Reducing recurrence in non-muscle-invasive bladder cancer using photodynamic diagnosis and immediate post-transurethral resection of the bladder chemoprophylaxis.
OBJECTIVE
The aim of this study was to evaluate the effect of fluorescence cystoscopy and immediate post-transurethral resection of the bladder (TURB) chemoprophylaxis on the risk of recurrence of non-muscle-invasive bladder cancer (NMIBC) under routine clinical conditions.


METHODS
Fluorescence cystoscopy using hexyl-aminolevulinate and post-TURB chemoprophylaxis using mitomycin C were simultaneously introduced in an effort to reduce the recurrence of NMIBC. In total, 190 consecutive patients were enrolled over a 2 year period and followed as the intervention group; 216 patients treated over a 2 year period before introduction served as controls. An intention-to-treat analysis was performed with baseline control.


RESULTS
The recurrence risk was reduced by 41% (hazard ratio 0.59, 95% confidence interval 0.45-0.78) (intention-to-treat analysis). Median recurrence-free survival was extended from 13.6 months to 36.8 months. Every third follow-up TURB was avoided. Patients with low-risk tumors and patients with primary as well as recurrent disease benefited from the treatment.


CONCLUSIONS
Fluorescence cystoscopy and immediate post-TURB chemoprophylaxis effectively reduced the recurrence risk and numbers of follow-up procedures under clinical routine conditions.
1Institute of Clinical Medicine, Aarhus University , Aarhus , Denmark.
Malene Risager
MR
Lykke
Tommy Kjaergaard
TK
Nielsen
Nanna Andersen
NA
Ebbensgaard
Karsten
K
Zieger
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use; D018890:Chemoprevention; D003558:Cystoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000627:therapeutic use; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D061848:Optical Imaging / Q000379:methods; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D013520:Urologic Surgical Procedures / Q000379:methods*
D000903:Antibiotics, Antineoplastic; D016685:Mitomycin
Aminolevulinic acid; chemoprevention; diagnostic use; neoplasm recurrence; prevention and control; urinary bladder neoplasm