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Journal Information
Vol. 46. Issue 10.
Pages 613-618 (December 2022)
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Vol. 46. Issue 10.
Pages 613-618 (December 2022)
Original article
Surveillance and office management of low-grade Ta bladder tumors
Vigilancia y manejo en consulta de los tumores de vejiga Ta de bajo grado
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S.D. Lokeshwara,
Corresponding author
soumlokeshwar@gmail.com

Corresponding author.
, S.N. Rahmana, B.H. Pressa, A.I. Khana, M.S. Solowayb
a Department of Urology, Yale University, New Haven, CT, USA
b Urologic Oncology, Memorial Physician Group, Division of Urology, Memorial Healthcare System, Aventura, FL, USA
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Abstract
Objective

Patients with low-grade (LG), grade 1–2, Ta bladder cancer (BC) will frequently have a “recurrence”. However, they rarely progress in stage. Although current guidelines mention surveillance and office management for these new or recurrent tumors, transurethral resection (TURBT) is the most common treatment. The purpose of this study is to determine if surveillance and/or office cautery is safe.

Materials and methods

This study was conducted as a retrospective case series analysis of 45 patients who had recurrent LG Ta appearing bladder cancer (BC) and were managed primarily with surveillance and/or office cautery. Patients with carcinoma in-situ were excluded. The primary outcome was stage progression.

Results

Median follow up was 62 months. 41 (91%) patients did not progress in stage. Three patients recurred with HG T1 BC; one is receiving systemic immunotherapy. One patient developed HG T2 BC and was treated with a bladder preservation protocol. 40 (89%) patients underwent office cauterization. Eleven received BCG and 26 received post-cautery intravesical chemotherapy. Five (11%) patients developed HG BC during follow up. No patients died. None of the 17 (38%) Hispanic patients had progression.

Conclusions

Active surveillance and/or office cautery for patients with small recurrent LG Ta bladder tumors is safe, reduces cost and improves quality of life by avoiding TURBTs.

Keywords:
Bladder cancer
Cauterization
Active surveillance
Office management
Resumen
Objetivo

Los pacientes con cáncer de vejiga (CV) Ta, de grado bajo (GB) 1–2, presentarán con frecuencia una “recidiva”, aunque rara vez una progresión a un estadio más avanzado. Si bien las directrices actuales mencionan la vigilancia y el manejo en consulta para estos tumores nuevos o recurrentes, la resección transuretral (RTUV) es el tratamiento realizado con mayor frecuencia. El objetivo de este estudio es determinar la seguridad de la vigilancia y/o la cauterización ambulatoria.

Materiales y métodos

Este estudio se llevó a cabo como un análisis retrospectivo de una serie de casos de 45 pacientes que tenían cáncer de vejiga ( CV) recurrente con apariencia de GB Ta y que fueron tratados principalmente con vigilancia y/o cauterización en la consulta. Se excluyeron los pacientes con carcinoma in situ. La variable de valoración principal fue la progresión a un estadio más avanzado.

Resultados

La mediana de seguimiento fue de 62 meses. En 41 (91%) pacientes no hubo progresión del estadio. Tres pacientes recidivaron con CV GA T1; uno de ellos está recibiendo inmunoterapia sistémica. Un paciente desarrolló un CV GA T2 y fue tratado con un protocolo preservador de la vejiga. A 40 (89%) pacientes se les realizó cauterización en consulta. Once recibieron BCG y 26 recibieron quimioterapia intravesical tras la cauterización. Cinco (11%) pacientes desarrollaron CV GA durante el seguimiento. Ningún paciente falleció. Ninguno de los 17 (38%) pacientes hispanos tuvo progresión.

Conclusiones

La vigilancia activa y/o la cauterización ambulatoria para pacientes con tumores vesicales pequeños GB Ta es segura, reduce costes y mejora la calidad de vida al evitar las RTU.

Palabras clave:
Cáncer de vejiga
Cauterización
Vigilancia activa
Manejo ambulatorio

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