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Management of Superficial Bladder Cancer in a Community Setting
1104
ONCOLOGY AND CHEMOTHERAPY
Review of Mayo Clinic Experience With Carcinoma In Situ
D. C. Urz AND G. M. FARROW, Departments of Urology and Pathology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota
H. ZINCKE,
Urology, suppl. 4, 26: 39-46 (Oct.) 1985 Experience with carcinoma in situ of the bladder during a 20-year period is reviewed. The most important clinical clues for diagnosis of this disease continue to be irritative bladder symptoms in the absence of infection in elderly men and a history of transurethral resection of the prostate. The most reliable method of diagnosis is urinary cytology. When not modified by treatment carcinoma in situ is the precursor of most invasive cancers, originating probably from an area of atypical hyperplasia into carcinoma in situ and, finally, into invasion. Among patients considered to have carcinoma in situ who undergo cystectomy 34 per cent may already have microinvasion. Carcinoma in situ has the potential to involve the entire urothelium. Prudence should guide the use of intravesical chemotherapy (mitomycin, thiotepa or doxorubicin), which may control the disease for extended periods in many patients. If primary treatment fails immediate second-line treatment should include bacillus Calmette-Guerin and/or hematoporphyrin derivative phototherapy. If such therapy fails delay of radical cystectomy seems inadvisable. Monitoring of the prostatic urethra during intravesical treatment is mandatory; a radical operation should be performed once the prostatic urethra is involved. Results of treatment for secondary prostatic and upper urinary tract cancer are dismal. Conversely, secondary urethral disease, although it occurs frequently beyond 5 years, may be associated with a good prognosis. W. W. K. 11 figures, 1 table, 18 references
Economic Aspects of Treatment of Superficial Bladder Cancer S. SUDOVAR,
Fairfax, Virginia
Urology, suppl. 4, 26: 57-61 (Oct.) 1985 Health economics research has shown pharmaceutical therapy to be a highly cost-effective modality of care in a variety of disease states. Specific examples include vaccines and products aimed at the treatment of infectious disease, mental illness, gastrointestinal disorders, diabetes and cancer. A review of the characteristics of mitomycin for injection therapy and of patients with superficial bladder cancer facilitates examination of mitomycin from the standpoint of cost-effectiveness. Thirdparty payment programs, including Medicare and Medicaid, often provide coverage for intravesical chemotherapy for superficial bladder cancer. Methods to obtain reimbursement for therapy associated with the management and treatment of superficial bladder cancer are suggested. Finally, the total cost of intravesical therapy is examined. Issues, such as the cost of surgery and chemotherapy, are discussed as well as the importance of weighing intangible factors, such as lost work time, productivity and social costs, into the sum of total cost of care. W. W. K. 2 figures, 2 tables, 8 references
Management of Superficial Bladder Cancer in a Community Setting J. A. HAAS, Decatur, Georgia
Urology, suppl. 4, 26: 51-54 (Oct.) 1985 During the last 4 or 5 years the urologist in private practice has gained experience with mitomycin in the treatment of superficial bladder cancers. Indications for use of mitomycin include carcinoma in situ, more than 2 or 3 recurrences on successive cystoscopic examinations of superficial transitional cell carcinomas, presence of multiple transitional cell carcinomas at the initial examination when it was believed that all tumor could not be removed cystoscopically and prophylaxis. The regimen for mitomycin has changed with time. Currently, the standard regimen is 40 mg. mitomycin in 40 cc sterile water given intravesically once a week for 8 weeks, followed by routine cystoscopic examinations every 3 months and maintenance therapy, if indicated, of 40 mg. mitomycin once a month. Results following use of this regimen in private practice have been most encouraging. Complications have been minimal. Only 1 patient had to discontinue therapy because of side effects, and 1 patient underwent radical cystectomy for recurrent disease after partial cystectomy and mitomycin therapy. Patients still receiving treatment include 1 who had not responded after initial treatment and who is being followed for possible recurrence. Mitomycin therapy appears to be effective in the control of superficial bladder cancer and, possibly, carcinoma in situ, with minimal side effects and good patient compliance. W. W. K. 2 figures, 1 table, 8 references
