1352 SYNERGISTIC EFFECT OF IMMEDIATE INTRAVESICAL CHEMOTHERAPY AND SUBSEQUENT INDUCTION COURSE OF BCG FOR NON-MUSCLE INVASIVE BLADDER CANCER

Abstract

You have accessJournal of UrologyBladder Cancer: Superficial1 Apr 20101352 SYNERGISTIC EFFECT OF IMMEDIATE INTRAVESICAL CHEMOTHERAPY AND SUBSEQUENT INDUCTION COURSE OF BCG FOR NON-MUSCLE INVASIVE BLADDER CANCER Kazuhiro Matsumoto, Hiroyuki Yamanaka, Masayuki Hagiwara, Akiharu Ninomiya, and So Nakamura Kazuhiro MatsumotoKazuhiro Matsumoto More articles by this author , Hiroyuki YamanakaHiroyuki Yamanaka More articles by this author , Masayuki HagiwaraMasayuki Hagiwara More articles by this author , Akiharu NinomiyaAkiharu Ninomiya More articles by this author , and So NakamuraSo Nakamura More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.979AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES BCG is currently the most effective intravesical agent at preventing the recurrence of non-muscle invasive bladder cancer. However, some patients treated with BCG still unfortunately experience tumor recurrence. To date, multiple clinical trials have focused on the efficacy of single immediate instillation of chemotherapeutic agents. The aim of this study was to evaluate the synergistic effect of immediate intravesical chemotherapy and a subsequent induction course of BCG. METHODS Between 1993 and 2007, 526 cases with diagnosed non-muscle invasive bladder cancer were treated with transurethral resection at our institution. Of these 526 cases, 115 low risk patients who had initially been diagnosed with a solitary Ta G1/2 tumor and 41 patients treated with induction courses of intravesical chemotherapy were excluded. The remaining 370 patients, consisting of 193 intermediate risk patients and 177 high risk patients, were the subjects in this retrospective study. The median follow-up interval was 3.1 years. RESULTS No adjuvant intravesical therapy was performed in 115 patients (Group A). Only immediate epirubicin 40 mg instillation was performed in 56 patients (Group B), and 125 patients received only an induction course of 6 BCG instillations (Group C). The remaining 74 patients were treated with both immediate epirubicin instillation and a subsequent induction course of BCG (Group D). Initially there was no significant difference in the clinicopathological backgrounds of Group A and Group B, but the 3-year recurrence-free survival rate in Group A (31.9%) was less than in Group B (57.5%) (p<0.001), which proved the efficacy of immediate intravesical therapy using epirubicin. In Group C, the 3-year recurrence-free survival rate was 57.9%, which was almost the same as that in Group B (p=0.533), although statistically Group C included more high risk patients (72 of 125 patients) than Group B (17 of 56 patients) (p<0.001). Next, we compared Group C and Group D. No significant difference in their respective backgrounds was observed. However, the 3-year recurrence-free survival rate in Group D was significantly higher than that in Group C (75.5% vs 57.9%) (p<0.001), which suggested the combination therapy had a synergistic effect. CONCLUSIONS For intermediate and high risk patients, our results indicate that the combination of immediate intravesical epirubicin instillation with a subsequent induction course of BCG exhibited a synergistic effect against potential tumor recurrence and is thus recommended. Tokyo, Japan© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e522 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kazuhiro Matsumoto More articles by this author Hiroyuki Yamanaka More articles by this author Masayuki Hagiwara More articles by this author Akiharu Ninomiya More articles by this author So Nakamura More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...