Search

Background/Aim: To develop an instrument that could estimate the 1-year survival probabilities of patients irradiated for recurrent carcinoma of the bladder. Patients and Methods: Thirty patients irradiated for locally recurrent bladder carcinoma were included. Six pre-treatment factors [age, gender, Karnofsky score (KPS), pack years, grading and time between cancer diagnosis and radiotherapy] were evaluated for survival. Of those factors showing a trend or significance on multivariate analysis, 1-year survival rates were added. Results: On multivariate analysis, KPS was significant (hazard ratio(HR)=3.76, p=0.008), age showed a trend (HR=2.04, p=0.13). Patient scores were five, nine, ten or fourteen points with 1-year survival rates of 13%, 25%, 57% and 82% (p=0.003). Three groups were designed, A (5-9 points), B (10 points) and C (14 points) with 1-year survival rates of 17%, 57% and 82% (p=0.001). Conclusion: This score, including three groups with different 1-year survival probabilities, can aid physicians treating patients with recurrent bladder carcinoma.

Aim: A small number of studies evaluated the detection rate of lesions from bladder carcinoma (BC) of 18F-FDG PET/CT in the restaging process. However, the prognostic role of FDG PET/CT still remains unclear. The aim of the present study was to evaluate the accuracy, the effect upon treatment decision, and the prognostic value of FDG PET/CT in patients with suspected recurrent BC. Materials and Methods: Forty-one patients affected by BC underwent FDG PET/CT for restaging purpose. The diagnostic accuracy of visually interpreted FDG PET/CT was assessed compared to histology (n = 8), other diagnostic imaging modalities (contrast-enhanced CT in 38/41 patients and MRI in 15/41) and clinical follow-up (n = 41). Semiquantitative PET values (SUVmax, SUVmean, SUL, MTV, TLG) were calculated using a graph-based method. Progression-free survival (PFS) and overall survival (OS) were assessed by using Kaplan-Meier curves. The risk of progression (hazard ratio, HR) was computed by Cox regression analysis by considering all the available variables. Results: PET was considered positive in 21 of 41 patients. Of these, recurrent BC was confirmed in 20 (95%). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FDG PET/CT were 87%, 94%, 95%, 85%, 90%. AUC was 0.9 (95 %IC 0.8-1). Bayesian positive and negative likelihood ratios were 14.5 and 0.13, respectively. FDG PET/CT findings modified the therapeutic approach in 16 patients (modified therapy in 10 PET-positive patients, watch-and-wait in six PET-negative patients). PFS was significantly longer in patients with negative scan vs. those with pathological findings (85% vs. 24%, p < 0.05; HR = 12.4; p = 0.001). Moreover, an unremarkable study was associated with a longer OS (88% vs. 47% after 2years and 87% vs. 25% after 3 years, respectively, p < 0.05). Standardized uptake value (SUV)max > 6 and total lesion glycolysis (TLG) > 8.5 were recognized as the most accurate thresholds to predict PFS (2-year PFS 62% for SUVmax < 6 vs. 15% for SUVmax > 6, p = 0.018; 2-year PFS 66% for TLG < 8.5 vs. 18% for TLG > 8.5, p = 0.09). Conclusion: A very good diagnostic performance for FDG PET/CT was confirmed in patients with suspected recurrent BC. FDG PET/CT allowed for a change in treatment decision in about 40% of cases and showed an important prognostic value in assessing PFS and OS.

Secondary perineal herniation of intraperitoneal contents represents a rare complication following procedures such as abdominoperineal rectal resection or cystectomy. We present a case of a perineal hernia formation with prolapse of an ileum neobladder following radical cystectomy and rectal resection for recurrent bladder cancer. Following consecutive resections in the anterior and posterior compartment of the lesser pelvis, the patient developed problems emptying his neobladder. Clinical examination and computed tomography revealed perineal herniation of his neobladder through the pelvic floor. Through a perineal approach, the hernial sac could be repositioned, and via a combination of absorbable and non-absorbable synthetic mesh grafts, the pelvic floor was stabilised. Follow-up review at one year after hernia fixation showed no signs of recurrence and no symptoms. In cases of extensive surgery in the lesser pelvis with associated weakness of the pelvic compartments, meshes should be considered for closure of the pelvic floor. Development of biological meshes with reduced risk of infection might be an interesting treatment option in these cases.

