Deintensification of Treatment for Low-grade Bladder Tumors: A Collaborative Review by the International Bladder Cancer Group (IBCG).

Autor: Contieri R; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Italy; Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands., Soloway MS; Division of Urology, Urologic Oncology Memorial Physician Group, Memorial Hospital, Hollywood, FL, USA., Gontero P; Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy., Herr H; Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA., Kassouf W; Division of Urology, McGill University Health Centre, Montreal, Canada., Mertens LS; Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands., Moschini M; Department of Urology, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy., O'Donnell M; Department of Urology, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA., Palou J; Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain., Psutka SP; Department of Urology, University of Washington School of Medicine, Fred Hutchinson Cancer Center, Seattle, WA, USA., Rouprêt M; GRC 5 Predictive Onco-Uro, Department of Urology, Sorbonne University, Pitie-Salpetriere Hospital, AP-HP, Paris, France., Teoh JYC; SH Ho Urology Centre, Division of Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China., Kamat AM; Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. Electronic address: akamat@mdanderson.org.
Jazyk: angličtina
Zdroj: European urology oncology [Eur Urol Oncol] 2024 Aug 31. Date of Electronic Publication: 2024 Aug 31.
DOI: 10.1016/j.euo.2024.08.001
Abstrakt: Background and Objective: Management of low-grade (LG) urothelium-confined (Ta stage) non-muscle-invasive bladder cancer (NMIBC) poses a distinct therapeutic challenge. Transurethral resection of bladder tumor (TURBT), the standard treatment, frequently has to be repeated because of high tumor recurrence rates. This places a considerable strain on both patients and health care infrastructure, underscoring the need for alternative management approaches. Herein, the IBCG (International Bladder Cancer Group), conducted a review to explore the efficacy and safety of deintensified treatment strategies for recurrent LG Ta NMIBC.
Methods: We conducted a collaborative review of relevant literature in the PubMed/MEDLINE and Cochrane CENTRAL databases. Our focus was on high-quality evidence, including randomized controlled trials, systematic reviews, and meta-analyses. We also reviewed guidelines published by prominent urological associations.
Key Findings and Limitations: Active surveillance, chemoablation, and office fulguration are valid treatment options for recurrent LG Ta NMIBC. These deintensified approaches offer several advantages over TURBT: lower complication rates, less morbidity, lower health care costs, and better quality of life for patients. Importantly, these benefits are achieved without compromising oncological safety.
Conclusions and Clinical Implications: Our review demonstrates that less intensive treatment strategies for recurrent LG Ta NMIBC are both feasible and valuable. The IBCG recommends use of these approaches for carefully selected patients to help lower health care costs and enhance patients' quality of life.
Patient Summary: We reviewed studies on less invasive management options for low-grade noninvasive bladder cancer, including active surveillance, chemical ablation, and heat treatment. Recent results confirm that these less intense treatment options can reduce the treatment burden and costs for patients and preserve their quality of life without negatively affecting cancer control outcomes.
(Copyright © 2024 European Association of Urology. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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