Journals / Üroloji Bülteni / 1999 / Cilt: 10 - Sayı: 1
Long term effects of intravesical bacillus Calmette-Guerin instillations in the treatment of superficial bladder tumors
- Journal
- Üroloji Bülteni
- Pages
- 12–16
- DOI
- —
Abstract
Long Term Effects Of lntravesical Bacillus Calmette-Guerin Instillations In Tlie Treatment Of Superficial Bladder Tumors- In this study, the long term effects of intravesical bacillus Calmette-Guerin (BCG) instillations on recurrence rates of bladder cancer were evaluated. Seventy-one patients with any two of risk factors such as grade II/III tumors, stage pTl, recurrent or multiple tumors and tumours greater than 4 cm, were included into the study. The mean follow up period was 24 months (range; 10-46 months). Twenty-four patients (33.8 %) had recurrences. The mean time to the first recurrence was 25.7months. It was also observed that recurrence rates tended to increase with increasing tumour stage and grade. Nine (37.5 %) out of 24 patients with recurrences showed disease progression that necessitated radical surgery in 4 cases (5.6.%). Biopsies obtained at the first followup cystoscopy were consistent with changes secondary to BCG in 80 % of cases. These changes had no statistically significant impact on disease progress or recurrences. Lesions resected with suspect of tumor on the first followup were devoid of tumor in all cases but 1 (6.6 %). However, similar lesions resected at followups after the first year always revealed transitional cell carcinoma. Data obtained in the present study revealed that recurrence free survival rate was nearly 70 % in 2 years, including high risk patients with superficial bladder tumors. Progression was usually observed in patients with stage pTl, grade II or III tumors. The secondary inflammatory changes, such as granuloma formation, had no correlation with tumor recurrence. Suspicious lesions seen at early control cystoscopies following BCG treatment mostly consisted of secondary inflammatory changes that suggested that the timing of the first control cystoscopies after BCG should be reconsidered.
Özet
Bu galismada, intravezikal bacillus Calmette-Guerin (BCG) kullaniminin uzun donemde mesane tu'moru nuksleri uzerine etkileri arastinlmistir. Orta veya yuksek grade (II, III), T1 evresi, rekurren tumor, multipl tumor ve 4 cm'den buyuk tumor gibi kotti prognostik kriterlerden en az ikisine sahip olan toplam 71 yuzeyel mesane tumorlu hastaya mesane igi BCG tedavisi verilmistir. Hastalann ortalama izlem suresi 24 aydir (10 ile 46 ay arasmda). Yirmi dort hastada (% 33.8) nuks gozlespmistir. Nukse kadar gegen ortalama sure 25.7 ay olarak bulunmustur. Tumorun grade ve evresi yukseldikge nuks hizinm da artma egiliminde oldugu gozlenmistir. Nuks gozlenen 24 hastanin 9'unda (% 37.5) progresyon izlenmis, bu hastalardan 4'unde (% 5.6) radikal cerrahiye gerek duyulmustur. ilk kontrol sistoskopilerde ahnan biyopsi sonuglan hastalann % 80'inde BCG'ye ikincil olarak gelisen degisikliklerle uyumlu bulunmustur. Bunlann hastaligin seyri ve nuks etmesiyle istatistiksel olarak anlamli bir iliskisinin olmadigi belirlenmistir. ilk kontrollerinde gros gorunumu tumor kuskusu uyandiran dokulann histopatolojik incelemesi sonucunda yalnizca 1 hastada (% 6.6) tranzisyonel hucreli karsinom gozlenirken, ikinci yil ve sonrasindaki kontrollerde benzer sekilde yorumlanan dokulann hepsinde neoplastik gelisim saptanmi§tir. Yuksek riskli yuzeyel mesane tumorlu hastalarda bile ortalama iki yillik bir gozlem suresinde tumorsuz kalma yuzdesi % 70'ler civanndadir ve progresyon genellikle evre pT1, grade II veya III tiimorlerde gozlenmektedir. Mesanede gozlenen granulom olu§umuyla nuks arasmda bir iliski saptanmamistir. BCG tedavisini izleyen erken donemde yapilan sistoskopik kontrollerde siklikla gozlenen ku§kulu lezyonlann buyuk kismini BCG'ye ikincil degisikliklerin olusturmasi, BCG tedavisi sonrasinda yapilan ilk kontrol sistoskopilerin zamanlamasimn yeniden duzenlenmesi gerektigini diisundurmektedir.