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ABSTRACT: Die korrigierte 5-Jahres-Überlebensrate für Patienten mit pTa-Tumoren beträgt 95%, für das Tumorstadium pT1 G1–2 81% und für
das Tumorstadium pT1 G3–4 64% [28]. Tritt ein Rezidiv auf, verschlechtert sich die Prognose bei pTa-Tumoren auf 77,7%, bei
pT1 G1–2-Tumoren auf 78,6% und bei pT1 G3–4-Tumoren auf 38,7%. Darüber hinaus sind der Differenzierungsgrad und die Multifokalität
des Primärtumors von prognostischer Bedeutung: Während hochdifferenzierte Tumoren nur in 0–6% eine Invasion der Lamina propria
und damit eine Progression aufwiesen, zeigten 22–52% der mittelgradig differenzierten Tumoren und 5–82% der niedrig differenzierten
Tumoren im Verlauf nach transurethraler Resektion ein invasives Wachstum. Primär multifokale Tumoren (mehr als 2 Tumoren bei
Erstdiagnose), ein begleitendes Carcinoma in situ und eine Tumorgröße von >5 cm beeinflussen die Prognose ebenfalls im Sinne
einer Verschlechterung [12].
Der Urologe 04/2012; 40(5):403-411. · 0.50 Impact Factor
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ABSTRACT: This multicentre phase III study was designed to compare the efficacy of Bacillus Calmette Guérin (BCG) instillations and photodynamic therapy (PDT) in the treatment of patients with intermediate and high-risk nonmuscle invasive bladder cancer.
Inclusion criteria were multifocal pTaG1-G2 tumours, recurrent pTaG1-2 tumours, pTa / 1G3 tumours, and primary or recurrent carcinoma in situ (CIS). All patients were centrally randomised after transurethral resection (TUR) to receive BCG induction and maintenance therapy or a single PDT with Photofrin. The primary endpoint of the trial was recurrence-free survival. Secondary endpoints were the 2-year recurrence rate, the 2-year progression rate, survival, and quality of life.
124 patients (63 PDT group, 61 BCG group) were enrolled at 7 institutions in Germany and Austria. Each patient had a follow-up for 2 years. Of the 124 enrolled patients 105 were eligible for this analysis. Kaplan-Meier curves demonstrated no statistically significant differences between the two therapy arms with respect to recurrence-free survival after randomisation (p = 0.4598). After intention-to-treat analysis and after as-treated analysis, the estimated median recurrence-free survival periods were 24.9 (BCG) versus 16.6 months (PDT) and 25.8 (BCG) versus 14.7 (PDT) months, respectively.
A single PDT with Photofrin(R) in intermediate and high-risk nonmuscle invasive bladder cancer patients could not be shown to be superior to BCG maintenance therapy. Vice versa, the results of this study cannot exclude a superiority of BCG.
Aktuelle Urologie 03/2009; 40(2):91-9. · 0.27 Impact Factor
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ABSTRACT: Immunotherapy for treatment of solid cancer mostly is an experimental treatment. In contrast, intravesical immunotherapy of superficial bladder cancer with bacille Calmette-Guérin (BCG) is clinically well established and accepted worldwide because of better results compared to topical chemotherapy. BCG is currently regarded as the most successful immunotherapy of cancer. Unfortunately the mechanism of action has not yet been fully clarified. This article gives an overview on the complex research on the mechanisms of actionhighly successful therapy.
Der Urologe 06/2006; 45(5):629-33, 635-6. · 0.50 Impact Factor
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ABSTRACT: Immuntherapeutische Anstze zur Bekmpfung solider Tumorerkrankungen haben bislang zumeist nur experimentellen Charakter. Lediglich die intravesikale Immuntherapie mit Bacillus-Calmette-Gurin (BCG) des oberflchlichen Harnblasenkarzinoms stellt die einzige Ausnahme dar, ist sie doch der topischen Chemotherapie klar berlegen und weltweit klinisch etabliert. Daher wird BCG als die zzt. erfolgreichste Immuntherapie angesehen. Der genaue Wirkmechanismus ist jedoch noch nicht vollstndig bekannt. Wir geben hier einen aktuellen berblick zum komplexen Forschungsbereich des Wirkmechanismus dieser Therapie.Immunotherapy for treatment of solid cancer mostly is an experimental treatment. In contrast, intravesical immunotherapy of superficial bladder cancer with bacille Calmette-Gurin (BCG) is clinically well established and accepted worldwide because of better results compared to topical chemotherapy. BCG is currently regarded as the most successful immunotherapy of cancer. Unfortunately the mechanism of action has not yet been fully clarified. This article gives an overview on the complex research on the mechanisms of actionhighly successful therapy.
