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Background. Bladder cancer is the ninth most common malignant neoplasm worldwide. Hidden metastases at the time of diagnosis are the main reason muscle-invasive bladder cancer has poor prognosis. Even after radical cystectomy, muscleinvasive bladder cancer mostly progresses within 2 years with a recurrence rate of over 50 %. At stages II–IV of the disease, drug treatment is indicated before radical cystectomy. The main goal of neoadjuvant chemotherapy is to affect micrometastases, which may be present at the beginning of disease development. The response to ongoing chemotherapy can serve as a predictor of long-term survival.Aim. To increase effectiveness of bladder cancer treatment.Materials and methods. A total of 231 patients with bladder cancer were included in the study. The main contingent consisted of men over 60 years old with locally advanced tumors at stage Т2–Т4. Drug therapy was carried out in neoadjuvant mode before surgical treatment. Standard regimens were used: cisplatin + gemcitabine and MVAC (methotrexate, vinblastine, adriamycin, cisplatin). After four courses of neoadjuvant chemotherapy, the results were evaluated. With complete normalization of a patient’s condition, the issue of surgical treatment – radical cystectomy with one of the types of urinary diversion – was decided.Results and conclusion. The follow-up period for patients after treatment was 62 months. In patients who underwent neoadjuvant chemotherapy, the median overall survival was 44.9 months, in patients without neoadjuvant treatment – 36.8 months with improvement in recurrence-free survival from 32.5 to 39.8 months (p = 0.08). Overall survival after neoadjuvant chemotherapy improved by 8.1 months (p = 0.09).

Objective. There is the second generalized analysis of administration of vinflunine in real clinical practice in Russia.Materials and methods. This analysis gathered 15 patients with urothelial carcinoma treated using this medicine in 8 cancer centers in Russia. We assessed efficacy, safety profile of vinflunine in this subset of patients.Results. Clinical efficacy of vinflunine (complete response + partial response + stable disease) was 73.3 %, one patient demonstrated complete response. Median of response duration accounts for 3.8 months. Six-month and 1-year survival rate made up 93.3 %. Adverse events were observed in 53.5 %, with only one episode of neutropenia 4 grade.Conclusion. In our second analysis vinflunine was more effective than in randomized clinical trial and other studies from real practice in Europe. Thus, we confirm expediency to administer of vinflunine for metastatic urothelial carcinoma.

Intravesical immunotherapy with the BCG vaccine «Imuron» along with courses of maintenance therapy has been performed in 25 patients. During a more than 10-year follow-up, there are 20 (80%) survivors; of them 15 (75%) patients have no recurrences. The used treatment regimen is effective and allows a long monitoring of the disease with the good quality of life. The occurrence of recurrences in 5 (25%) patients in the late period of the follow-up (after 8-13.5 years) leads to the conclusion that patients should be long followed up by an oncourologist and undergo cytoscopic studies with photodynamic diagnosis.

Use of immunotherapy in treatment of muscle-invasive bladder cancer remains the most promising method in case of impossibility of chemotherapy with cisplatin or progression during cisplatin treatment. This approach is the method of choice and can prolong patient’s life. In particular, use of checkpoint inhibitors allows to obtain effective treatment of bladder cancer. However, to prescribe immunotherapeutic medication, patient must have point of application for these drugs. Individualized approach will allow to increase treatment effectiveness and disease prognosis while maximally improving the quality of life.

Tumor grade and pT stage are significant prognostic factors in non-muscle-invasive papillary urothelial bladder carcinoma (BC) therefore these indicators are of great importance. The purpose of the investigation was to determine whether molecular biological markers (Ki-67 level, p53, CK20, and c-erbB-2 expression) may specify the grade and invasive potential of papillary urothelialBC. The investigators examined the specimens taken after transurethral resection of the bladder from 57 patients (46 men and 11 women) aged 24 to 75 years (mean age 56 ± 1.5 years) with non-muscle-invasive papillary urothelial BC referring to as a moderate and poor prognostic group according to the EORTC scoring system, who had received combined treatment at the Medical Radiology Research Center in 1998 to 2005 (the postoperative follow-up was 2 to 9 years).

