CRUCIAL-R Study : Cruciferous Vegetables Dietary Regimen in NMIBC

Emerging evidence highlights the importance of nutrition in modulating cancer-related pathways, suggesting that specific dietary patterns and food choices may influence cancer risk. A protective role has been suggested for high consumption of vegetables, non-saturated fat oil (Mediterranean diet), fruits, and flavonoids \[10-13\]. In contrast, a diet rich in saturated fats and meat has been linked to an increased risk of BC \[14,15\]. Particularly, the consumption of vegetables of the Cruciferae family, such as broccoli, cauliflower, brussels sprouts, cabbage, kale, turnips, and others, has gathered attention for their potential protective effects due to their bioactive compounds: Isothiocyanates (ITCs). Dietary ITCs are a group of phytochemicals with multifaceted anticancer mechanisms primarily derived from cruciferous vegetables (CV) as glucosinolates and converted to ITCs by the action of the enzyme myrosinase \[16\]. Organic ITCs, particularly allyl isothiocyanate (AITC), benzyl isothiocyanate (BITC), phenethyl isothiocyanate (PEITC), and sulforaphane (SF), are among the most extensively studied cancer chemopreventive agents. Several mechanisms for ITCs in protection against carcinogenesis have been proposed, which include inhibition of carcinogen activation and promotion of detoxification, induction of cell cycle arrest and activation of apoptosis, inhibition of cancer cell invasion, modulation of the tumor microenvironment, inhibition of self-renewal of stem cells, rearrangement of energy metabolism and regulation of microbial homeostasis \[17-22\]. Aims Primary Objective • To evaluate the effect, in terms of recurrence-free survival (RFS) at 1 year, of a dietary regimen characterized by high consumption of the Cruciferae family vegetables versus no dietary regimen in patients with Intermediate, High, or Very High-grade Non-Muscle Invasive Bladder Cancer treated with BCG (defined as the standard of care - SOC). Secondary Objectives * To evaluate the effect, in terms of time to recurrence, of a dietary regimen characterized by high consumption of the Cruciferae family vegetables versus no dietary regimen in patients with Intermediate, High, and Very High-grade Non-Muscle Invasive Bladder Cancer. * To evaluate the effect, in terms of recurrence-free survival (RFS), of a dietary regimen characterized by high consumption of the Cruciferae family vegetables versus no dietary regimen in patients with Intermediate, High, and Very High-grade Non-Muscle Invasive Bladder Cancer with prior recurrence ≤1/yr and \<4 tumors (according to 2016 EORTC risk stratification for patients treated with maintenance BCG). * To evaluate the impact of high Cruciferous vegetable consumption on urinary ITC levels. * To evaluate the impact of high Cruciferous vegetable consumption on quality of life (QoL).

Sex

All

Minimum age

18 Years

Maximum age

75 Years

Inclusion Criteria:

* Histologically confirmed Non-Muscle Invasive Bladder Cancer of Intermediate, High, or Very High risk according to the 2021 EAU NMIBC scoring model.
* Age ≥ 18

Exclusion Criteria:

* Low-Risk Non-Muscle Invasive Bladder Cancer
* Muscle Invasive Bladder Cancer
* Life expectancy \< 5 years
* WHO performance status 3 or 4
* Variant histology
* Concomitant Urothelial Bladder Cancer in the Upper-Urinary Tract
* Prostate or bladder radiotherapy
* Urinary tract infection
* Chronic urinary retention or indwelling catheters
* Other ongoing oncological diseases
* Active oncological treatments in the past 12 months
* Persistent disease (defined as residual disease detected within three months after TURB or at first cystoscopy)
* Specific dietary restrictions such as a vegetarian diet, celiac disease, or lactose intolerance
* Chronic Kidney Disease
* Chronic inflammatory diseases such as Crohn's disease or ulcerative colitis
* History of gastric resection
* Hepatic disorders such as cirrhosis or ALT/AST levels three times above the upper normal limit
* Thyroid disorders
* Warfarin therapy