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Bacillus Calmette-Guérin Is Superior to a Combination of Epirubicin and Interferon-alpha2b in the Intravesical Treatment of Patients with Stage T1 Urinary Bladder Cancer. A Prospective, Randomized, Nordic Study.

https://arctichealth.org/en/permalink/ahliterature95037
Source
Eur Urol. 2009 Oct 6;
Publication Type
Article
Date
Oct-6-2009
Author
DuchekMiloš
JohanssonRobert
JahnsonStaffan
MestadOddvar
HellströmPekka
HellstenSverker
MalmströmPer-Uno
Author Affiliation
Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University Hospital, Umeå, Sweden.
Source
Eur Urol. 2009 Oct 6;
Date
Oct-6-2009
Language
English
Publication Type
Article
Abstract
BACKGROUND: Bacillus Calmette-Guérin (BCG) instillation is regarded as the most effective bladder-sparing treatment for patients with high-grade T1 tumours and carcinoma in situ (CIS). The major problem with this therapy is the side-effects, making maintenance therapy difficult, even impossible, in a proportion of patients. Thus, alternative schedules and drugs have been proposed. OBJECTIVE: To compare BCG to the combination of epirubicin and interferon-alpha2b as adjuvant therapy of T1 tumours. DESIGN, SETTING, AND PARTICIPANTS: This is a Nordic multicenter, prospective, randomised trial in patients with primary T1 G2-G3 bladder cancer. Initial transurethral resection (TUR) was followed by a second-look resection. Patients were randomised to receive either regimen, given as induction for 6 wk followed by maintenance therapy for 2 yr. MEASUREMENTS: The drugs were compared with respect to time to recurrence and progression. Also, side-effects were documented. RESULTS AND LIMITATIONS: A total of 250 patients were randomised. At the primary end point, 62% were disease free in the combination arm as opposed to 73% in the BCG arm (p=0.065). At 24 mo, there was a significant difference in favour of the BCG-treated patients (p=0.012) regarding recurrence, although there was no difference regarding progression. The subgroup analysis showed that the superiority of BCG was mainly in those with concomitant CIS. In a multivariate analysis of association with recurrence/progression status, significant variables for outcome were type of drug, tumour size, multiplicity, status at second-look resection, and grade. A corresponding analysis was performed separately in the two treatment arms. Tumour size was the only significant variable for BCG-treated patients, while multiplicity, status at second-look resection, and grade were significant for patients treated with the combination. CONCLUSIONS: For prophylaxis of recurrence, BCG was more effective than the combination. There were no differences regarding progression and adverse events between the two treatments.
PubMed ID
19819617 View in PubMed
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A population-based study of patterns of care for muscle-invasive bladder cancer in Sweden.

https://arctichealth.org/en/permalink/ahliterature89083
Source
Scand J Urol Nephrol. 2009 May 8;:1-6
Publication Type
Article
Date
May-8-2009
Author
JahnsonStaffan
DammOle
HellstenSverker
HolmangSten
LiedbergFredrik
LjungbergBorje
MalmstromPer-Uno
MånssonWiking
StrombergFredrik
WijkstomHans
Author Affiliation
Department of Urology, University Hospital, Linkoping, Sweden.
Source
Scand J Urol Nephrol. 2009 May 8;:1-6
Date
May-8-2009
Language
English
Publication Type
Article
Abstract
Objective. To analyse the management of muscle-invasive bladder cancer in a population-based national register, and specifically to investigate the role of curative therapy (i.e. cystectomy or radiotherapy) in relation to patient, tumour and hospital characteristics. Material and methods. The Swedish Bladder Cancer Register covers more than 90% of all patients in the country who have been diagnosed with such disease since 1997. Results from 1997-2003 were analysed regarding curative-intent treatment given within 3-6 months of diagnosis of muscle-invasive bladder cancer. Results. In total, 3463 patients with clinical T2-T4 bladder cancer were included in the analysis. Of those patients, 1426 (41%) received curative-intent treatment in the form of radiotherapy (285, 20%) or cystectomy (1141, 80%). Male gender, age
PubMed ID
19424934 View in PubMed
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