Purpose: To improve the efficacy of palliative radiation therapy for patients with bladder cancer (BC).Materials and Methods: In the years 1990−2010, 90 patients with BC were treated with palliative external beam radiation therapy (EBRT) using three regimens: conventional fractionation in group 1 (n = 37), hypofractionation in group 2 (n = 22) and accelerated dynamic fractionation in group 3 (n = 31).Results: The immediate efficacy of EBRT was evaluated taking into account rapid relief of local symptoms of disease. In group 1, a clinically significant response (hematuria relief) was achieved in 63,0 % cases, in group 2 — in 62,5 %, in group 3 — in 91,7 % cases. The 10-year follow-up showed that in group 1, the median survival was 21,8 ± 3,3 months; in groups 2 and 3, the median survival was 27,0 ± 7,8 and 32,6 ± 9,8 months, respectively. In group 2, an increase in the rate of acute radiation reactions was noted, whereas in group 3, palliative EBRT did not produce higher rates and severity of acute radiation reactions and complications.Conclusion: Accelerated dynamic fractionation was found to shorten treatment times and to improve outcomes and quality of life for incurable patients with BC.

The prognostic value of the expression of c-erbB-2 oncoprotein, p53 protein, cytokeratin 20, and Ki-67 was estimated in papillary urothelial non-muscle-invasive bladder carcinoma (BC). The biopsy and surgery samples from 57 patients (46 males and 11 females) aged 24 to 75 years (mean age 56±1.5 years), who received combination treatment for non-muscle-invasive BC, were examined. It has been found that с-erbB-2 and р53 are important prognostic markers of non-muscle-invasive BC. Co-expression of 3 markers is of high statistic significance.

The paper analyzes the data on 34 patients with non-muscle-invasive bladder cancer (NMIBC) who have undergone radical cystectomy (RCE). The patients were divided into 2 groups according to the preoperative period: with delayed and early RCE. Heterotopic and orthotopic reservoirs were the methods of choice for urinary derivation. Five-year overall relapse-free survival was 68.9±12.6%. There were differences in the number of relapses in the delayed and early RCE groups. The timely established indications for RCE make it possible to prevent disease progression and to long maintain a good quality of life in the majority of patients with NMIBC.

Objective: to evaluate the efficiency of beam radiotherapy (BRT) in patients with non-muscle-invasive bladder cancer (NMIBC).Subjects and methods. The data on 40 patients diagnosed as having stage T1 NMIBC, who had been treated at the Medical Radiology Center in 1990 to 2009, were studied. Of them, 75% were aged < 70 years. They all had verified transitional cell carcinoma: G1 in 11 (27.5%) patients; G2 in 12 (30%), and G3 in 17 (42.5%). Multifocal tumor growth (T1m) was found in 22 (55%); the largest tumor exceeded 3 cm in 31 (77.5%). More than half (60%) of the patients had clinically significant concomitant diseases. Three (7.5%) had a history of treated malignancy. The mean follow-up of the patients was 58.6 months.Results. Survival at 60 months follow-up was 67.9 ± 8.0%. Three (7.5 %) patients died at 21–42 months follow-up. Five-year relapse-free survival was 50.0 ± 8.5%. Seven (17.5 %) patients were withdrawn at 5 to 99 months follow-up (mean 34.7 months). Four (10 %) patients died from disease progression at 21 to 143 months follow-up. After radiotherapy to the bladder area, 17 (42.5 %) patients were diagnosed as having more than 50 % tumor regression, which permitted transurethral resection of a residual tumor. The frequency and degree of radiation reactions were estimated. Acute radiation cystitis was diagnosed in 11 (27.5 %) patients and rectitis was found in 6 (15.0 %). Radiation reactions were not a reason for forced treatment discontinuation. Grade I-II late radiation cystitis (RTOG/EORTC) was diagnosed in 9 (22.5 %) patients.Conclusion. The efficiency of BRT in patients with NMIBC who had refused surgical treatment or had contraindications to it was confirmed during the study. BRT could preserve the functioning bladder in 97.5 % of cases and remove the residual tumor in 42.5 %. Radiation reactions were not a reason for forced treatment interruption.

The authors consider general immunological effects of intravesical BCG vaccine as an independent method of immunotherapy of superficial cancer of the bladder (CB). 27 patients (15 males and 12 females, mean age 57 years) with a recurrence of superficial CB (T1-2N0M0) were treated. The patients had undergone transurethral or transvesical bladder resection and combined therapy. Intravesical immunotherapy of CB recurrence with BCG vaccine induced persistent changes in the immune system: stimulate lymphocyte activity and phagocytic activity of neutrophils, T-cell function, normalizes function of endogenic suppressors, increases the amount of IgM and CIC. Repeat courses of the vaccine maintain the above immunological effects for a long time.