BCG VESICAL CANCER

Background: High-risk non-muscle invasive bladder cancer (HR-NMIBC) is a clinically unpredictable disease. Despite clinical risk estimation tools, many patients are undertreated with intra-vesical therapies alone, whereas others may be over-treated with early radical surgery. Molecular biomarkers, particularly DNA methylation, have been reported as predictive of tumour/patient outcomes in numerous solid organ and haematologic malignancies; however, there are few reports in HR-NMIBC and none using genome-wide array assessment...

Immunotherapy, via intra-vesical instillations of BCG, is the therapy of choice for patients with high-risk non-muscle invasive bladder cancer. The subsequent recruitment of lymphocytes and myeloid cells, as well as the release of cytokines and chemokines, is believed to induce a local immune response that eliminates these tumors, but the detailed mechanisms of action of this therapy are not well understood. Here, we have studied the phenotype and function of the responding lymphocyte populations as well as the spectrum of cytokines and chemokines produced in an in vitro model of human peripheral blood mononuclear cells (PBMCs) co-cultured with BCG...

Extending up to the submucosa, superficial bladder tumours (pTis, pTa et pTi) are initially treated by transurethral resection. According to their risk of recurrence and progression, this frequent cancer subsequently benefits from intra-vesical instillations of cytotoxic agents and immunomodulators. Several new treatments are currently being evaluated, namely new genetically modified BCG strains, so as novel means to administrate intravesical chemotherapy, which seam to improve prognosis. Owing to the significant prevalence of superficial bladder cancer and its morbidity, these new therapeutic means will probably be increasingly used...

Bacille Calmette-Guérin (BCG) immunotherapy is widely used for the treatment of superficial bladder cancer. The authors believe that the present report is one of the first to document cerebral BCG tuberculoma in a 73-year-old immunocompetent man, three years after intra-vesical BCG immunotherapy. His workup revealed no identifiable extracranial source. He responded well to treatment with rifampin, ethambutol and moxifloxacin.Patients undergoing intravesical BCG therapy should be closely monitored for the development of this complication...

BACKGROUND: The management of stage T1 poorly differentiated G3 bladder cancer invading the lamina propria continues to be debated. These tumours are associated with a high risk of recurrence and progression; concomitant carcinoma in situ and/or multifocality are negative prognostic factors. Choosing between a preserving approach such as trans-urethral resection of the bladder (TURB) followed by maintenance bacillus Calmette-Guerin (BCG) and an invasive approach like cystectomy is critical...

Urothelial tumours which infiltrate the vesical muscle or more superficial tumours which resist localised treatment (resection+/-BCG or mytomicin C) should be considered for excision. Excision is successful in female cystectomy and in male radical cystoprostatectomy. For local tumours of the bladder (<T3), this treatment allows for a specific survival of 5 years at 90 % to be obtained. After the excision of the bladder, several types of urinary diversions may be proposed. The replacement neo-bladder by ilioplasty (orthotopic replacement) should be chosen when possible (conservation of the urether)...

The importance in the study of bacillus of Calmette-Guérin or BCG is related to several functions derived from its influence on the immunological system, between which it is found the prevention of the dissemination of the tubercular bacillus, its utilization as immunomodulator in some oncologic illness (as vesical cancer) in order to avoid post-surgical recidiva or in some forms of immunotherapy, as the cytokine (interferon alpha and interleukin-2); in addition, BCG vaccine is supplied like an immunomodulator in treatment of melanoma...

OBJECTIVE: After endoscopic resection of high-grade superficial urothelial neoplasms (Ta, T1 or Tis), adjuvant bacillus Calmette-Guérin (BCG) therapy is performed routinely to avoid recurrence and/or progression. Vesical biopsies often are performed to assess the efficacy of treatment. The aim of our study was to evaluate the usefulness of these biopsies. MATERIALS AND METHODS: During this retrospective bi-centre study, 130 patients who had undergone vesical high-grade tumour resection were included...

Bacillus Calmette-Guerin (BCG) instillation therapy is now a standard therapy for high-risk superficial bladder cancer patients. Although the complete response rate is approximately 70%, extra-vesical progression is sometimes observed. In particular, those patients who present a positive urinary cytology even after complete response from bladder lesion should be thoroughly examined. We present two cases of stromal invasion of the prostate after complete remission by BCG therapy of carcinoma in situ of the ureter and bladder found by transrectal prostate biopsy...

