title: Hexaminolevulinate hydrochloride in the detection of nonmuscle invasive cancer of the bladder.
abstract: Clinical trials have shown that hexaminolevulinate (HAL) fluorescence cystoscopy improves the detection of bladder tumors compared with standard white-light cystoscopy, resulting in more efficacious treatment. However, some recent meta-analyses report controversially on recurrence-free rates with this procedure. A systematic review of literature was performed from December 2014 to January 2015 using the PubMed, Embase and Cochrane databases for controlled trials on photodynamic diagnosis (PDD) with HAL. A total of 154 publications were found up to January 2015. Three of the authors separately reviewed the records to evaluate eligibility and methodological quality of clinical trials. A total of 16 publications were considered eligible for analysis. HAL-PDD-guided cystoscopy increased overall tumor detection rate (proportion difference 19%, 95% confidence interval [CI] 0.152-0.236) although the benefit was particularly significant in patients with carcinoma in situ (CIS) lesion (proportion difference 15.7%, 95% CI 0.069-0.245) and was reduced in papillary lesions (Ta proportion difference 5.9%, 95% CI 0.014-0.103 and T1 proportion difference 1.2%, 95% CI 0.033-0.057). Moreover, there were 15% of patients (95% CI 0.098-0.211) with at least one additional tumor seen with PDD. With regard to recurrence rates, the data sample was insufficient for a statistical analysis, although the evaluation of raw data showed a trend in favor of HAL-PDD. This meta-analysis confirms the increased tumor detection rate by HAL-PDD with a most pronounced benefit for CIS lesion.
authors.affiliation: Department of Experimental Medicine and Surgery, Tor Vergata University, Via Montpellier 1, 00133 Rome, Italy.
authors.forename: Savino M
authors.initials: SM
authors.lastname: Di Stasi
authors.affiliation: Department of Experimental, Medicine and Surgery, Tor Vergata University, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: De Carlo
authors.affiliation: Department of Emergency and Organs Transplantation, 'Aldo Moro' University, Bari, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Pagliarulo
authors.affiliation: Department of Medicine and Public Health, University of L'Aquila, L'Aquila, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Masedu
authors.affiliation: Department of Experimental, Medicine and Surgery, Tor Vergata University, Rome, Italy.
authors.forename: Cristian
authors.initials: C
authors.lastname: Verri
authors.affiliation: Operative Unit of Urologic Oncology, Policlinico Casilino, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Celestino
authors.affiliation: Department of Urology, Landesklinikum Baden-Mödling, Baden, Austria.
authors.forename: Claus
authors.initials: C
authors.lastname: Riedl
keywords: bladder cancer; hexaminolevulinate; meta-analysis; photodynamic diagnosis; tumor detection