UROLOGICAL ONCOLOGY

A single immediate postoperative instillation of chemotherapy decreases the risk of recurrence in patients with stage Ta T1 bladder cancer: a meta-analysis of published results of randomized clinical trials
Sylvester RJ, Oosterlinck W, van der Meijden AP
European Organization for the Research and Treatment of Cancer Data Center, Brussels, the Universitair Ziekenhuis Gent, Gent, Belgium
J Urol. 2004; 171: 2186-90

• Purpose: We determined if 1 immediate instillation of chemotherapy after transurethral resection (TUR) decreases the risk of recurrence in patients with stage Ta T1 single and multiple bladder cancer overall and separately.
• Materials and Methods: A meta-analysis was performed of the published results of randomized clinical trials comparing TUR alone to TUR plus 1 immediate instillation of chemotherapy.
• Results: Our study included 7 randomized trials with recurrence information on 1476 patients. Based on a median followup of 3.4 years and a maximum of 14.5 years, 267 of 728 patients (36.7%) receiving 1 postoperative instillation of epirubicin, mitomycin C, thiotepa or (2’R)-4'-O-tetrahydropyranyl-doxorubicin (pirarubicin) had recurrence compared to 362 of 748 patients (48.4%) with TUR alone, a decrease of 39% in the odds of recurrence with chemotherapy (OR 0.61, p < 0.0001). Patients with a single tumor (OR 0.61) and those with multiple tumors (OR 0.44) benefited. However, after 1 instillation 65.2% of patients with multiple tumors had recurrence compared to 35.8% of patients with single tumors, showing that 1 instillation alone is insufficient treatment for patients with multiple tumors.
• Conclusions: One immediate intravesical instillation of chemotherapy significantly decreases the risk of recurrence after TUR in patients with stage Ta T1 single and multiple bladder cancer. It is the treatment of choice in patients with a single, low risk papillary tumor and is recommended as the initial treatment after TUR in patients with higher risk tumors.
  
  
• Editorial Comment
  This paper should be read by every urologist dealing with superficial bladder cancer. Briefly, the facts are clear-single-shot instillation is a highly effective treatment with low cost. It should be give after every TUR. High-risk tumors deserve further therapy, to my opinion with BCG.
  Intravesical cytotoxic drug instillations have their clear role in urology now: as single shot therapy.

Dr. Andreas Böhle
Professor of Urology
HELIOS Agnes Karll Hospital
Bad Schwartau, Germany