Instillation therapy for non-muscle-invasive bladder cancer (NMIBC) reduces recurrences but is associated with side effects. Preoperative instillation of chemotherapy could potentially be associated with fewer side effects compared with adjuvant instillations and in some patients make tumour resection (transurethral resection of the bladder tumour [TURBT]) superfluous.
To investigate tumour response and adverse events related to short-term, intensive chemoresection with mitomycin C compared with adjuvant instillations in patients with recurrent NMIBC.
A randomised, controlled trial was conducted in two urological departments in Denmark from January 2018 to June 2019. In total, 120 participants with a history of Ta bladder tumours, low grade or high grade, were included upon recurrence.
Intravesical mitomycin C (40 mg/40 ml) three times a week for 2 wk in the intervention group (59 patients) was compared with TURBT and six weekly adjuvant instillations in the control group (61 patients).
Tumour response was evaluated in the intervention group by flexible cystoscopy after 4 wk. Side effects were prospectively registered in both groups using the National Cancer Institute's Common Terminology Criteria for Adverse Events. Groups were compared using χ2 or Fisher's exact test.
Complete tumour response was seen in 33 participants (57%) in the intervention group. Fewer adverse events were reported in the intervention group than in the control group. Two patients in each group ceased instillation treatment due to adverse events. The main limitation is the current lack of long-term follow-up.
Short-term, intensive chemoresection yields a tumour response of 57%. Hence, only half of those treated with chemoresection needed TURBT. The treatment was furthermore associated with fewer clinically significant side effects. Owing to small numbers, further investigations on Ta high-grade tumours are needed.
We compared a nonsurgical treatment with standard treatment in patients with superficial bladder tumours. We found it to be safe and able to avoid surgery in more than half of the patients.
European urology. 2020 Jul 28 [Epub ahead of print]
Maria S Lindgren, Peter Bue, Nessn Azawi, Linea Blichert-Refsgaard, Maria O Sundelin, Lars Dyrskjøt, Jørgen B Jensen
Department of Urology, Aarhus University Hospital, Aarhus, Denmark; Department of Urology, Regional Hospital West Jutland, Holstebro, Denmark; Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark. Electronic address: ., Department of Urology, Regional Hospital West Jutland, Holstebro, Denmark., Department of Urology, Zealand University Hospital, Roskilde, Denmark., Department of Urology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark., Department of Urology, Aarhus University Hospital, Aarhus, Denmark; Department of Urology, Regional Hospital West Jutland, Holstebro, Denmark; Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark., Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark; Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark.