背景:自2012年6月以来,世界范围内一直缺乏康诺特菌株。2012年12月,一组专家在西班牙泌尿外科协会开会,分析这种情况并提出替代方案。
目的:介绍上述委员会所做的工作以及由此产生的建议。
方法:对中高危肿瘤治疗的主要现有证据进行了更新。特别提到了与使用BCG相关的那些,以及由于BCG的不同可用性而可能的替代方案。
结果:在进展风险高的肿瘤中,当没有卡介苗时,应考虑立即进行膀胱切除术,减少剂量或与化学疗法交替作为在可用性降低时节省使用BCG的方法。在有中等进展风险的肿瘤中,化疗可以使用,尽管当它与高复发风险相关时,如果有的话,将向BCG提供上述节约准则。BCG需要维护以保持其有效性,有必要优化膀胱化疗的应用,并使用可增加其对膀胱壁(EMDA)的渗透的系统。
结论:由于卡介苗的稀缺性,有必要就西班牙泌尿外科协会网页上发布的一系列建议达成一致.
BACKGROUND: Since June 2012, the has been a worldwide lack of available of the Connaught strain. In December 2012, a group of experts met in the Spanish Association of Urology to analyze this situation and propose alternatives.
OBJECTIVE: To present the work performed by said committee and the resulting recommendations.
METHODS: An update has been made of the principal existing evidence in the treatment of middle and high risk tumors. Special mention has been made regarding the those related with the use of BCG and their possible alternative due to the different availability of BCG.
RESULTS: In tumors with high risk of progression, immediate cystectomy should be considered when BCG is not available, with dose reduction or alternating with chemotherapy as methods to economize on the use of BCG when availability is reduced. In tumors having middle risk of progression, chemotherapy can be used, although when it is associated to a high risk of relapse, BCG would be indicated if available with the mentioned savings
guidelines. BCG requires maintenance to maintain its effectiveness, it being necessary to optimize the application of endovesical chemotherapy and to use systems that increase its penetration into the bladder wall (EMDA) if they are available.
CONCLUSIONS: Due to the scarcity of BCG, it has been necessary to agree on a series of recommendations that have been published on the web page of the Spanish Association of Urology.