Background The long-term prospective data on bacillus Calmette-Guerin (BCG) and mitomycin C (MMC) instillation therapy are limited. Objective To compare the long-term benefit of BCG and MMC maintenance therapy in patients with recurrent bladder carcinoma. Design, setting, and participants Eighty-nine patients with frequently recurrent TaT1 disease without carcinoma in situ (CIS) were eligible. Originally, the patients were enrolled in the prospective FinnBladder I study between 1984 and 1987 and randomised to receive BCG or MMC. Both regimens involved five weekly instillations, followed by monthly instillations for 2 yr. Because of alkalinising the urine and adjusting the dose to bladder capacity, the average concentration of MMC was low: 30–40mg in 150–200ml of phosphate buffer. Overall median follow-up time was 8.5 yr, whereas the median follow-up time of the patients who were still alive was 19.4 yr. Measurements Primary end points were time to first recurrence and overall mortality. Secondary end points were progression and disease-specific mortality. Results and limitations Thirty-six of 45 patients (80.0%) in the MMC group experienced recurrence in contrast to 26 of 44 patients (59.1%) in the BCG group. This finding was reflected in significantly lower cumulative incidence estimates in the BCG group ( p =0.005). There was a weak trend for fewer progressions ( p =0.1) and cancer-specific deaths ( p =0.2) in the cumulative incidence analysis, as 4 patients versus 10 patients progressed and 4 patients versus 9 patients died from the disease in the BCG group versus the MMC group, respectively. No difference existed in the overall mortality. The study population, however, was too small for conclusive evidence about progression or survival. Conclusions An intensive intravesical BCG immunotherapy results in a sustained and significant long-term reduction in recurrence in frequently recurrent bladder carcinoma. The relatively low progression rate during the long follow-up suggests that it may be difficult to show significant differences in overall mortality with a substantially larger but otherwise similar study population. Trial registration Registration was not considered to be necessary at this stage of the follow-up because the study was initiated as early as 1984 and the last randomisation took place in July 1987, that is, long before the current requirements concerning study registrations were implemented.

BACKGROUND. Detecting recurrent bladder carcinoma early is important because it is a multifocal disease that may affect the bladder mucosa, ureters, urethra, and renal pelvis and is associated with high morbidity and mortality rates. However, specimens from patients who have undergone cystectomy with urinary diversion can be difficult to interpret by cytologic evaluation because they often contain degenerated epithelial cells, histiocytes, acute inflammatory cells, bacteria, and cellular debris. In this retrospective study, the reliability of quantitative digital cytometry (QDC) in conjunction with cytologic evaluation in detecting recurrent disease was determined in these patients. METHODS. In all, 116 specimens were identified from the cytology files from 83 patients who had undergone radical cystectomy with urinary diversion for bladder carcinoma at the study institution between 2002 and 2005; all specimens underwent cytologic evaluation and 105 underwent QDC. Two cytospin slides were prepared for cytologic evaluation and 1 for QDC. At least 100 of the most atypical cells were interactively digitized and evaluated for ploidy, the percentage of proliferating cells, and the percentage of cells with a DNA content greater than 5c. Based on these parameters, the DNA histograms were grouped by pattern: diploid, abnormal diploid, tetraploid, and aneuploid. The cytologic evaluation and QDC results were compared with the clinical follow-up data. RESULTS. In all, 103 specimens were negative for recurrent disease or had atypical cells on cytologic examination and were found to have diploid or abnormal diploid patterns on QDC. None of these cases had clinical evidence of upper urinary tract disease at the time the first specimen was obtained. However, recurrent urothelial carcinoma was found in subsequent conduit specimens from 2 patients. Thirteen specimens from 9 patients were suspicious or positive for malignancy by cytology. Five of these patients had an upper urinary tract recurrence and their specimens were found to be abnormal on cytologic evaluation and QDC, with 15% of cells with a DNA content greater than 5c. CONCLUSIONS. Combined cytologic evaluation and QDC is a reliable method of detecting recurrent disease in patients with urinary diversions and can be used to regularly monitor these high-risk patients. Cancer (Cancer Cytopathol) 2007. © 2007 American Cancer Society.

