Results of a prospective randomized study assessing the efficacy of fluorescent cystoscopy-assisted transurethral resection and single instillation of doxorubicin in patients with non-muscle-invasive bladder cancer.

Abstract

To assess the efficacy of two treatment options for non-muscle-invasive bladder cancer (NMIBC): (1) transurethral resection (TUR) guided by fluorescence cystoscopy (FC) with the use of 5-aminolevulinic acid (5-ALA) and (2) single early instillation of doxorubicin in a single-center open-label prospective randomized study with a 2×2 factorial design. Patients with clinical suspicion of primary or recurrent NMIBC were randomized into four study arms: FC-assisted TUR with 5-ALA and single instillation of doxorubicin, FC-assisted TUR without instillation, TUR in white light (WL) with single instillation of doxorubicin, and WL-TUR only. The study was designed to assess recurrence-free survival in arms with and without any of two interventions. Of 525 patients included, 377 (72%) were eligible for primary outcome assessment. The median follow-up was 54.8months. FC statistically significantly decreased the risk of disease recurrence and progression with hazard ratio (HR) 0.56 (95% CI 0.39-0.80, p=0.001) and 0.33 (95% CI 0.12-0.91, p=0.031), respectively. The HRs for recurrence and progression for single instillation of doxorubicin were 0.76 (95% CI 0.54-1.07, p=0.11) and 0.65 (95% CI 0.28-1.52, p=0.32), respectively. The overall and cancer-specific survival rates did not differ significantly based on the therapeutic interventions. In patients with NMIBC, FC-assisted TUR with 5-ALA results in a substantial recurrence and progression risk reduction as compared to WL-TUR. The single early postoperative instillation of doxorubicin did not have a statistically significant impact on recurrence and progression risks.