939 Systematic review and individual patient data meta-analysis of randomized trials comparing a single immediate instillation of chemotherapy after transurethral resection to transurethral resection alone in patients with stage pTa-pT1 urothelial carcinoma of the bladder

Sylvester, Richard; Oosterlinck, W; Holmäng, Sten; Sydes, M; Birtle, Alison; Guðjónsson, Sigurður; Nunzio, Cosimo De; Okamura, Kikuo; Kaasinen, Eero; Solsona, E.; Ali‐El‐Dein, Bedeir; Tatar, Can Ali; Inman, B. A.; N’Dow, James; Oddens, Jorg R.; Babjuk, M.

doi:10.1016/s1569-9056(15)60927-7

Cited by 13 publications

(16 citation statements)

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Section: Intravesical Therapymentioning

confidence: 99%

“…Recurrences are significantly reduced (hazard ratio 0.40-0.66) when using mitomycin C (MMC), doxorubicin, epirubicin, or gemcitabine [21,[31][32][33][34]. Sylvester et al [34] used individual patient data from 13 randomized controlled trials to show that the median time to first recurrence was extended from 3 to 12 months with the use of postoperative intravesical chemotherapy; this benefit was limited, however, to patients in the lowest EORTC risk category. Despite level 1 evidence for post-transurethral resection of bladder tumour (TURBT) single-dose intravesical chemotherapy, it has not been widely adopted for reasons of cost and inconvenience as well as possible extravasation of the drug which can result in serious morbidity [35,36].…”

Section: Intravesical Therapymentioning

confidence: 99%

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Risk‐adapted management of low‐grade bladder tumours: recommendations from the International Bladder Cancer Group (IBCG)

et al. 2020

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Objective To provide a contemporary update and recommendations for the diagnosis and management of low‐grade non‐muscle‐invasive bladder cancer (BCa) based on current literature and expert consensus of the International Bladder Cancer Group. Methods We reviewed published trials, guidelines, meta‐analyses and reviews (up to March 2019) and provide recommendations on baseline evaluations, treatment, endpoints, study design and surveillance protocols. Results Low‐grade Ta BCa poses minimal risk to patients in terms of progression and disease‐specific survival. Thus, to minimize patient morbidity, this entity should be managed appropriately. After initial diagnosis of low‐grade Ta tumour, subsequent stable, low‐grade‐appearing recurrences can be managed conservatively with office cystoscopy and fulguration or even followed using an active surveillance protocol. Intravesical therapy other than single‐dose peri‐operative chemotherapy instillation should be used judiciously, and only after assigning appropriate risk points. Routine use of urinary cytology – other than at initial risk stratification, or for patients on active surveillance without therapy – is not recommended; and surveillance cystoscopy may be discontinued after 5 years. Clinical studies in this group of patients should focus on recurrence rates, and time to recurrence, rather than progression events. Conclusions The International Bladder Cancer Group has developed formal recommendations regarding the diagnosis, treatment and surveillance of low‐grade non‐muscle‐invasive BCa to minimize morbidity and encourage uniformity among studies in this disease.

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Section: Intravesical Therapymentioning

confidence: 99%

Section: Intravesical Therapymentioning

confidence: 99%

Risk‐adapted management of low‐grade bladder tumours: recommendations from the International Bladder Cancer Group (IBCG)

et al. 2020

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“…3,4 A single post-TURBT instillation of chemotherapy as adjuvant therapy within 24 hours, but ideally within 6 hours, reduces the relative risk of recurrence by 35% (HR: 0.65, 95% CI 0.58-0.74) in an individual patient data meta-analysis of low, intermediate and high-risk NMIBC. 5 A course of intravesical chemotherapy is recommended for intermediate-risk NMIBC and reduces the relative risk of recurrence by 44% (HR: 0.56, 95% CI: 0.48-0.65). 6 Mitomycin C (MMC) is the most commonly used intravesical chemotherapy.…”