A proportion of patients under surveillance for recurrent bladder carcinoma with no immediate evidence of bladder tumor recurrence have positive multitarget fluorescence in situ hybridization (FISH; UroVysion, Vysis, Downers Grove, IL) results. The course of these "anticipatory positive" cases and the time to bladder tumor recurrence remains unknown. We followed up 250 patients with urine cytologic results, concurrent multitarget FISH, and cystoscopic examination for recurrent urothelial carcinoma. Of 81 cases (32.4%) with FISH-positive results, tumor recurrence developed in 60 (74.0%). Of 169 (67.6%) FISH-negative cases, recurrent urothelial carcinoma developed in 22 (13.0%). Of 211 patients (84.4%) with negative cystoscopic examination results, 56 (26.5%) had positive FISH results, and in 35 (62.5%) of these patients, recurrent urothelial carcinoma developed. Approximately 27% of patients under bladder carcinoma surveillance without immediate evidence of tumor recurrence will have a positive FISH result, defining the anticipatory positive subset. In about 65% of this anticipatory positive group, recurrent bladder urothelial carcinoma developed within 29 months.

Renal transplant recipients are at increased risk of malignancy and infection. We present the case of a 72-year-old-man with recurrent bladder carcinoma, abdominal aortic aneurysm repair, and end-stage renal failure due to renovascular disease. He received a cadaveric renal allograft into his left iliac fossa, was given cyclosporin A, azathioprine, and prednisolone triple therapy immunosuppression, and had no rejection episodes. He presented four years post-transplantation with a two-year history of intermittent sweats and fevers. Previous episodes had been investigated with no firm diagnosis made. This time he had right iliac fossa pain of three weeks' duration. Examination revealed a tender mass. Investigations showed unchanged graft function, but elevated inflammatory indices. Ultrasonography and computed tomography detailed an infiltrating mass associated with the sigmoid colon, which colonoscopy failed to visualise. At laparotomy a 6-cm tumor was removed, with adherent sigmoid colon and bladder dome. Macroscopically the mass was an abscess, and microscopy found acute and chronic inflammatory giant cells and fibrillary masses suggestive of actinomycosis, with no malignancy. The patient recovered uneventfully on antibiotics. At six months' follow-up, examination, inflammatory markers, and radiographic imaging showed no evidence of recurrence. Twelve months later the patient died of rupture of his proximal abdominal aorta. There was no evidence of recurrence at postmortem examination. We conclude with a brief review of actinomycosis in transplant recipients.

BACKGROUND It has been shown that microsatellite analysis (MA) is able to detect bladder carcinoma in urine. Relatively small groups of patients often with high stage and grade disease were investigated. However, greater than 85% of cystoscopies are performed for follow-up of superficial bladder carcinoma. The authors evaluated this DNA-based method in a group of consecutive patients in follow-up after transurethral resection of superficial disease. METHODS Matched blood and urine samples from 109 patients were obtained before cystoscopy and subjected to MA. The BTA stat test (Bard Diagnostic Sciences, Inc., Redmond, WA) and cytology were used for comparison. RESULTS Sixteen patients were excluded: the DNA was of insufficient quality for 7 patients and leukocyte abundance rendered the result of MA unreliable for 9 patients. For the remaining 93 patients, MA detected 18 of the 24 recurrent tumors. The six undetected tumors were small pTaG1 lesions for which immediate surgery was not necessary. Conversely, 5 of 9 patients with a positive MA and a negative cystoscopy had a tumor recurrence within 6 months after urine collection. In contrast, a recurrence occurred in only 7 of 60 patients who were negative in both MA and cystoscopy (P = 0.006). The MA (74%) appeared more sensitive than the BTA stat test (56%) or urine cytology (22%). CONCLUSIONS Microsatellite analysis is a DNA test in urine that reliably signals the presence of recurrent bladder carcinoma, sometimes even before cystoscopic evidence of the disease. This noninvasive diagnostic tool has the potential to replace cystoscopy in many cases. The authors' results warrant the need for randomized trials. Cancer 2001;92:768–75. © 2001 American Cancer Society.

