title: Long-term decrease in bladder cancer recurrence with hexaminolevulinate enabled fluorescence cystoscopy.
abstract: OBJECTIVE
  We assessed the impact of hexaminolevulinate fluorescence cystoscopic detection of papillary, nonmuscle invasive bladder cancer on the long-term recurrence rate.
  
  
  METHODS
  Long-term followup was assessed in 551 participants enrolled in a prospective, randomized study of fluorescence cystoscopy for Ta or T1 urothelial bladder cancer. In the original study 280 patients in the white light cystoscopy group and 271 in the fluorescence cystoscopy group were followed with cystoscopy for 3, 6 and 9 months after initial resection or until recurrence. A study extension protocol was done for long-term followup of these patients.
  
  
  RESULTS
  Followup information was obtained for 261 of the 280 patients (93%) in the white light group and 255 of the 271 (94%) in the fluorescence group. Median followup in the white light and fluorescence groups was 53.0 and 55.1 months, and 83 (31.8%) and 97 patients (38%) remained tumor free, respectively. Median time to recurrence was 9.4 months in the white light group and 16.4 months in the fluorescence group (p = 0.04). The intravesical therapy rate was similar in the 2 groups (46% and 45%, respectively). Cystectomy was done in 22 of 280 cases (7.9%) in the white light group and in 13 of the 271 (4.8%) in the fluorescence group (p = 0.16).
  
  
  CONCLUSIONS
  Hexaminolevulinate fluorescence cystoscopy significantly improves long-term bladder cancer time to recurrence with a trend toward improved bladder preservation.
authors.affiliation: Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: H Barton
authors.initials: HB
authors.lastname: Grossman
authors.forename: Arnulf
authors.initials: A
authors.lastname: Stenzl
authors.forename: Yves
authors.initials: Y
authors.lastname: Fradet
authors.forename: Lance A
authors.initials: LA
authors.lastname: Mynderse
authors.forename: Martin
authors.initials: M
authors.lastname: Kriegmair
authors.forename: J Alfred
authors.initials: JA
authors.lastname: Witjes
authors.forename: Mark S
authors.initials: MS
authors.lastname: Soloway
authors.forename: Alexander
authors.initials: A
authors.lastname: Karl
authors.forename: Maximilian
authors.initials: M
authors.lastname: Burger
mesh_terms: D000368:Aged; D000622:Aminolevulinic Acid / Q000031:analogs & derivatives*; D002170:Canada / Q000453:epidemiology; D002250:Carbon Radioisotopes; D003558:Cystoscopy / Q000379:methods*; D003937:Diagnosis, Differential; D005060:Europe / Q000453:epidemiology; D005260:Female; D005453:Fluorescence; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009017:Morbidity / Q000639:trends; D009361:Neoplasm Invasiveness / Q000175:diagnosis; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000453:epidemiology*; D009367:Neoplasm Staging / Q000379:methods*; D017319:Photosensitizing Agents; D011446:Prospective Studies; D015203:Reproducibility of Results; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000601:surgery
chemical_list: D002250:Carbon Radioisotopes; D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid; C419924:5-aminolevulinic acid hexyl ester