Der Urologe 01/2006; 45(5):629-636. · 0.50 Impact Factor
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ABSTRACT: Hematogenous spread of BCG after intravesical instillation against bladder cancer is rare, but may result in systemic infection and hypersensitivity reaction. We investigated fluoroquinolones and steroids in an animal model to improve the therapeutic options in local and systemic BCG infection. Furthermore, we tested the antitumor effectiveness of intravesical BCG with simultaneous application of fluoroquinolones and/or steroids.
After systemic BCG infection, experiments were performed with quinolones as antimicrobial agent. Trimethoprim/sulfamethoxazole (TMS) was also tested in comparison to quinolones as a non-specific antimicrobial agent. To evaluate the hyperergic reaction after repeated BCG infection (hypersensitivity model), re-infection was performed seven days after primary infection with accompanying oral antimicrobial therapy with and without steroids. Intravesical tumor therapy was carried out with BCG in orthotopic murine bladder tumor model MB 49 together with simultaneous antimicrobial therapy.
After primary infection, quinolones led to a significant prolonged survival independent of steroid administration. Steroids alone after primary BCG infection reduced the survival. In contrast to these experiments, only steroid-treated mice had a significant improvement in survival after a second challenge with BCG. Therapeutic efficacy of BCG was not affected by antibacterial therapy with quinolones. Steroids alone induced a significantly increased death rate during intravesical BCG therapy.
Quinolones have a positive effect on survival in acute systemic BCG infection in mice. Re-infection with BCG led to severe hyperergic reaction that can only be influenced by steroids. Thus, quinolones can be used in primary systemic BCG infection after topical application as a sufficient alternative to common tuberculostatics. Repeated BCG instillation may lead to hyperergic reaction, making additional administration of steroids essential. In this animal model, therapeutic efficacy of BCG obviously was not affected by additional administration of antimicrobials.
Aktuelle Urologie 10/2004; 35(5):406-12. · 0.27 Impact Factor
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ABSTRACT: The Ki-67 antigen is only present in proliferating cells. We have shown previously that phosphorothioate-modified antisense oligonucleotides (ON) against this antigen are potent antitumoral agents in bladder and prostate cancer-derived cells. Since ON are known to accumulate in vivo in the kidney, high local effectivity may be expected. Here, we evaluated and characterized antitumoral effects in an orthotopic renal cell cancer (RENCA) model.
RENCA cells were incubated with antisense and control ON in the presence of a cationic lipid. Uptake studies were performed with FITC-labeled ON. Ki-67 protein analysis after ON treatment was performed by immunohistochemical staining. For animal studies, 1 x 10(5) RENCA cells were implanted under the renal capsule of Balb/c mice. Antisense and control ON were injected intraperitoneally daily for 14 days. Tumor weights and status of metastasis were documented after sacrifice. Furthermore, vessel density in tumor tissues was determined by CD31 immunolabeling.
Antisense treatment of RENCA cells resulted in specific reduction of the Ki-67 protein and inhibition of cell growth. A substantial cellular uptake of labeled ON was noted in vitro and in vivo. The growth of orthotopically implantated syngeneic kidney tumors in immunocompetent mice was significantly inhibited in antisense-treated animals (p < 0.05). Furthermore, lung metastases were noted in 10% of antisense-treated animals compared to 30-40% in control groups. Immunohistochemical staining of the vessel density showed no significant difference among treatment groups.
The results demonstrate that Ki-67-directed antisense oligonucleotides are potent inhibitors of target protein expression and proliferation of tumor cells in vitro, and of tumor growth and lung metastasis formation in murine renal cell carcinoma whereas tumor vascularization is not significantly affected.
European Urology 07/2004; 46(1):118-24; discussion 124-5. · 8.49 Impact Factor
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ABSTRACT: To compare the therapeutic efficacy of intravesical bacille Calmette-Guérin (BCG) with mitomycin C (MMC) on progression of Stage Ta and T1 bladder carcinoma.
Combined published and unpublished data from comparative studies on BCG versus MMC in superficial bladder carcinoma were analyzed, considering possible confounding factors. Odds ratios (ORs) and 95% confidence intervals (CIs) were used as the primary effect size estimate. Tumor progression was defined as progression to a higher tumor stage or the development of metastatic disease.
