Bacillus Calmette-Guerin versus Gemcitabine for Intravesical Therapy in High-Risk Superficial Bladder Cancer: A Randomised Prospective Study
ABSTRACT To evaluate the safety, tolerability and efficacy of adjuvant intravesical gemcitabine versus bacillus Calmette-Guérin (BCG) in the treatment of high-risk superficial bladder cancer.
64 patients with high-risk superficial bladder cancer (pT1 and/or G3 and/or CIS) were assigned to interventions (gemcitabine or BCG) in a randomised controlled trial. All the patients were evaluated for recurrence and progression rates (primary endpoint) and safety and tolerability (secondary endpoint).
The two groups were comparable in terms of baseline characteristics. Tolerability was better for gemcitabine, whereas the BCG group experienced the need for delayed treatment or withdrawal in 12.5% of cases. At a mean follow-up of 44 months, the recurrence rate in patients treated with BCG was 28.1%; the recurrence rate in patients who received gemcitabine was 53.1% (p = 0.037). Time to recurrence was shorter in patients treated with BCG (25.6 vs. 39.4 months, p = 0.042). No patients developed disease progression.
Gemcitabine is significantly inferior to BCG, but given its favourable toxicity profile, it may be useful for patients intolerant to or otherwise unable to receive BCG.
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Conference Paper: 2D magnetic micro fluxgate system with digital signal output[Show abstract] [Hide abstract]
ABSTRACT: The magnetic microsystem presented contains, on a single chip, two orthogonal planar microfluxgate sensors and the complete electronics for fluxgate excitation and signal readout. The system uses on-chip ΣΔ A/D conversion with digital feedback in the magnetic field domain. It is realized in standard CMOS technology followed by post-processing. The system is for use as an electronic compass. Other possible applications are magnetic pattern sensing and nondestructive material testingSolid-State Circuits Conference, 1999. Digest of Technical Papers. ISSCC. 1999 IEEE International; 02/1999
- European Urology 07/2010; 58(1):178. DOI:10.1016/j.eururo.2010.04.013 · 12.48 Impact Factor
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ABSTRACT: Around 80 % of newly diagnosed bladder cancers are confined to the mucosa and staged as non-muscle-invasive bladder cancer (NMIBC) (Ta, T1, Cis). These tumours appear to segregate into different main molecular pathways with extremely variable prognoses. The standard treatment for NMIBC is transurethral tumour resection (TUR) with Re-TUR and adjuvant intravesical chemotherapy or intravesical immunotherapy in most cases. Several developments associated with diagnosis such as the usefulness of the new WHO grading classification, the benefit of photodynamic diagnosis (PDD) or narrow band imaging (NBI), as well as the clinical value of tumour markers are discussed. Therapy for NMIBC includes monopolar or bipolar TUR. Subsequent instillation therapy is given according to the risk stratification. Several promising new substances as well as device-assisted procedures such as thermochemotherapy or EMDA are discussed. The additional information gained by PDD obviously leads to a better diagnosis and treatment of all NMIBC. Routine IVU does not seem necessary. The value of diagnostic urine tests is still insufficiently defined. Several new aspects concerning prognostic markers are presented. While early chemotherapy instillation seems sufficient in low-risk tumours and BCG is the standard treatment for high-risk disease, the literature about treatment of intermediate risk tumors is still conflicting. Especially problematic is the case of recurrent disease after intravesical therapy in intermediate and high-risk patients. The question as to what has to be done in failure after BCG is discussed. Cystectomy is a safe option but other approaches are potential alternatives.Aktuelle Urologie 09/2010; 41(5):307-15. DOI:10.1055/s-0030-1262555 · 0.28 Impact Factor