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🌱 來自: bladder cancer

management of nonmuscle invasive disease

• Depends on T stage & grade:
  • TURBT,
  • followed by either observation for low risk,
  • or intravesical therapy w/ BCG or chemo (mitomycin or gemcitabine)
    • (Eur Urol 2021;79(4):480; J Urol 2005;174(1):86; JNCI 2001;93(8):597)
• Strongly consider reresection if no muscle in TURBT specimen for accurate staging
• The majority (50-80%) of nonmuscle invasive dz will recur if treated by TURBT alone,
  • with a proportion (20-25%) progressing to more invasive dz
• Cystectomy considered for residual T1,
  • high-grade or muscle-invasion at reresection
• BCG:
  • Unknown exact MOA,
  • but triggers local immune response,
  • given weekly × 6 wks followed by maintenance for 1-3 y
    • based on risk status for relapse.
• Pembrolizumab:
  • Given IV for pts with BCG-unresponsive CIS ± papillary dz who were ineligible for or declined radical cystectomy (Lancet Onc 2021;22:919-930)
• Surveillance:
  • Cystoscopy & urine cytology ∼3 mos,
  • can be spaced if no recurrent dz