In nine eligible clinical trials, 1277 patients were treated with BCG and 1133 with MMC. Within the overall median follow-up of 26 months, 7.67% of the patients in the BCG group and 9.44% of the patients in the MMC group developed tumor progression. In all nine individual studies and in the combined results, no statistically significant difference in the ORs for progression between the BCG and MMC-treated groups was found (combined OR = 0.77; 95% CI 0.57 to 1.03; P = 0.081). In the subgroup with BCG maintenance, the combined result of the five individual studies showed a statistically significant superiority of BCG over MMC (OR = 0.66; 95% CI 0.47 to 0.94; P = 0.02). In the four studies without BCG maintenance, the combined result indicated no statistically significant difference between the two treatments (OR = 1.16; 95% CI 0.65 to 2.07; P = 0.612). Potential confounders, such as tumor risk status, duration of follow-up, BCG strain, BCG and MMC treatment regimen, and year of publication did not significantly influence these results.
The results demonstrated statistically significant superiority for BCG compared with MMC for the prevention of tumor progression only if BCG maintenance therapy was provided.
Urology 05/2004; 63(4):682-6; discussion 686-7. · 2.43 Impact Factor
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ABSTRACT: CA 19-9 is a tumor marker of pancreatic and gastrointestinal cancer. Elevation in nonmalignant disease is rare. The case of a patient with a partial staghorn calculus, giant hydronephrosis, and elevated CA 19-9 serum levels is presented. Open transperitoneal right-sided nephrectomy was performed. In immunohistochemical analysis, CA 19-9 was expressed in the renal tubular epithelium and the renal pelvis. During postoperative follow-up, the CA 19-9 levels returned to normal. Hydronephrosis might cause false-positive results when CA 19-9 measurement is used to screen for malignant disease. Posttreatment CA 19-9 levels of patients with hydronephrosis have to be monitored closely to safely exclude malignant disease.
Urology 03/2004; 63(2):381-2. · 2.43 Impact Factor
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ABSTRACT: Antisense oligonucleotides are short DNA sequences designed to modulate the information transfer from gene to protein. Sequence-related hybridisation with the mRNA of a specific protein results in selective inhibition of gene expression and downregulation of protein expression. This allows the study of gene function and therapy on a molecular level. Antisense oligonucleotide inhibitors can be designed directly from genomic sequence information by simply making the reversed complement of the desired sequence. In this review, we focus on the mechanisms of action of antisense oligonucleotides and summarize the progress in urological antisense therapy. The ability to inhibit individual gene expression with antisense oligonucleotides has been promising in preclinical cancer models. Current clinical studies test antisense compounds targeted against various cancer related genes. Although some of these studies comprise patients with urological tumors, such as advanced prostate cancer, experimental antisense therapy in urology is still in its infancy.
Aktuelle Urologie 01/2004; 34(7):458-68. · 0.27 Impact Factor
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ABSTRACT: Although the current system of classifying bladder cancer by stage and histological grade is very useful, it is still difficult to predict the natural progression of the disease either with or without therapy. Cystoscopy and urine cytology are currently the gold standards in the monitoring and diagnosis of bladder cancer. Classical urine cytology is, however, at least in the diagnosis of G1-tumors, characterized by a relatively low sensitivity. In the last few years, the molecular biological investigation of the basic mechanisms involved in carcinogenesis has provided a host of markers which are of potential diagnostic value for bladder cancer. We provide a current, comprehensive review of the literature on bladder tumor markers and summarize their diagnostic and prognostic potential. At present, no diagnostic marker with a comparable sensitivity and specificity to cystoscopy exists, given that cystoscopy has never been evaluated. The combined analysis of several tumor markers seems to be the most promising approach as an adjunct to cystoscopy. Moreover, the increasing simplification of test systems will increase their acceptance by clinicians.
