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Clinical Scenario: Persistent CIS and High-Grade Ta Bladder Cancer After BCG

Clinical history: 79-Year-old man who has a persistent CIS despite induction and maintenance BCG for 6 months

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Management of Bladder Cancer

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Abstract

The standard treatment for Ta-T1 high-grade (G3) TCC of the bladder and CIS is TUR followed by BCG full dose once a week for 6 weeks and then at month 3, 6, 12, 18, 24, 30, 36 according to the SWOG schedule.

The efficacy of adjuvant immunotherapy in the elderly has been discussed and questioned. A reduced activity of BCG has been reported due to the impairment of the immune-system response than in patients more than 75 years of age.

When a patient with CIS presents with a recurrence during BCG therapy it can be called BCG failure. The therapy of patients with CIS who experienced a BCG failure is radical cystectomy, according to international guidelines. However, in elderly patients with co-morbidities unfit or refusing surgery a conservative treatment can be adopted.

Chemotherapy with MMC and hyperthermia (Synergo) once a week for 6 weeks should be the first choice. A second option for these patients with recurrent CIS is the administration of Gemcitabine high dose (2,000 mg a week) for 6 weeks.

Finally, INF-alfa with BCG has shown efficacy in these patients.

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Authors and Affiliations

  1. Department of Urology Ausl Modena, B. Ramazzini Hospital, Via G.Molinari 1, Carpi-Modena, 41012, Italy

    Maurizio Brausi

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  1. Maurizio Brausi
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Correspondence to Maurizio Brausi .

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Editors and Affiliations

  1. Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA

    Badrinath R. Konety

  2. Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA

    Sam S. Chang

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Brausi, M. (2015). Clinical Scenario: Persistent CIS and High-Grade Ta Bladder Cancer After BCG. In: Konety, B., Chang, S. (eds) Management of Bladder Cancer. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1881-2_21

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  • DOI: https://doi.org/10.1007/978-1-4939-1881-2_21

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1880-5

  • Online ISBN: 978-1-4939-1881-2

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