Sequential intravesical chemoimmunotherapy with mitomycin C and bacillus Calmette-Guérin and with bacillus Calmette-Guérin alone in patients with carcinoma in situ of the urinary bladder: results of an EORTC genito-urinary group randomized phase 2 trial (30993)

Andreas Bohle
2011 International Brazilian Journal of Urology  
Urological Survey features, LND was performed at the time of nephrectomy, and the numbers and sites of regional lymph node metastasis were recorded for each patient. Results and Limitations: Of the 169 high-risk patients, 64 (38%) had lymph node metastases. All patients with nodal metastases had nodal involvement within the primary lymphatic sites of each kidney prior to involvement of the nodes overlying the contralateral great vessel. A limitation of the study is the lack of a standardized
more » ... f a standardized LND performed throughout the study period. Conclusions: Pathologic features of renal tumors are associated with the risk of regional lymph node metastases and lymph node metastases that appear to progress though the primary lymphatic drainage of each kidney. Based on these findings we recommend that when performing LND the lymph nodes from the ipsilateral great vessel and the interaortocaval region be removed from the crus of the diaphragm to the common iliac artery. Editorial Comment The landing zone of lymph node metastasis and hence the extent of lymph node dissection in renal cancer is not very well defined. The authors report on a historical cohort of patients with high-risk renal cancer and demonstrate the extent of lymph node metastases. Several clinically important conclusions can be drawn from these data. First, in 66% of patients with metastases these were suspected meaning that roughly one third of lymph node metastases were unsuspected. So clearly, lymphadenectomy (LND) should be performed in all high-risk patients. But to which extent? Interestingly, 45% of metastatic patients had no peri-hilar lymph node involvement. Furthermore, no patient with a right-sided tumor had para-aortic metastases without other retroperitoneal involvement, and no patient with a left-sided tumor had paracaval involvement without involvement of para-aortic or inter-aortocaval lymph nodes. Thus, the surgical recommendation in high-risk tumors is that in patients with right-sided tumors LND should involve all para-caval and inter-aortocaval nodes, whereas in left-sided tumors para-aortic and interaortocaval lymph nodes should be removed. Background: Bacillus Calmette-Guérin (BCG) is the intravesical treatment of choice for carcinoma in situ (CIS). Objective: Our aim was to assess if sequential mitomycin C (MMC) plus BCG after transurethral resection (TUR) is worthy of further study in non-muscle-invasive bladder cancer patients with CIS. Design, Setting, and Participants: In a noncomparative phase 2 study, 96 patients with primary/secondary/concurrent CIS of the urinary bladder were randomized to sequential MMC plus BCG or to BCG alone after TUR. Effect of dutasteride on prostate biopsy rates and the diagnosis of prostate cancer in men with lower urinary tract symptoms and enlarged prostates in the combination of avodart and tamsulosin trial Roehrborn CG,
doi:10.1590/s1677-55382011000200024 fatcat:ltfssqunn5djjmfmua2dwfqrgy