title: A single instillation of epirubicin after transurethral resection of bladder tumors prevents only small recurrences.
abstract: OBJECTIVE
  We studied whether a single instillation of epirubicin after transurethral bladder tumor resection would influence the interval to and size of the first recurrence.
  
  
  METHODS
  A total of 404 patients from 13 hospitals were randomized to 1 instillation of 50 mg epirubicin or placebo within 6 hours after transurethral resection of bladder tumors.
  
  
  RESULTS
  Of 155 evaluable patients in the epirubicin group 79 (51.0%) had recurrence compared to 95 of 152 (62.5%) in the placebo group (p = 0.04). Of the recurrences 63.3% were small (1 to 5 mm). Tumor size was unknown in 5 patients. Of 79 patients with recurrence in the epirubicin arm 33 (42.9%) vs 29 (31.5%) of 95 in the placebo arm had larger (more than 5 mm) first recurrences (p = 0.12). Approximately half of the patients with first recurrences were treated as outpatients and the other half spent a total of 145 days in the hospital with no difference between the groups.
  
  
  CONCLUSIONS
  We confirmed the results of previous studies showing that 8.5 patients must be treated with a single instillation to prevent 1 recurrence. Furthermore, our data may indicate that only small recurrences are prevented, which could easily be fulgurated using local anesthesia at followup cystoscopy. The benefit of single instillations can be questioned if this finding is confirmed by others.
authors.affiliation: Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden.
authors.forename: Ingela
authors.initials: I
authors.lastname: Berrum-Svennung
authors.forename: Torvald
authors.initials: T
authors.lastname: Granfors
authors.forename: Staffan
authors.initials: S
authors.lastname: Jahnson
authors.forename: Hans
authors.initials: H
authors.lastname: Boman
authors.forename: Sten
authors.initials: S
authors.lastname: Holmäng
mesh_terms: D000283:Administration, Intravesical; D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage*; D015653:Cystectomy / Q000379:methods; D015251:Epirubicin / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D011446:Prospective Studies; D014521:Urethra; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000601:surgery*
chemical_list: D000903:Antibiotics, Antineoplastic; D015251:Epirubicin