Use of Mitomycin as Prophylaxis Following Endoscopic Resection of Superficial Bladder Cancer H. HULAND AND U. OTTO,
Department of Urology, University of Hamburg, Hamburg, West Germany
Urology, suppl. 4, 26: 32-35 (Oct.) 1985 A prospective controlled study evaluated the influence of long-term mitomycin instillation therapy on tumor recurrence, tumor progression rate and patient survival after transurethral resection of superficial bladder tumors. In the mitomycin group, 11.1 per cent had recurrent tumors and among the controls 54.8 per cent had recurrent tumors during a mean followup of 33½ and 34½ months, respectively. The control group had 8 recurrent tumors of higher stage and 4 of higher grade, whereas all recurrent tumors in the mitomycin group that occurred in the bladder were either the same grade and the same stage (1), or a lower stage and lower grade (6). Side effects were minimal, with 72 per cent of the patients having no side effects. Chemical cystitis was the most common side effect, followed by generalized rash. No general toxic signs, such as myelosuppression, were seen. W. W. K. 5 tables, 14 references
The Role of Surgery in Localized Neuroblastoma
J. A.
K. SOPER, J. of Surgery, Radiation Therapy, Clinical Epidemiology and Pathology, University of Pennsylvania School of Medicine and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; CCSC Pathology Center, Columbus Children's Hospital, Columbus, Ohio, and Yokahama City University, Yokahama, Japan O'NEILL, P. LITTMAN, P. BLITZER, CHATTEN AND H. SHIMADA, Departments
J. Ped. Surg., 20: 708-712 (Dec.) 1985 A 30-year experience at 1 institution with 83 children (median age 2 years) with localized neuroblastoma (stages I to Ill)
ONCOLOGY AND CHEMOTHERAPY
Review of Mayo Clinic Experience With Carcinoma In Situ
D. C. Urz AND G. M. FARROW, Departments of Urology and Pathology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota
H. ZINCKE,
Urology, suppl. 4, 26: 39-46 (Oct.) 1985 Experience with carcinoma in situ of the bladder during a 20-year period is reviewed. The most important clinical clues for diagnosis of this disease continue to be irritative bladder symptoms in the absence of infection in elderly men and a history of transurethral resection of the prostate. The most reliable method of diagnosis is urinary cytology. When not modified by treatment carcinoma in situ is the precursor of most invasive cancers, originating probably from an area of atypical hyperplasia into carcinoma in situ and, finally, into invasion. Among patients considered to have carcinoma in situ who undergo cystectomy 34 per cent may already have microinvasion. Carcinoma in situ has the potential to involve the entire urothelium. Prudence should guide the use of intravesical chemotherapy (mitomycin, thiotepa or doxorubicin), which may control the disease for extended periods in many patients. If primary treatment fails immediate second-line treatment should include bacillus Calmette-Guerin and/or hematoporphyrin derivative phototherapy. If such therapy fails delay of radical cystectomy seems inadvisable. Monitoring of the prostatic urethra during intravesical treatment is mandatory; a radical operation should be performed once the prostatic urethra is involved. Results of treatment for secondary prostatic and upper urinary tract cancer are dismal. Conversely, secondary urethral disease, although it occurs frequently beyond 5 years, may be associated with a good prognosis. W. W. K. 11 figures, 1 table, 18 references
Economic Aspects of Treatment of Superficial Bladder Cancer S. SUDOVAR,
Fairfax, Virginia
