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Title: Chemotherapy in the minimally-invasive management of superficial bladder cancer : studies of the maximum potential of intravesical thioTEPA
Author: Walker, Lawrence
Awarding Body: University of Glasgow
Current Institution: University of Glasgow
Date of Award: 1992
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Fibreoptic out-patient cystoscopy has become established in the follow-up of bladder cancer, and increased the need for outpatient treatment and prophylaxis. Despite a variety of indications and a constellation of schedules, intravesical chemotherapy has been found to prevent progression and recurrence. Optimum methods remain undefined. Because of the anatomical separation of the therapeutic and toxic effects of thioTEPA, not found with more recent agents, it was thought that there might be a greater clinical opportunity to exploit positive laboratory findings. A model course of ten instillations of intravesical chemotherapy was developed in vitro. Cells were less sensitive after treatment. Potential markers or predictors of drug resistance were studied, but no differences were identified. The addition of a solvent, dimethyl sulphoxide, did not increase the cytotoxic effect of four drugs that have commonly been used to treat bladder cancer. Adjusting pH during drug exposure to acid levels increased the effect of thioTEPA on a range of human urothelial cell lines a hundredfold. Pilot studies of amiloride gave no evidence of further effect, when used with thioTEPA. A first prospective comparison of UK methods found flexible cystoscopy no more likely to miss tumours or induce bacteriuria than rod-lens cystoscopy.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available