Der Urologe 08/2003; 42(7):912-21. · 0.50 Impact Factor
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ABSTRACT: Zusammenfassung Obwohl das derzeitige Klassifikationssystem von Harnblasenkarzinomen durch Tumorstadium und -differenzierungsgrad ntzliche Informationen leistet, kann der natrliche Verlauf der Erkrankung mit oder ohne Therapie nur eingeschrnkt prognostiziert werden. Die Zystoskopie und Urinzytologie sind derzeit als "golden standard" in der Diagnostik und berwachung des Harnblasenkarzinoms anzusehen. Die klassische Urinzytologie ist jedoch zumindest beim G1-Karzinom durch eine relativ niedrige Sensitivitt gekennzeichnet und unterliegt einer deutlichen Untersucherabhngigkeit. Durch die Erforschung der molekularbiologischen Grundlagen der Karzinogenese wurde eine Vielzahl potenziell diagnostischer oder prognostischer Marker fr das Harnblasenkarzinom beschrieben. In der vorliegenden bersichtsarbeit wurde die Literatur zu den verschiedenen Tumormarkern des Harnblasenkarzinoms im Hinblick auf deren diagnostische Wertigkeit aktuell und umfassend dargestellt. Unter der Prmisse, dass die Zystoskopie selbst nie evaluiert wurde, besteht zusammenfassend derzeit kein diagnostischer Marker, der eine vergleichbare Sensitivitt und Spezifitt wie die Zystoskopie besitzt und diese ersetzen knnte. Unter den diagnostischen Markern scheint der kombinierte Nachweis mehrerer Tumorantigene als Ergnzung zur Zystoskopie am vielversprechendsten zu sein. Zudem wird die zunehmende Vereinfachung der Testsysteme die Akzeptanz des Klinikers weiter erhhen.
Der Urologe 06/2003; 42(7):912-921. · 0.50 Impact Factor
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ABSTRACT: The fact that urothelial carcinomas (UC)often contain areas with different histologicgrades has been recently shown to bear someprognostic relevance. Here we examined theprognostic significance of a grading systemconsidering tumor heterogeneity inmuscle-invasive bladder carcinomas.151 UC treated by radical cystectomy wereincluded. According to the World HealthOrganization/International Society ofUrological Pathology (WHO/ISUP) classification,histologic grade was low-grade (LG) in 8 andhigh-grade (HG) in 143 cases. 65 HG tumorswhich focally harbored LG areas were assignedto mixed-type (MT) carcinomas. Mean follow-upwas 50 months.While the WHO/ISUP classification showedno significant correlation withdisease-specific survival (p = 0.3995 bylog-rank test), stratification into LG/MT andHG tumors had a significant prognosticrelevance (p = 0.0404). Nodal status wasidentified as the only independent prognosticfactor (p = 0.0001 by multivariate analysis).In this respect, stratification into LG/MT andHG tumors missed the level of statisticalsignificance by a norrow margin (p = 0.07 bymultivariate analysis), but it turned outbetter than tumor category (p = 0.08).In conclusion, a grading systemconsidering tumor heterogeneity may improve thepredictive power of the WHO/ISUP classificationin muscle-invasive UC of the urinary bladder.Although the two-tired grading system proposedin this study was not identified as anindependent prognostic factor, it may help toobtain additional prognostic information onpatients with advanced bladder cancer treatedby radical cystectomy.
International Urology and Nephrology 05/2003; 35(2):169-173. · 1.47 Impact Factor
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ABSTRACT: The fact that urothelial carcinomas (UC) often contain areas with different histologic grades has been recently shown to bear some prognostic relevance. Here we examined the prognostic significance of a grading system considering tumor heterogeneity in muscle-invasive bladder carcinomas. 151 UC treated by radical cystectomy were included. According to the World Health Organization/International Society of Urological Pathology (WHO/ISUP) classification, histologic grade was low-grade (LG) in 8 and high-grade (HG) in 143 cases. 65 HG tumors which focally harbored LG areas were assigned to mixed-type (MT) carcinomas. Mean follow-up was 50 months. While the WHO/ISUP classification showed no significant correlation with disease-specific survival (p = 0.3995 by log-rank test), stratification into LG/MT and HG tumors had a significant prognostic relevance (p = 0.0404). Nodal status was identified as the only independent prognostic factor (p = 0.0001 by multivariate analysis). In this respect, stratification into LG/MT and HG tumors missed the level of statistical significance by a norrow margin (p = 0.07 by multivariate analysis), but it turned out better than tumor category (p = 0.08). In conclusion, a grading system considering tumor heterogeneity may improve the predictive power of the WHO/ISUP classification in muscle-invasive UC of the urinary bladder. Although the two-tired grading system proposed in this study was not identified as an independent prognostic factor, it may help to obtain additional prognostic information on patients with advanced bladder cancer treated by radical cystectomy.
