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Ablative Intravesical Chemotherapy for Small Recurrent Non-Muscle-Invasive Bladder Cancer: A Prospective Study
Karel Decaestecker1, Nicolaas Lumen, Annelies Ringoir
1Department of Urology, Ghent University Hospital, Ghent, Belgium.
Objective:
The efficacy of intravesical chemotherapy in abolishing small papillary recurrences of non-muscle-invasive bladder cancer (NMIBC), the disease-free interval in responders and patients' preferences were explored.
Methods:
When a small (≤1 cm) papillary recurrence of a NMIBC was diagnosed, the patient could choose between immediate transurethral resection of the bladder (TURB) or four weekly intravesical instillations with mitomycin C (MMC) or epirubicin (ERC). Control cystoscopy was scheduled 2-3 weeks after the last instillation. Complete remission was defined as total disappearance of all papillary tumours and negative cytology.
Results:
25 patients with 47 recurrence episodes were recruited from February 2003 until August 2011. The median follow-up was 35 months. After exclusion of 2 patients with intolerance to the instillations, 45 study episodes could be analysed. All patients to whom this was proposed preferred the instillations over immediate TURB. Complete, partial and no response was seen in 23 (51%), 6 (13%) and 16 (36%) out of 45 episodes, respectively. The median disease-free interval after complete remission was 16 months (95% confidence interval 9-24).
Conclusions:
Small papillary recurrences of NMIBC completely disappear in about half of the cases receiving four weekly bladder instillations with MMC or ERC. This is followed by a disease-free interval. Intravesical chemotherapy was preferred by all patients over immediate TURB.
Insights
Intravesical chemotherapy effectively treats small non-muscle-invasive bladder cancer recurrences, achieving remission in about half of patients. This bladder cancer treatment was preferred over surgery, leading to a disease-free interval.
Area of Science:
- Urology
- Oncology
- Chemotherapy
Background:
- Non-muscle-invasive bladder cancer (NMIBC) frequently recurs.
- Small papillary recurrences pose a treatment challenge.
Purpose of the Study:
- To evaluate intravesical chemotherapy for small NMIBC recurrences.
- To assess the disease-free interval in responders.
- To explore patient preferences for treatment options.
Main Methods:
- Patients with small (≤1 cm) NMIBC recurrence chose between transurethral resection of the bladder (TURB) or four weekly intravesical instillations (mitomycin C or epirubicin).
- Complete remission was defined as total tumor disappearance and negative cytology.
- Follow-up included control cystoscopy 2-3 weeks post-instillation.
Main Results:
- 51% of patients achieved complete remission with intravesical chemotherapy.
- The median disease-free interval after complete remission was 16 months.
- All patients preferred intravesical instillations over immediate TURB.
Conclusions:
- Intravesical chemotherapy is effective in eradicating approximately half of small papillary NMIBC recurrences.
- Successful treatment is followed by a disease-free interval.
- Intravesical chemotherapy offers a preferred alternative to TURB for NMIBC recurrence.
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