The conundrum of recurrent low-grade tumours: to treat or to observe?
Curr Opin Urol
; 28(6): 557-562, 2018 11.
Article
em En
| MEDLINE
| ID: mdl-30239413
ABSTRACT
PURPOSE OF REVIEW To describe the importance of risk stratification and the role of more conservative management like office fulguration, office laser ablation and active surveillance in recurrent low-grade Ta tumours. RECENT FINDINGS:
Updated models have been designed for risk stratification of intermediate-risk tumours. Conservative forms of management like office fulguration or laser ablation and even active surveillance seem well tolerated; however, randomized, controlled trials are lacking. In patients who have been tumour free for 5 years, late recurrences have been described.SUMMARY:
Recurrent low-grade Ta tumours are classified in the intermediate risk group, which is a heterogeneous group. Therefore, risk stratification should be done by updated models or patients should be stratified in a risk group sub-classification. Recurrent low-grade Ta patients have a favourable prognosis and consequently are prone to overtreatment. Office fulguration or laser ablation or even active surveillance could be implemented in strictly selected patients. For active surveillance, Miyake et al. proposed a helpful flowchart with criteria for patient selection and for intervention. Follow up using cystoscopy and cytology is essential, but an optimal scheme has not been identified. As late recurrences are not infrequent and recurrent low-grade Ta patients can even die from bladder cancer, long term follow-up should be performed yearly, by cystoscopy and cytology.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Neoplasias da Bexiga Urinária
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Carcinoma de Células de Transição
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Recidiva Local de Neoplasia
Tipo de estudo:
Clinical_trials
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Etiology_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Humans
Idioma:
En
Ano de publicação:
2018
Tipo de documento:
Article