Urology, suppl. 4, 26: 57-61 (Oct.) 1985 Health economics research has shown pharmaceutical therapy to be a highly cost-effective modality of care in a variety of disease states. Specific examples include vaccines and products aimed at the treatment of infectious disease, mental illness, gastrointestinal disorders, diabetes and cancer. A review of the characteristics of mitomycin for injection therapy and of patients with superficial bladder cancer facilitates examination of mitomycin from the standpoint of cost-effectiveness. Thirdparty payment programs, including Medicare and Medicaid, often provide coverage for intravesical chemotherapy for superficial bladder cancer. Methods to obtain reimbursement for therapy associated with the management and treatment of superficial bladder cancer are suggested. Finally, the total cost of intravesical therapy is examined. Issues, such as the cost of surgery and chemotherapy, are discussed as well as the importance of weighing intangible factors, such as lost work time, productivity and social costs, into the sum of total cost of care. W. W. K. 2 figures, 2 tables, 8 references
Management of Superficial Bladder Cancer in a Community Setting J. A. HAAS, Decatur, Georgia
Urology, suppl. 4, 26: 51-54 (Oct.) 1985 During the last 4 or 5 years the urologist in private practice has gained experience with mitomycin in the treatment of superficial bladder cancers. Indications for use of mitomycin include carcinoma in situ, more than 2 or 3 recurrences on successive cystoscopic examinations of superficial transitional cell carcinomas, presence of multiple transitional cell carcinomas at the initial examination when it was believed that all tumor could not be removed cystoscopically and prophylaxis. The regimen for mitomycin has changed with time. Currently, the standard regimen is 40 mg. mitomycin in 40 cc sterile water given intravesically once a week for 8 weeks, followed by routine cystoscopic examinations every 3 months and maintenance therapy, if indicated, of 40 mg. mitomycin once a month. Results following use of this regimen in private practice have been most encouraging. Complications have been minimal. Only 1 patient had to discontinue therapy because of side effects, and 1 patient underwent radical cystectomy for recurrent disease after partial cystectomy and mitomycin therapy. Patients still receiving treatment include 1 who had not responded after initial treatment and who is being followed for possible recurrence. Mitomycin therapy appears to be effective in the control of superficial bladder cancer and, possibly, carcinoma in situ, with minimal side effects and good patient compliance. W. W. K. 2 figures, 1 table, 8 references
Use of Mitomycin as Prophylaxis Following Endoscopic Resection of Superficial Bladder Cancer H. HULAND AND U. OTTO,
Department of Urology, University of Hamburg, Hamburg, West Germany
Urology, suppl. 4, 26: 32-35 (Oct.) 1985 A prospective controlled study evaluated the influence of long-term mitomycin instillation therapy on tumor recurrence, tumor progression rate and patient survival after transurethral resection of superficial bladder tumors. In the mitomycin group, 11.1 per cent had recurrent tumors and among the controls 54.8 per cent had recurrent tumors during a mean followup of 33½ and 34½ months, respectively. The control group had 8 recurrent tumors of higher stage and 4 of higher grade, whereas all recurrent tumors in the mitomycin group that occurred in the bladder were either the same grade and the same stage (1), or a lower stage and lower grade (6). Side effects were minimal, with 72 per cent of the patients having no side effects. Chemical cystitis was the most common side effect, followed by generalized rash. No general toxic signs, such as myelosuppression, were seen. W. W. K. 5 tables, 14 references
The Role of Surgery in Localized Neuroblastoma
J. A.
K. SOPER, J. of Surgery, Radiation Therapy, Clinical Epidemiology and Pathology, University of Pennsylvania School of Medicine and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; CCSC Pathology Center, Columbus Children's Hospital, Columbus, Ohio, and Yokahama City University, Yokahama, Japan O'NEILL, P. LITTMAN, P. BLITZER, CHATTEN AND H. SHIMADA, Departments
J. Ped. Surg., 20: 708-712 (Dec.) 1985 A 30-year experience at 1 institution with 83 children (median age 2 years) with localized neuroblastoma (stages I to Ill)