Thursday, 30 January 2014

Bladder cancer and Synergo latest updates


Bladder Cancer  

Bladder cancer is the fourth most common non-dermatological cancer in men in the UK. In 2005, the estimated male and female crude incidence rates of bladder cancer were 24.6 and 9.3 per 100,000 population with 6091 and 2403 new cases, respectively, in England. In Wales the incidence is 43.0 and 17.2 per 100,000 population, that is 619 and 260 new cases, respectively. Altogether, more than 10,000 people in the UK are newly diagnosed with bladder cancer each year. Around 75–85% of these patients have non-muscle-invasive bladder cancer (NMIBC) including carcinoma in situ (CIS).

NMIBC has a probability of recurrence at 5 years of up to 80% and a probability of progression of between 0.8% and 30% after initial treatment (depending on the stage and grade of disease). A combined analysis of 2596 patients from seven EORTC Trials with stage Ta T1 Bladder Cancer indicated a 70% recurrence within 3 years (Sylvester R. Eur Urol 2006)

Patients with bladder cancer are differentiated into one of three groups: (1) those with low risk disease in whom the main risk is recurrent low-risk papillary disease with a small chance of dying of the disease; (2) those with intermediate and high-risk non-muscle-invasive disease and CIS in whom there is a high chance of disease progression and subsequent death from bladder cancer; and (3) those with muscle-invasive disease in whom there is imminent risk of death from bladder cancer.

The goals of current treatment for patients with non-muscle-invasive bladder cancer are to prevent disease recurrence or progression to muscle-invasive disease, to avoid cystectomy and, ultimately, to enhance survival.

Transurethral resection of the bladder tumour (TURBT) is the first-line treatment for patients with NMIBC. Unfortunately, the high rate of recurrence and progression after TURBT necessitates the use of adjuvant treatments. This entails instillation of a chemotherapeutic agent, usually mitomycin (MMC), or immunotherapeutic agents such as BCG, either alone or in various combinations.

Intravesical BCG is the an effective treatment but patients who fail BCG treatment are often treated again with low probability to remain disease-free and are often referred to cystectomy. Some patients are unable to tolerate BCG and/or are refractory to treatment and some patients cannot receive treatment due to impaired immune system (e.g. lung/kidney transplants).

Synergo technology has become a therapy option[1] in many centres throughout Europe for:
·         intermediate and high-risk patients with recurrent tumours, especially after failed BCG treatment
·         patients who are unsuitable or refuse radical cystectomy
·         patients who are unfit for operation
·         patients for whom BCG treatment is contraindicated.

[1] Lammers RJ, Witjes JA, Inman BA, Leibovitch I, Laufer M, Nativ O, Colombo R: The Role of a Combined Regimen With Intravesical Chemotherapy and Hyperthermia in the Management of Non-muscle-invasive Bladder Cancer: A Systematic Review. Eur Urol 2011, 60:81-93