International Urology and Nephrology 02/2003; 35(2):169-73. · 1.47 Impact Factor
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ABSTRACT: We compare the therapeutic efficacy and toxicity of intravesical bacillus Calmette-Guerin (BCG) with mitomycin C on recurrence of stages Ta and T1 bladder carcinoma.
Combined published and unpublished data from comparative studies on BCG versus mitomycin C for superficial bladder carcinoma considering possible confounding factors were analyzed. Odds ratio (OR) and its 95% CI were used as primary effect size estimate. Toxicity data were evaluated descriptively.
In 11 eligible clinical trials 1,421 patients were treated with BCG and 1,328 were treated with mitomycin C. Within the overall median followup time of 26 months 38.6% of the patients in the BCG group and 46.4% of those in the mitomycin C group had tumor recurrence. In 7 of 11 studies BCG was significantly superior to mitomycin C, in 3 studies no significant difference was found, while in 1 study mitomycin C was significantly superior to BCG. An overall statistically significant superiority of BCG versus mitomycin C efficacy in reducing tumor recurrence was detected (OR 0.56, 95% CI 0.38 to 0.84, p = 0.005). In the subgroup treated with BCG maintenance all 6 individual studies showed a significant superiority of BCG over mitomycin C (OR 0.43, 95% CI 0.35 to 0.53, p <0.001). In 4 of the 5 studies with reported data on toxicity BCG associated cystitis was significantly more frequent than in the mitomycin C group (53.8% versus 39.2%). The combined cystitis OR was 1.81 (95% CI 1.48 to 2.23, p <0.001). The OR for cystitis in the BCG maintenance group did not significantly differ from that in the nonmaintenance therapy group.
The results suggest superiority of BCG over mitomycin C for prevention of tumor recurrences in the combined data and particularly in the BCG maintenance treatment subgroup, irrespective of the actual (intermediate or high) tumor risk status. The toxicity with BCG is higher but does not differ between BCG maintenance and nonmaintenance groups.
The Journal of Urology 01/2003; 169(1):90-5. · 3.75 Impact Factor
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ABSTRACT: Antisense oligonucleotides are short modified DNA or RNA molecules designed to bind selectively messenger RNA and inhibit synthesis of the encoded protein. In the last 20 years antisense technology has emerged as an exciting and promising strategy, especially for treating cancer. We provide urologists with a contemporary review of relevant background information and outline current treatment strategies and clinical trials of antisense oligonucleotide therapy for urological tumors.
We comprehensively reviewed the literature, including PubMed and recent abstract proceedings from international meetings, on preclinical and clinical studies of antisense oligonucleotide therapy in urology.
Current preclinical antisense strategies in urological cancer research include the inhibition of proliferation and induction of tumor cell differentiation, reversal of immunosuppression by tumor secreted molecules and induction of apoptosis. The use of phosphorothioate oligonucleotides as antisense agents has shown promising results in various preclinical cancer models. In recent and current clinical trials in patients with urological tumors antisense agents targeted against c-raf kinase, protein kinase C-alpha, protein kinase A and bcl-2 are being evaluated.
Many compounds have achieved convincing in vitro reduction of target messengerRNA and protein expression. Early clinical trials show safety and mild toxicity at the given doses. Overall the current state of antisense oligonucleotide research described promises a highly productive future for this technology. However, for most medical applications of antisense compounds many obstacles related to nuclease stability, affinity, cellular delivery and specificity remain to be clarified.
The Journal of Urology 08/2002; 168(1):239-47. · 3.75 Impact Factor
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ABSTRACT: A presumed reason for the high recurrence rate of superficial bladder cancer after transurethral tumor resection is the reimplantation of tumor cells. Because tumor cell adhesion to the extracellular matrix is mediated by integrin molecules, we tested specific integrin receptor blocking oligopeptides to prevent this mechanism.
An in vitro cell adherence assay with various bladder cancer cell lines and extracellular matrices, including fibronectin, collagen type I, laminin and combinations, was used to analyze the inhibition of tumor cell adhesion by the matrix specific oligopeptides GRGDS, DGEA and EILDV. In therapeutic in vivo experiments the orthotopic murine bladder tumor model MB49 was used. The ability of oligopeptides to interfere with tumor cell adhesion and consecutive tumor outgrowth was evaluated and compared with that of nonspecific peptides, commercially available irrigation fluid and single dose epirubicin chemotherapy.
