Carcinoma in situ of urinary bladder: incidence, treatment and clinical outcomes during ten-year follow-up.

Bladder carcinoma in situ (CIS) is a rare, high-grade intraepithelial neoplasm with a high tendency of progression and unpredictable clinical course. The aim of this study was to evaluate the incidence, treatment and clinical outcome of patients with CIS during a 10-year period. Medical records of 1062 patients with primary bladder cancer and 847 patients with recurrent bladder cancer that underwent tumor resection at Department of Urology, Split University Hospital Center, Split, Croatia, between January 2001 and December 2010, were analyzed. Among all treated patients with primary bladder neoplasms, 51 (4.8%) had CIS. Primary CIS was diagnosed in 18 (1.7%) and concomitant CIS in 33 (3.1%) patients. In the same period, 847 patients with recurrent tumors were treated by transurethral resection (TUR), 12 (1.4%) of them with secondary CIS. Clinical course was followed-up in 15 patients with primary CIS and 21 patients with concomitant (TaT1) CIS. BCG immunotherapy was applied in 12 patients with primary and 17 patients with concomitant CIS. After median follow-up of 50 months, 9 patients with primary CIS had no sign of disease, 4 progressed, 1 had recurrence and 1 died. After median follow-up of 37 months, 13 (62%) patients with concomitant CIS had complete response, 3 progressed (14%), 1 had recurrence (4%) and 4 patients died, however, only 2 (10%) of these due to bladder cancer. Of all patients receiving BCG immunotherapy, 8 (27%) had significant side effects. The incidence and treatment of patients with CIS of urinary bladder in our institution is comparable to other recent literature reports.

Biopsies of the normal-appearing urothelium in primary bladder cancer.

AIM: The aim of the study was to determine the incidence of "positive" findings in biopsies of the normal-appearing urothelium near primary cancer and their influence on therapeutic decisions. MATERIALS AND METHODS: Between January 2001 and October 2008, in 230 patients with primary bladder cancer during initial resection of tumor, we also performed random biopsy of surrounding normal-appearing urothelium. We analyzed retrospectively the number and type of positive biopsy findings and their impact on further treatment. RESULTS: There were 40% of patients (92/230) whose normal-appearing urothelium biopsy revealed pathological findings such as tumor tissue, Tis, and dysplasia. In 24.4% of patients, the stage of the primary tumor was Ta (32/131), in 50% it was T1 stage (30/61), and in 79% T2 stage (30/38). When we assessed the grade of malignancy, we found 18% of biopsies with G1 tumors (16/88), 33% with G2 tumors (19/59), and 69% with G3 tumors (57/83). Tumor tissue that was found in the normal-appearing urothelium in biopsy specimens in 13% of patients was in stage Ta (17/131), in 16% it was T1 stage (10/61), and in 39% of patients, the tumor was in T2 stage (15/38). Pathological findings of random biopsies were crucial in changing therapeutical decisions in 4.6% (9/192) of patients. CONCLUSION: Biopsy of the normal-appearing urothelial tissue is easy to perform and may help in identifying patients with high risk of disease progression and recurrence. Based on our results and results from the literature we recommend this simple tool as part of the routine management during transurethral resection of primary bladder cancer.

Concomitant chemobrachyradiotherapy with ifosfamide and cisplatin followed by consolidation chemotherapy for women with locally advanced carcinoma of the uterine cervix--final results of a prospective phase II-study.

OBJECTIVES: To evaluate the efficacy and toxicity of ifosfamide and cisplatin administered concomitantly with low-dose rate brachyradiotherapy followed by consolidation chemotherapy in the treatment of locally advanced squamous cell carcinoma (LASCC) or adeno/adenosquamous carcinoma of the uterine cervix. METHODS: Sixty-two patients with primary uterine cervical cancer were enrolled between August 1999 and November 2004. The patients had to have FIGO-stage IB2 bulky to IVA disease, biopsy-proven squamous cell or adeno/adenosquamous carcinoma of the uterine cervix. The patients were to receive external radiotherapy (50 Gy in 25 fractions); ifosfamide 2 g/m2 plus cisplatin 75 mg/m2 was applied concomitantly during two low-dose rate brachyradiotherapy applications; the planned dose to point A was 85 Gy in total. After the completion of radiotherapy, i.e. external and concomitant chemobrachyradiotherapy, four cycles of consolidation chemotherapy with the same drug combination were to be administered. RESULTS: The clinical complete response rate according to WHO-classification (assessed after the completion of the whole treatment procedures by gynecologic and radiologic evaluation and cervical biopsy) was 100%. After a median follow-up of 49 months (range 11-74 months), the recurrence-free and overall survival rates were 88.7%, respectively. The most frequent early toxicities were grade 3 and 4 leukopenias occurring in 25% and 11% of the cycles, respectively. Major delayed local complications occurred in 10 patients (16.1%). CONCLUSION: These results indicate that concomitant chemobrachyradiotherapy with ifosfamide and cisplatin followed by consolidation chemotherapy with the same drug combination is a highly efficacious and very promising treatment protocol for patients with locally advanced LASCC or adeno/adenosquamous carcinoma of the uterine cervix.