Section: [H1] Introductionmentioning

confidence: 99%

Intravesical device-assisted therapies for non-muscle-invasive bladder cancer

Tan

Kelly

2018

Nat Rev Urol

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Non-muscle-invasive bladder cancer (NMIBC), the most prevalent type of bladder cancer accounts for approximately 75% of bladder cancer diagnoses. This disease has a 50% risk of recurrence and 20% risk of progression within 5 years , despite the use of intravesical adjuvant treatments (such as BCG or mitomycin C (MMC)) that are recommended by clinical guidelines. Intravesical device-assisted therapies, such as radiofrequency-induced thermochemotherapeutic effect (RITE), conductive hyperthermic chemotherapy, and electromotive drug administration (EMDA), have shown promising efficacy. These deviceassisted treatments are an attractive alternative to BCG , as issues with supply has been a problem in some countries. RITE might be an effective treatment option in patients who have experienced BCG failure and are not candidates for radical cystectomy. Data from trials using EMDA suggest it is effective in high risk disease but require further validation and results of randomised trials are eagerly awaited for conductive hyperthermic chemotherapy. Considerable heterogeneity in patient cohorts, treatment sessions, use of maintenance regimens, and single-arm study design makes it difficult to draw solid conclusions, although randomized controlled trials have been reported for RITE and EMDA.

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“…Transurethral resection of the bladder tumor(s) (TURBT) is the first step in the treatment of NMIBC. TURBT can be combined with immediate intravesical chemotherapy post-operatively, most often using mitomycin C (MMC), which has proven to reduce the risk of recurrence in low-and low to intermediate-risk patients [5][6][7] and probably in all risk groups [8]. Patients with an intermediate to highrisk bladder cancer can be treated using repetitive immunotherapy using the Bacillus Calmette-Guérin (BCG) vaccine or by a series of treatments using intravesical chemotherapy [5].…”

Section: Introductionmentioning

confidence: 99%

Recurrence in Non-Muscle Invasive Bladder Cancer Patients: External Validation of the EORTC, CUETO and EAU Risk Tables and Towards a Non-Linear Survival Model

Lucas

Jansen

Oddens

et al. 2020

BLC

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BACKGROUND: EORTC, CUETO and EAU are the most commonly used risk stratification models for recurrence and progression in non-muscle invasive bladder cancer (NMIBC). OBJECTIVE: We assessed the predictive value of the EORTC, CUETO and EAU risk group stratification methods for our population and explore options to improve the predictive value using Cox Proportional Hazards (CPH), Boosted Cox regression and a non-linear Random Survival Forest (RSF) model. MATERIALS: Our retrospective database included of 452 NMIBC patients who underwent a transurethral resection of bladder tumor (TURBT) between 2000 and 2018 in our hospital. The cumulative incidence of recurrence was calculated at one- and five-years for all risk stratification methods. A customized CPH, Boosted Cox and RSF models were trained in order to predict recurrence, and the performances were compared. RESULTS: Risk stratification using the EORTC, CUETO and EAU showed small differences in recurrence probabilities between the risk groups as determined by the risk stratification. The concordance indices (C-index) were low and ranged between 0.51 and 0.57. The predictive accuracies of CPH, Boosted Cox and RSF models were also moderate, with C-indices ranging from 0.61 to 0.64. CONCLUSIONS: Prediction of recurrence in patients with NMIBC based on patient characteristics is difficult. Alternative (non-linear) approaches have the potential to improve the predictive value. Nonetheless, the currently used characteristics are unable to properly stratify between the recurrence risks of patients.

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939 Systematic review and individual patient data meta-analysis of randomized trials comparing a single immediate instillation of chemotherapy after transurethral resection to transurethral resection alone in patients with stage pTa-pT1 urothelial carcinoma of the bladder

Cited by 13 publications

References 0 publications

Risk‐adapted management of low‐grade bladder tumours: recommendations from the International Bladder Cancer Group (IBCG)

Risk‐adapted management of low‐grade bladder tumours: recommendations from the International Bladder Cancer Group (IBCG)

Intravesical device-assisted therapies for non-muscle-invasive bladder cancer

Recurrence in Non-Muscle Invasive Bladder Cancer Patients: External Validation of the EORTC, CUETO and EAU Risk Tables and Towards a Non-Linear Survival Model

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