Should all patients with non-muscle invaziv bladder tumor receive postoperative early single dose intravesical chemotherapy?

  • Sümer Baltacı
  • Ömer Gülpınar

Bull Urooncol 2012;11(1):30-33

Several randomized trials in non muscle invasive bladder cancer (NMIBC) have addressed the role of a single intravesical instillation of various chemotherapeutic agents just after transurethral resection of the bladder tumor (TURBT), showing significant reductions in subsequent tumor recurrences. Additionally, according to European Association of Urology (EAU) Guidelines, immediate instillation of a cytotoxic drug after TURBT is strongly recommended, independent of whether tumor was confined to mucosa (Ta, Tis) or submucosa (T1). However, it was found that 8,5 patients would have to have a perioperative instillation to prevent one recurrence. It was also shown that, single instillation of a chemotherapeutic agent in patients treated with TURBT for NMIBC prevents only small (< 5 mm) recurrences, which can easily be fulgurated at follow-up cystoscopy. The reduction in tumor recurrences after a single instillation of a chemotherapeutic agent is seen during the first 2 years of follow-up.

Recent studies revealed that in patients with high risk tumors, a single instillation that would precede BCG therapy would not influence the progression or recurrence rate compared with patients treated with BCG therapy only. Patents with multiple tumors also did not benefit from a single instillation. Additionally, cost and possible adverse events of a single instillation are the disadvantages of the treatment. Like the international bladder cancer group, in our opinion, for small, solitary and low grade tumors (low risk group) immediate chemotherapeutic instillation after TURBT is beneficial and should be recommended in those cases. For intermediate or high risk disease there is no significant benefit from an immediate, postoperative chemotherapeutic instillation.

Keywords: bladder cancer, intravesical instillation, drug therapy, tumor recurrence