BACKGROUND Early detection of recurrent transitional cell carcinoma of the bladder (TCC) is important to permit early treatment, which produces maximal preservation of the bladder and maximum survival. METHODS This retrospective cohort study attempted to determine the period of time over which urinary DNA image analysis combined with visual cytology is useful in the early detection of recurrent TCC of the bladder. The authors believe this study is unique in that it measured the effectiveness of this test (image analysis plus visual cytology combined) at varying times before clinical diagnosis of recurrence was made. The cohort was comprised of 175 urologic patients from urologic practices across the U.S. Data, collected between January 1991 and February 1994, included cystoscopy, biopsy, DNA image analysis, and visual cytologic reports. RESULTS Sixty patients in the cohort were found to have active TCC whereas 115 patients had a history of, but no active, disease during the follow-up period. As expected, the sensitivity and specificity of DNA image analysis in combination with visual cytology, and DNA image analysis alone, were greatest when urinary samples were obtained close to the time of diagnosis. In general, the longer the interval from the combined tests to the time of diagnosis, the lower the sensitivity. The combined tests had predictive value up to 3 months prior to clinical diagnosis when any detectable cytologic abnormality was considered positive. At the optimal cutoff points as determined from receiver operating characteristic curves, sensitivity increased when DNA image analysis was supplemented with visual cytology. CONCLUSIONS The combination of DNA image analysis and visual cytology provides a better method for the early detection of recurrent TCC than DNA image analysis alone. This test potentially may be useful in providing information regarding bladder tumor recurrence up to 3 months prior to clinical evidence of disease. Cancer 1998;82:1738-48. © 1998 American Cancer Society.

Most of recurrent bladder carcinoma after partial cystectomy did not cause diagnostic difficulties for urologists, because of the appearance of typical papillary in ultrasonography or cystoscopy, and could be easily confirmed by tumor biopsy. Three patients, ages from 35 to 62 years, had undergone bladder sparing treatment for muscle invasive bladder cancer, all of them had biopsy revealed benign bladder lesion at surveillance cystoscopy. However, transurethral resection of bladder tumor showed high-grade muscle invasive urothelial bladder carcinoma for these patients. Two patients were thus delayed for timely cystectomy and consequently resulted in local or distal metastasis. As a result, we recommended that timely pelvic enhanced computed tomography and transurethral resection of bladder tumor were necessary when bladder lesion occurred after partial cystectomy, avoiding the possibility of missing muscle invasive urothelial bladder carcinoma recurrence and delaying timely cystectomy.

BACKGROUND The urinary concentration of soluble cytokeratin 19 fragments, measured by the CYFRA 21-1 assay, may be used for the noninvasive, early detection of bladder carcinoma. METHODS This prospective study examined urine samples from 325 patients. The authors included 152 patients who presented with hematuria or irritative voiding symptoms (Group 1), 107 patients who were under surveillance after undergoing transurethral resection of bladder carcinoma (Group 2), 46 patients with urinary tract pathology other than bladder carcinoma (Group 3), and 20 healthy participants (Group 4). The urine concentration of CYFRA 21-1 was measured by an immunoradiometric assay. The patients in Groups 1 and 2 underwent cytoscopy and urine cytopathology. Biopsies were obtained if a tumor was seen on cytoscopy or if there was a suspicion of carcinoma in situ (CIS). RESULTS The optimal cut-off concentration for the detection of primary bladder tumors, 4.9 μg/L, resulted in a sensitivity of 79.3% and a specificity of 88.6%. The optimal threshold for the detection of recurrent bladder tumors (excluding patients who had been treated with intravesical bacillus Calmette–Guerin [BCG]), 4.04 μg/L, resulted in a sensitivity of 76.2% and a specificity of 84.2%. There was no significant advantage for centrifugation of the urine samples or for determination of the creatinine concentration in the urine samples. The CYFRA 21-1 assay of urine samples provided a three-fold greater sensitivity compared with the sensitivity of cytology for detecting Grade 1 transitional cell tumors. CYFRA 21-1 detected 91.9% of Grade 3 tumors, 100% of CIS, and 92.8% of invasive bladder tumors (T2 or higher classification). The CYFRA 21-1 assay detected all tumors that had positive cytology with the exception of only one tumor. Conversely, the assay identified 71% of primary tumors and 65% of recurrent tumors that were missed by cytopathology. Urinary stones, infection, and previous intravesical BCG immunotherapy caused many false positive results. CONCLUSIONS The urinary CYFRA 21-1 assay is a useful test for the noninvasive detection of bladder carcinoma and for surveillance of patients who were not treated previously with BCG. It may be used in combination with urine cytology and bladder ultrasound. Multi-institutional trials are required to compare the accuracy as well as the cost of this combination of tests with cystoscopy. Cancer 2002;94:2914–22. © 2002 American Cancer Society. DOI 10.1002/cncr.10565

Seventy-five patients with recurrent bladder carcinoma were randomized after electroresection to receive either epirubicin (E) or epirubicin + verapamil (E + V) instillation of the bladder at regular intervals for 2 years. Samples of the bladder wall, tumour tissue and peripheral blood were taken from 20 patients. The average follow-up period was 21 months. Fifty per cent of the patients in the E group and 37% in the E + V group developed recurrent tumours. Recurrence rates (RR) were 6.3 and 4.7, respectively. Before the instillation therapy the RR was 16.0. There was a highly significant reduction of RR during the instillation therapies; in group E p less than 0.005 and in group E + V p less than 0.001. The difference between the treatment groups was not statistically significant. Verapamil increased epirubicin concentrations in both the bladder wall and the tumour tissue, but did not affect concentrations in the peripheral blood. Side effects were few and did not lead to discontinuation of treatment.