In vitro fibronectin specific oligopeptides showed a concentration dependent inhibition of tumor cell adherence to fibronectin, whereas adhesion to laminin, collagen and combined matrices was not inhibited. In contrast, combinations of integrin receptor blocking oligopeptides were highly active. In vivo local tumor take was not affected by irrigation fluid, nonspecific peptides or monospecific oligopeptides alone, whereas the combination of the 3 oligopeptides effectively inhibited tumor outgrowth.
Combining oligopeptides with various specificities significantly inhibited tumor cell adhesion and tumor outgrowth. Application of this principle in a clinical setting may be an effective method for reducing the recurrence rate of superficial bladder cancer.
The Journal of Urology 02/2002; 167(1):357-63. · 3.75 Impact Factor
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ABSTRACT: The current pathological and clinical parameters provide important prognostic information, yet still have limited ability to predict the true malignant potential of most bladder tumors. In the last years, investigation of the basic mechanisms involved in carcinogenesis and tumor progression by molecular biology has provided a host of markers which are of potential diagnostic or prognostic value for bladder carcinoma. These markers may serve as tools for early and accurate prediction of tumor recurrence, progression and development of metastases and for prediction of response to therapy. The precise prediction of tumor biological behavior would facilitate treatment selection for patients who may benefit from radical surgical treatment or adjuvant therapy. We provide a current, comprehensive review of the literature on bladder tumor markers with a special emphasis on their prognostic potential. The literature suggests that currently no single marker is able to accurately predict the clinical course of bladder tumors and thus would serve as a reliable prognosticator. A combination of prognostic markers could predict which superficial tumors need an aggressive form of therapy and which invasive tumors require adjuvant therapy. Altogether, the most promising markers are, at this point, Ki-67 and p53 expression as well as matrixmetalloproteinase complex and angiogenesis.
European Urology 02/2002; 41(1):15-29. · 8.49 Impact Factor
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ABSTRACT: In recent studies, a crucial role for IFN-gamma in immunosurveillance of tumours and in IL-12 immunotherapy has been suggested. Nevertheless, little is known about the relevance of IFN-gamma and IL-12 for tumour surveillance in noncytokine immunotherapy. Adjuvant immunotherapy with viable BCG (Bacillus Calmette--Guérin) is considered to be the most powerful clinical treatment regimen of bladder cancer and is known to induce a variety of proinflammatory cytokines. Consequently, we analysed the antitumour response of IFN-gamma knockout (KO), IL-12 KO and IL-10 KO mice in the absence and presence of BCG immunotherapy in a syngeneic orthotopic model of bladder cancer. IFN-gamma KO and IL-12 KO mice died much earlier and by far smaller tumour inocula compared to wildtype mice, while this intrinsic antitumour response was not altered in IL-10 KO mice. BCG immunotherapy was effective in wildtype mice, but totally ineffective in IFN-gamma KO and IL-12 KO mice. BCG induced a massive local immune response in the bladder of treated animals. This response was markedly increased in IL-10 KO mice, which coincides with increased therapeutic efficacy in this mouse strain compared with wildtype mice. Our data establish a crucial role for a Th1 type immune response in the intrinsic and immunotherapeutic control of local orthotopic bladder cancer.
Clinical & Experimental Immunology 02/2002; 127(1):20-6. · 3.36 Impact Factor
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ABSTRACT: Radiotherapy of bladder cancer is a locally effective therapeutic approach. It is increasingly becoming part of the multimodal protocols aimed at the preservation of both organ and organ function. In this context, it is an alternative to cystectomy. The addition of chemotherapy to radiotherapy enhances the curative potential of this non-surgical approach and may be useful especially in older, multimorbid patients. If chemotherapy can not be applied, the use of radiotherapy alone is reasonable, although in advanced tumors the results are disappointing. After the transurethral resection of bladder cancer, postoperative radiotherapy should be considered in muscle-invasive cancer as well as when other negative prognostic factors occur. The prerequisites for an effective, minimally toxic, state of the art radiotherapy are a subtle treatment-planning procedure and an accurate delivery of the radiation.
Der Urologe 10/2001; 40(5):376-9. · 0.50 Impact Factor
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ABSTRACT: Radical cystectomy is the current standard therapy for muscle invasive or locally advanced transitional cell carcinoma of the bladder. Organ-preserving monotherapeutic alternatives (e.g. transurethral resection, radiotherapy) do not lead to similar cure rates. In selected cases, a trimodal approach using transurethral resection and combined radio- and chemotherapy can be as efficient as cystectomy.
Der Urologe 10/2001; 40(5):380-3. · 0.50 Impact Factor
