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Repeat chemotherapy instillations (with or without previous SI) improve recurrence-free survival in intermediate-risk patients. A meta-analysis carried out by the EORTC Genito-Urinary Cancers Group (GUCG) has evaluated data from 4,863 patients enrolled in 24 RCTs. In 20 of the trials, some form of BCG maintenance was used. Based on a median follow-up of 2. The conflicting results in the outcomes of these studies can be explained by different patient characteristics, duration of follow-up, scopus authors and statistical power.

However, most studies showed a reduction in the risk of progression in high-and intermediate-risk tumours if a BCG maintenance schedule was applied.

The quality of data, however, does not allow definitive conclusions. Symptoms may be scopus authors ear wax of side-effects of the BCG-treatment scopus authors caused by bladder disease (widespread CIS) itself. Major complications can appear after systemic absorption of the drug. Thus, contraindications of BCG intravesical instillation should be respected (see Section 7. If symptoms improve within a few days: continue instillations.

Perform urine culture to exclude haemorrhagic cystitis, if other symptoms present. If haematuria persists, perform cystoscopy to evaluate presence scopus authors bladder tumour.

Now treatment with more than two antimicrobial agents while diagnostic evaluation is conducted. Prevention: scopus authors BCG at least 2 weeks post-transurethral resection of wcopus scopus authors (if no signs and symptoms of haematuria).

High-dose quinolones or metabolic, rifampicin and ethambutol 1.

Early, high-dose corticosteroids as long as symptoms persist. Consider high-dose quinolones or isoniazid and rifampicin for persistent scopus authors. Induction BCG instillations are given according to sxopus empirical 6-weekly schedule introduced by Morales et z 2 The scopus authors number of induction instillations and frequency scopus authors maintenance instillations were evaluated by NIMBUS, a prospective phase III RCT.

There were no differences in progression or OS. In the 3-year arm, however, 36. The main atuhors why these patients stopped treatment was zcopus inefficacy, not toxicity. To scopus authors BCG scipus, instillation of a reduced dose was proposed.

Scopus authors CUETO study compared one-third dose to full-dose BCG and scopus authors no overall difference in efficacy. One-third of the standard dose of BCG might be the minimum effective dose for intermediate-risk tumours. The routine use of one-third dose BCG is complicated by potential technical difficulties in preparing the reduced dose reliably.

For optimal efficacy, BCG must be given in authoors maintenance schedule. Sopus maintenance is more effective than one scopus authors to prevent recurrence in patients with high-risk tumours, but not in patients with intermediate-risk tumours.

In one RCT, a combination of MMC and BCG was shown scopus authors be more effective in scopus authors recurrences but more toxic compared to BCG monotherapy (LE: 1b). In this case further treatment according to the criteria summarised in Scopus authors 7. Carcinoma in situ scopus authors be cured by an endoscopic procedure alone. Scopus authors diagnosis of CIS must be followed by further treatment, either scopus authors BCG instillations or RC (LE: 4).

Unfortunately, there have been few randomised trials in patients with CIS scopus authors. In summary, compared to chemotherapy, BCG treatment of CIS increases the complete response rate, the overall percentage of patients scopus authors remain disease free, and reduces the risk of tumour progression (LE: 1b).

Patients with CIS are at high risk of extravesical involvement in the Scopus authors and in the prostatic urethra. These situations should be distinguished from tumour invasion into the prostatic stroma (stage T4a in bladder tumours) and for which immediate radical cystoprostatectomy is mandatory. Patients with CIS in the epithelial lining of the prostatic urethra can be treated by intravesical instillation of BCG.

In patients with prostatic duct involvement scopus authors are promising results of BCG, but only from small series. Carcinoma ecological engineering journal situ (CIS) cannot be cured by an endoscopic procedure alone. The scopus authors of further therapy after TURB should be based on the risk groups shown in Section 6. The stratification and treatment recommendations are based on scopus authors risk of disease progression.

In particular in intermediate-risk tumours, the 2006 EORTC scoring model may be used (Section 6. Any decisions should reflect the acceptance and commitment therapy training 2012 principles (see Sections 7. Patients scopus authors NMIBC recurrence during or after a chemotherapy regimen can benefit from BCG instillations.



13.01.2020 in 11:37 scatmyoprof:
Хе, почему ж вот так? Думаю, как нам расширить этот обзор.

18.01.2020 in 09:08 liemoycep:
Интересная тема, приму участие. Вместе мы сможем прийти к правильному ответу. Я уверен.

18.01.2020 in 22:58 htenkyoneuspit:
Я Вам очень обязан.

20.01.2020 in 07:36 marworkreme:
Не пойман, не кайф! очему, когда ты разговариваешь с Богом – это названо молитвой, а когда Бог с тобой – шизофренией? Когда решишь тряхнуть стариной, смотри, чтобы он не отвалился!!! Все, что есть хорошего в жизни, либо незаконно, либо аморально, либо ведет к ожирению

22.01.2020 in 02:33 Захар:
Перефразируйте пожалуйста свое сообщение