Management Of Superficial Bladder Tumors: Does Photo Dynamic TURB Improve Outcome Of Initial T1 High Grade Bladder Cancer?

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology;  Clinical Trials / Drug Trials
Article Date: 06 Apr 2008 - 0:00 PDT

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UroToday.com - Long-term Follow-up of a Randomized Study

Studies have shown that 5-aminolevulinic acid (5-ALA) induced fluorescence cystoscopy improves the detection of superficial bladder cancer. The results suggest a reduced rate of recurrent tumors with the use of 5-ALA fluorescence technique prior to bladder tumor resection. On behalf of a group of German investigators, Dr. Burger presented a prospective, randomized trial to investigate whether the long-term tumor recurrence and residual tumor rate can be decreased by fluorescence diagnosis.

A total of 301 patients with suspected superficial bladder carcinoma were randomized to transurethral resection (TUR) under conventional white light (WL) or fluorescence diagnosis (FD). Transurethral resection was repeated to evaluate the residual tumor rate. In addition, patients were followed for a median of 83 (WL) and 86 (FD) months to evaluate recurrence-free survival (RFS).

At analysis, 191 patients were available for efficacy analysis. The residual tumor rate was 25.2% in the WL arm versus 4.5% in the FD arm (p<0.0001). RFS after 2, 4, 6, and 8 years was 73%, 64%, 54% and 45% in the WL group and 88%, 84%, 79%, and 71% in the FD group, respectively. With regard to RFS, FD is statistically significantly superior to WL TUR (p=0.0003).

Dr. Burger concluded that ALA-induced FD is statistically significantly superior to conventional WL TUR with respect to both residual tumor rate and recurrence free survival. He stated that this advantage of decreased bladder tumor recurrence risk is maintained with high statistical significance for at least 8 years. The differences in RFS imply that FD offers a clinically relevant procedure to reduce the number of tumor recurrences. Burger M., Stief C., Zaak D., Rößler W., Wieland W-F., Filbeck T., Knüchel R., Denzinger S.

Presented by: M. Burger, MD, et al, at the European Association of Urology - 23rd Annual EAU Congress - March 26 - 29, 2008 - Milan, Italy

Reported by UroToday.com Contributing Editor, Christopher P. Evans, MD

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