UNLABELLED: We studied 67 patients with bladder cancer in stage T1, with terminated BCG treatment and in pursuit. No stage Ta neither carcinoma in situ was included. The protocol was: beginning of treatment upon retiring vesical catheter, instilation of 1 mg of liofilized BCG vaccine (16 x 10(6) bacilles) in 40-50 ml of intravesical saline solution. A weekly instilation during the first month. An instilation each 15 days during the second and third month and one monthly until complete 12 months of treatment...

PURPOSE: Photodynamic therapy combines a photosensitizer, such as porfimer sodium (Photofrin), with red laser light (630 nm.) to destroy cancer cells. Investigators have reported the effectiveness of photodynamic therapy in the treatment of patients with recurrent superficial bladder cancer. We assess the safety and efficacy of 1 or 2 photodynamic treatments using porfimer sodium and controlled uniform laser light (630 nm.) as an alternative to cystectomy in patients with refractory vesical carcinoma in situ of the bladder...

We evaluated the immune response after BCG treatment in superficial bladder cancer analyzing the modifications induced on lymphocytic sub-populations. In 21 patients with superficial bladder cancer we performed TURB and after 12 days began the induction cycle of 6 weeks with Pasteur BCG (75 mg/50 micromilligrams), followed by one instillation monthly for one year. Before treatment every patients underwent Mantoux intradermoreaction, blood-count and determination of peripheral blood lymphocytic subpopulations...

At present, the most efficacious and used immunostimulant agent in the superficial bladder cancer immunotherapy field, is the BCG, even if its mechanism of action is still partly unknown. The therapeutic effects of BCG don't seem to depend exclusively on local immune response, so that according to this assertion, this immunohistochemical study had been conducted on 14 patients affected by superficial bladder cancer (pTa-pT1) which aimed to value both the apoptosis and proliferation indexes and the expression of the genetic product p53 and EGFR before and after the exposition of the vesical mucosa to the BCG...

In our department 14 patients with primary carcinoma in situ of the bladder were treated. Thirteen patients were male and 1 patient was female. Most of the patients complained of irritative vesical symptoms such as painful urination and/or pollakisuria. Cystoscopic examination revealed no overt tumor but some abnormal findings like localized or diffuse hyperemia or fine granular changes were noted. In 4 patients, total cystectomy was performed primarily and 10 other patients were treated at first with intravesical chemotherapy or intravesical BCG...

A prophylaxis with a minidose of BCG Vaccine (1 mgr.) is performed in vesical instillation during one year, to 108 patients bearing bladder cancer in the stage T1. In the first month the instillations are once a week, each fifteen days the second and third month and then, once a month for one year. An 19.4% of recurrences is obtained with an general average observation time of 37.3 months as well as an important increase of muster populations of T lymphocytes and a positive test of dinitroclorobenzene. As complications we have obtained an inguinal BCG adenitis and in a few cases disury and frequency for two or three days...

Presentation of results obtained in 171 evaluable patients from a series of 181, presenting surface vesical cancer in Tis, Ta and T1 stages, treated with 3 different dosages of endovesical BCG as prophylaxis for tumour relapse: a) high dose, 100 to 120 mg, 72 patients; b) intermediate dose, 20 to 50 mg, 39 patients; and, c) minidose of 1 mg, 60 patients. Complications and adverse reactions were seen to be dose-dependent, also percentage of patients free of disease both after treatment and following addition of retreatment in several patients was similar in all the dosages used...

Clinical studies on intracavitary bacillus Calmette-Guerin therapy for bladder cancer have been conducted at this institution for more than 10 years. The 82 patients treated for prophylaxis of multiple superficial recurrences, residual tumors or carcinoma in situ have been followed for 2 to 7 years after treatment. The long-term results confirm previous studies showing the effectiveness of bacillus Calmette-Guerin in the prophylaxis and therapy of superficial vesical neoplasms. However, some decrease is observed in the population free of disease with a prolonged followup...

We administered BCG at microdoses (1 mg) to 34 patients after surgical operation for bladder cancer, from 1981 to 1989. A 9% recurrency rate was observed during a 42 month follow up period. This is not significantly different from that observed with 120 mg doses, which are associated to known complications.

Thirty-two patients with transitional cell cancer of the bladder infiltrating the lamina propria were treated with intravesical BCG. Seventy-five percent of these patients could keep their bladder at the cost of regular BCG treatment and strict endoscopic monitoring. A better evaluation of prognostic criteria, including malignancy grade, total amount of vesical muscle removed during the initial resection and investigation for lymphatic system emboli, should help in a better selection of patients, separating those who might have recurrent infiltrative tumours from those who would benefit from a conservative treatment and offering the former a more aggressive therapy...