This retrospective study describes the accuracy of magnetic resonance (MR) imaging in determination of local disease extent in 34 examinations performed for evaluation of primary or recurrent bladder carcinoma. The 34 examinations were carried out in 29 patients (17 men, 12 women, aged 34-89 years). All studies were followed within 30 days by surgical and pathologic evaluation. Images were interpreted by two radiologists unaware of clinical or pathologic findings. MR imaging staging conformed to the TNM system of the International Union Against Cancer (IUAC). Pathologic evaluation showed bladder neoplasms in all cases; three patients' pathologic specimens contained two or more histologic types of tumors. MR imaging staging of the depth of tumor invasion was correct in 85% of examinations. Sensitivity of MR imaging for detection of deep muscle invasion was 97%, specificity 83%, and accuracy 94%. Sensitivity of MR imaging for detection of extravesical tumor extension was 95%, specificity 100%, and accuracy 97%. Sensitivity for detection of pelvic lymph node metastases was 50%, specificity 100%, and accuracy 82%. Our population included many patients with locally advanced disease. This pattern reflects standards of clinical practice by which superficial lesions are staged and resected endoscopically, and deeply invasive tumors are imaged prior to radical surgery.

Purpose: We analyze the evolution of superficial transitional cell carcinoma in the intramural distal ureter treated with transurethral resection. Materials and Methods: A total of 19 patients underwent transurethral resection of the intramural distal ureter with a mean followup of 57 months. All cases were diagnosed as superficial transitional cell carcinoma and all but 2 had a history of bladder tumor. Upper urinary tract followup consisted of excretory urography every 6 months and ureterorenoscopy in cases with a doubtful diagnosis or positive cytology. Results: Pathological examination revealed stage Ta disease in 42%, T1 in 31.5% and Tx in 26.3% of intramural tumors. Upper urinary tract recurrence was noted in 8 patients (42.1%), including 5 (62.5%) with involvement of the distal ureter. Nontumoral stenosis of the distal ureter in 3 cases was treated endoscopically. An endoscopic procedure resolved 75% of recurrences. A high surgical risk patient who did not undergo open surgery died of recurrence. Conclusions: Superficial transitional cell carcinoma of the intramural ureter is uncommon in the setting of multiple bladder tumors and recurrent bladder carcinoma. There was a 42.1% rate of ipsilateral recurrence and endoscopic treatment allowed us to preserve 89.5% of the involved renal units. Closer followup of the urinary tract must be performed since these tumors have a higher incidence of upper urinary tract recurrence.

Transcatheter arterial infusion and arterial embolization are employed in the treatment of various neoplasms. In patients with carcinoma of the colon metastatic to the liver, the hepatic arterial infusion (HAI) of floxuridine and Mitomycin© produced a 55% partial response and a 12% complete response, as well as an improved median survival of 18 months. In metastatic breast carcinoma, a 30% response was achieved. In some cases, proximal embolization of aberrant hepatic arteries was performed to redistribute the hepatic flow to a single vessel to assist infusion of the entire liver using a single catheter. Devascularization by hepatic artery embolization has also been used to treat hepatic neoplasms. Arterial occlusion of renal carcinoma, followed after four to seven days by nephrectomy and hormonal therapy, produced a 36% response rate in 49 patients with distant metastases. In 14 patients with osteosarcoma treated with cis-diaminedichloroplatinum (CDDP) arterial infusion, a 57% response rate was achieved. Benign bone tumors were treated with arterial occlusion with a 60% response rate. Tumors of the pelvis were managed by bilateral internal iliac artery infusion using CDDP. In 21 patients with recurrent bladder carcinoma, control of pain and hematuria and prolonged survival were achieved.

