A randomized controlled trial of short-term versus long-term prophylactic intravesical instillation chemotherapy for recurrence after transurethral resection of Ta/T1 transitional cell carcinoma of the bladder.
OBJECTIVE
In a prospective randomized controlled study, we investigated the optimal schedule for intravesical instillation of epirubicin for maximizing its effect on prophylaxis and disease progression after transurethral resection of newly diagnosed Ta/T1 bladder cancer.


METHODS
The patients were instilled with epirubicin (30 mg/30 ml in normal saline) within 24 hours after transurethral resection and then randomized into 2 groups after a definite histopathological diagnosis of Ta/T1 bladder cancer. One group of 77 patients received 19 intravesical instillations of epirubicin in the year after transurethral resection (group 1). The second group of 73 patients received 9 intravesical instillations of epirubicin during the 3 months after transurethral resection (group 2). Nonrecurrence rates and toxicity were compared.


RESULTS
In the followup period, 10 group 1 patients (13.0%) and 23 group 2 patients (31.5%) had recurrent disease. The 3-year nonrecurrence rate was 85.2% in group 1, whereas it was 63.9% in group 2. The nonrecurrence rate of group 1 was significantly higher than that of group 2 throughout the observation period (p = 0.005). The incidence and severity of toxicity were not significantly different between the 2 groups.


CONCLUSIONS
Our study indicates that long-term instillation of epirubicin is more effective than short-term instillation in preventing recurrence after transurethral resection of Ta/T1 bladder cancer.
Koga
Hirofumi
H
Department of Urology, Graduate School of Medicine, Kyushu University, Japan.
Kuroiwa
Kentaro
K
Yamaguchi
Akito
A
Osada
Yukio
Y
Tsuneyoshi
Masazumi
M
Naito
Seiji
S
D000283:Administration, Intravesical; D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage*; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000517:prevention & control* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D015251:Epirubicin / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D009367:Neoplasm Staging; D011446:Prospective Studies; D013997:Time Factors; D014521:Urethra; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000517:prevention & control* / Q000601:surgery
D000903:Antibiotics, Antineoplastic; D015251:Epirubicin