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Short schedule intravesical mitomycin preceding transurethral resection for recurrent Ta-T1, G1-G2 bladder cancer
M Maffezzini1, A Simonato, C Lodolo
1Clinica Urologica University of Trieste, Italy.
Aims And Background:
Intravesical instillations commonly follow resection, when all visible lesions have been removed, making impossible any direct assessment of efficacy. The study was conceived to evaluate the ablative effect on the tumor and the efficacy in reducing the risk of recurrence of short schedule intravesical chemotherapy administered before endoscopic resection.
Study Design:
Four weekly intravesical instillations of mitomycin C followed by transurethral resection (TUR) were administered to 31 patients with recurrent small volume superficial bladder cancer.
Results:
At TUR no evidence of disease was found in 22 patients (70.9%) and residual disease in the remaining 9 (29.1%). At a median follow-up of 15 months (range, 3-33) 16 of 31 patients (51.6%) had recurrence of disease. The treatment was well tolerated.
Conclusions:
Short-schedule intravesical chemotherapy can completely ablate small volume recurrent superficial bladder cancer in a relevant number of patients but is probably not sufficient to obtain long-term prophylaxis.
Insights
Short-schedule intravesical chemotherapy before resection can eliminate small bladder tumors in many patients. However, this treatment likely does not provide sufficient long-term protection against recurrence.
Area of Science:
- Uro-oncology
- Neoadjuvant chemotherapy
- Superficial bladder cancer treatment
Background:
- Intravesical chemotherapy often follows bladder cancer resection, hindering direct efficacy assessment.
- Evaluating neoadjuvant intravesical chemotherapy's role in reducing recurrence risk is crucial.
Purpose of the Study:
- To assess the tumor-ablative effect of neoadjuvant intravesical chemotherapy.
- To evaluate the efficacy of short-schedule intravesical chemotherapy in preventing superficial bladder cancer recurrence.
Main Methods:
- 31 patients with recurrent, small-volume superficial bladder cancer received four weekly intravesical mitomycin C instillations.
- Transurethral resection (TUR) was performed after the chemotherapy course.
Main Results:
- No evidence of disease was observed in 70.9% of patients at TUR.
- Residual disease was found in 29.1% of patients.
- Recurrence occurred in 51.6% of patients at a median follow-up of 15 months.
- The treatment demonstrated good tolerability.
Conclusions:
- Neoadjuvant intravesical chemotherapy can achieve complete ablation of small-volume superficial bladder cancer in a significant number of patients.
- This short-schedule regimen may not be sufficient for long-term recurrence prophylaxis.