Carcinoma in situ of the bladder: why is it underdetected?
Por:
Subiela, JD, Rodriguez Faba, O, Guerrero-Ramos, F, Aumatell, J, Breda, A, Palou, J
Publicada:
1 may 2020
Resumen:
Purpose of review
The standard diagnosis of carcinoma in situ (CIS) of the bladder, based on white light cystoscopy and urine cytology, is limited because CIS can vary from normal-appearing mucosa to a lesion indistinguishable from an inflammatory process. Intravesical instillation of Bacillus Calmette-Guerin (BCG) remains first-line therapy; however, a significant proportion of cases persist or recur after BCG treatment. This review summarizes recent improvements in the detection and treatment of CIS.
Recent findings
The new optical technologies improve CIS detection, with a potential positive impact on oncological outcomes. The usefulness of MRI-photodynamic diagnosis fusion transurethral resection in CIS detection is unclear and further studies are needed. BCG instillation remains the first-line therapy in CIS patients and seems to improve recurrence and progression rates, especially with the use of maintenance. Intravesical device-assisted therapies could be effective in both BCG-naive and BCG-unresponsive CIS patients, but further studies are ongoing to clarify their clinical benefit. A phase II clinical trial with pembrolizumab has shown the potential effectiveness of immune checkpoint inhibitors in BCG-unresponsive CIS patients and further trials are ongoing.
Summary
New optical techniques increase the CIS detection rate. BCG instillation remains the first-line treatment. Immune checkpoint inhibitors could be a future alternative in BCG-naive and BCG-unresponsive CIS patients.
Filiaciones:
Subiela, JD:
Univ Autonoma Barcelona, Oncol Urol Unit, Dept Urol, Fundacio Puigvert, Carrer Cartagena 340-350, Barcelona 08025, Spain
Rodriguez Faba, O:
Univ Autonoma Barcelona, Oncol Urol Unit, Dept Urol, Fundacio Puigvert, Carrer Cartagena 340-350, Barcelona 08025, Spain
Guerrero-Ramos, F:
Univ Hosp 12 Octubre, Oncol Urol Unit, Dept Urol, Madrid, Spain
Aumatell, J:
Univ Autonoma Barcelona, Oncol Urol Unit, Dept Urol, Fundacio Puigvert, Carrer Cartagena 340-350, Barcelona 08025, Spain
Breda, A:
Univ Autonoma Barcelona, Oncol Urol Unit, Dept Urol, Fundacio Puigvert, Carrer Cartagena 340-350, Barcelona 08025, Spain
Palou, J:
Univ Autonoma Barcelona, Oncol Urol Unit, Dept Urol, Fundacio Puigvert, Carrer Cartagena 340-350, Barcelona 08025, Spain
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