From November 1981 through 1983, salvage cystectomy was performed on five men with recurrent bladder carcinoma after definitive irradiation; three of the men were 75 years or older. There were no deaths, but the complication rate was fairly high, though acceptable. Salvage cystectomy was further performed, together with radical extirpation of reproductive organs, in two women with recurrent gynaecologic malignancy and a history of local irradiation. The authors conclude that salvage cystectomy is a fairly safe procedure, even in elderly patients, relieving discomfort and probably also prolonging survival.

Summary— A series of 27 patients with measurable metastases from primary carcinoma of the bladder received cis-platinum 50 mg/m2/3-weekly. Twenty-six per cent (32% if patients receiving only one injection are excluded) responded for a median of 4 months.

Peripheral neuropathy developed in two cases of recurrent bladder carcinoma treated with Cis-dichlorodiammineplatinum (II) (DDP) at a dose of 75 mg/m2 IV every 3 weeks. The neuropathy appeared in both patients while they were achieving a subjective and objective response to DDP. The neuropathy was reversible in one patient. In the other patient, a disabling sensory neuropathy progressed despite cessation of therapy. The temporal relationship between the neurological symptoms and the administration of DDP implicate this drug as the possible causative agent in the peripheral neuropathy.

The prognosis of patients with stage D bladder cancer is dismal. This report expands the results of our efforts to modify the clinical course of such patients by administration of doxorubicin hydrochloride sandwiched around pelvic radiation. Pathologic stage D bladder cancer was recognized in 19 patients by evaluation of tissue obtained by radical cystectomy and pelvic lymphadenectomy (8), pelvic lymph node dissection (5) or biopsies (3), ileal conduit and pelvic lymph node biopsy (1), or transurethral biopsy of the bladder and prostate (2). Treatment of these patients with doxorubicin hydrochloride before and after radiation was initiated 3 to 4 weeks postoperatively. The treatment regimen consisted of 1) 60 mg. per M.2 doxorubicin intravenously every 3 weeks for 3 cycles, 2) 5,000 rad external radiation to the entire pelvis in 5 to 6 weeks and 3) doxorubicin for 5 cycles. The observed survival rates were 37 per cent at 3 years and 28 per cent at 5 years. The median survival time was 16 months. Five patients had no evidence of disease 13 to 63 months postoperatively. One patient underwent salvage cystectomy for recurrent bladder carcinoma at 33 months and had no evidence of disease at 74 months. One patient was alive with recurrent disease at 13 months. Three patients who died did not complete the protocol owing to metastatic disease, 8 lived 6 to 52 months without recognized disease and died of metastases, and 1 died of a second primary. The extent of surgical excision was not associated significantly with survival. Of 8 patients treated with radical cystectomy 7 suffered a significant obstruction of the small bowel that required decompression or bypass surgery and all 7 recovered completely. These preliminary observations indicate encouraging results with a high but manageable morbidity for this regimen.

Two cases of the urothelial cancers associated with extramammary Paget's disease are reported. In one patient, vulvar Paget's disease was discovered 6 years after complete resection of a ureteral tumor. In another patient, vulvar and vaginal Paget's disease developed during a period of repeated transurethral surgery leading up to the final total cystectomy for recurrent bladder carcinoma. Since genital Paget's disease is frequently accompanied by internal malignancies, a skin biopsy is mandatory when an eczematous lesion has been persistent in the genital region of patients with genitourinary cancers.

Eighteen patients with transitional cell bladder carcinoma and increasingly abnormal ploidy were assembled to evaluate the relation over time between ploidy and ABH isoantigen deletion. Fifteen patients with diploid recurrent tumors and 16 with aneuploid tumors over time were used as controls. ABH isoantigen deletion at diagnosis was closely related to cancer death, while isoantigen assessments on recurrences gave less prognostic information. Aneuploidy at diagnosis also indicated an adverse prognosis, as did recurrent bladder carcinoma with deteriorating ploidy. Patients with tumors deleted of isoantigen expression at diagnosis but with normal ploidy had as bad a prognosis as patients with deleted tumors and aneuploidy, indicating that isoantigen deletion may occur earlier than ploidy changes.

Two patients with who metastases from transitional cell carcinoma of the bladder have disappeared during chemotherapy which included cisplatin are described. Both patients have been free of tumour recurrence for over 12 months after chemotherapy was ceased. Side effects included peripheral neuropathy, but renal function was impaired. Cisplatin can produce clinically valuable remissions in recurrent and metastatic bladder carcinoma.