perfusion can promote the selection of more invasive and aggressive tumor cells and can also impede the tumor-killing action of immune cells. Furthermore, abnormal tumor perfusion also reduces the diffusion of chemotherapeutic drugs and radiotherapy efficiency. To fight against this defective phenotype, the normalization of thetumor vasculature has emerged as a new therapeutic strategy. Vascular normalization, by restoring proper tumor perfusion and oxygenation, could limit tumor cell invasiveness and improve the effectiveness of anticancer treatments. In this review, we investigate the mechanisms involved in tumor angiogenesis and describe strategies used to achieve vascular normalization.

Current impact of age and comorbidity assessment on prostate cancer treatment choice and over/undertreatment risk.

We evaluated the influence of age and comorbidity (Charlson score assessment) on localized prostate cancer therapeutic management and the risk of prostate cancer over- and under-treatment. Among the 2571 prostate cancer cases diagnosed in 2011, a subset of 633 patients was randomly selected from the prospectively accrued cohort of the Regional Cancer Registry, among the 17 participating institutions. Treatment distributions were examined for patients at each individual prostate cancer risk, age and comorbidity level and analyzed by multivariate logistic regression analysis. Treatments with curative intent were observed less often when age increased (p<0.001). We found no impact of the Charlson score on the selection of a curative treatment [HR 0.89, 95% CI (0.70-1.15)]. A 20% overtreatment rate was reported in low-risk prostate cancer patients. For younger patients (65-75years) with high comorbidity score, a 14% overtreatment rate was observed. Conversely, a 16% undertreatment rate was reported in older patients >75 years without any significant comorbidity. A better consideration of comorbidities could significantly reduce overtreatment in patients <75year and promote curative treatment in aggressive prostate cancer for older patients without any significant comorbidity.

Pharmacognostic standardisation and antiproliferative activity of Aegle marmelos (L.) Correa leaves in various human cancer cell lines.

Therapeutic management of cancer is a great clinical challenge and alternative medicines are being extensively explored to have integrated approach to cure cancer. Aegle marmelos (L.) Correa (Rutaceae) is known for its hypoglycaemic, radioprotective, antidiarrhoeal and many other pharmacological activities. The present study is designed to carryout pharmacognostic standardisation and evaluation of antiproliferative activity of the leaf extracts Aegle marmelos (L.) Correa (Rutaceae) and the chromatographic fractions of the most active extract. Hexane, petroleum ether, chloroform and ethanol extracts of the shade dried leaves were prepared by soxhelation and antiproliferative activity was assessed using human cancer cell lines of lung (A-549), colon (CoLo-05), ovary (IGR-OV-1), prostrate (PC3), leukaemia (THP-1) and breast (MCF-7) cancer. Bioactivity-derived fractionation was carried out for most active extract by column chromatography. The phytochemical studies indicated alkaloids, anthraquinones, terpenoids in the alcohol, chloroform extracts and tannins, terpenoids, reducing sugars in the petroleum ether and hexane extracts. Ethanol extract showed maximum inhibition in colon and breast carcinoma cell lines at a dose of 100 μg/ml. Column chromatography of the ethanol extract yielded five fractions. Out of this, fractions 2, 4 and 5 showed significant inhibition in leukaemia cell line with IC50 of 12.5, 86.2 and >100 μg/ml for fractions 2, 4 and 5, respectively. High-performance thin layer chromatography of the fraction 2 revealed imperatorin as one of the major phytoconstituents. Among the different extracts investigated, ethanol extract exhibited significant antiproliferative activity and its fraction 2 containing furanocoumarin imperatorin showed antiproliferative activity against leukaemia cell line with IC50 of 12.5 μg/ml.

Nutrition in cancer patients with cachexia: A role for the gut microbiota?

Summary Cachexia is a multifactorial syndrome that includes muscle wasting and inflammation, and that is associated with chronic underlying diseases, such as cancer, chronic heart failure and chronic kidney disease. Since gut microbes influence host immunity and metabolism, we hypothesized a few years ago that the gut microbiota could be a potential therapeutic target to tackle cancer-related cachexia. In this review, we present evidence from animal and human studies suggesting that the gut microbiota and its crosstalk with the intestine might constitute unexpected targets in the therapeutic management of cancer and related cachexia. Finally, we discuss future research directions and hypotheses to progress in this new promising field, i.e. the role of the gut microbiota in cancer cachexia.

Synbiotic approach restores intestinal homeostasis and prolongs survival in leukaemic mice with cachexia.

Cancer cachexia is a multifactorial syndrome that includes muscle wasting and inflammation. As gut microbes influence host immunity and metabolism, we investigated the role of the gut microbiota in the therapeutic management of cancer and associated cachexia. A community-wide analysis of the caecal microbiome in two mouse models of cancer cachexia (acute leukaemia or subcutaneous transplantation of colon cancer cells) identified common microbial signatures, including decreased Lactobacillus spp. and increased Enterobacteriaceae and Parabacteroides goldsteinii/ASF 519. Building on this information, we administered a synbiotic containing inulin-type fructans and live Lactobacillus reuteri 100-23 to leukaemic mice. This treatment restored the Lactobacillus population and reduced the Enterobacteriaceae levels. It also reduced hepatic cancer cell proliferation, muscle wasting and morbidity, and prolonged survival. Administration of the synbiotic was associated with restoration of the expression of antimicrobial proteins controlling intestinal barrier function and gut immunity markers, but did not impact the portal metabolomics imprinting of energy demand. In summary, this study provided evidence that the development of cancer outside the gut can impact intestinal homeostasis and the gut microbial ecosystem and that a synbiotic intervention, by targeting some alterations of the gut microbiota, confers benefits to the host, prolonging survival and reducing cancer proliferation and cachexia.

Narrow-band imaging cystoscopy in non-muscle-invasive bladder cancer: a prospective comparison to the standard approach

A single-centre, prospective trial was performed aiming to assess the impact of narrow-band imaging (NBI) cystoscopy in cases of non-muscle-invasive bladder cancer (NMIBC) in comparison to standard white light cystoscopy (WLC). A total of 95 NMIBC-suspected consecutive cases were enrolled. The inclusion criteria were hematuria, positive urinary cytology or ultrasound suspicion of bladder tumors. All patients underwent WLC and NBI cystoscopy. Standard resection was performed for all lesions visible in white light and NBI transurethral resection of bladder tumors for only NBI-observed tumors. The overall detection rates of NMIBC and carcinoma in situ (CIS) were significantly improved for NBI (96.2% versus 87.2% and 100% versus 66.7% respectively). Also, NBI cystoscopy showed significantly superior detection for CIS, pTa and overall tumors (95.2% versus 61.9%, 93.9% versus 85.2% and 94.8% versus 83.9% respectively). Additional tumors were diagnosed by NBI in a significant proportion of patients with CIS, pTa, pT1 and NMIBC (55.5% versus 11.1%, 26.5% versus 10.2%, 30% versus 10% and 30.8% versus 10.3%). Postoperative treatment was significantly improved due to NBI results (16.7% versus 5.1%). NBI cystoscopy represents a valuable diagnostic alternative in patients with NMIBC, with significant improvement in tumor visual accuracy as well as detection. This approach provides a substantial improvement to bladder cancer therapeutic management.