Improved long-term outcome of patients with non-muscle invasive, low and intermediate risk bladder cancer between 1997 and 2014; a Swedish population-based study

Re: Rakesh Heer, Rebecca Lewis, Thenmalar Vadiveloo, et al. A Randomized Trial of PHOTOdynamic Surgery in Non-muscle-invasive Bladder Cancer. NEJM Evid. In press. https://doi.org/10.1056/EVIDoa2200092

“…Awareness of such differences in outcomes has contributed to the implementation of multiple measures to improve RFS for patients with NMIBC, including the use of PDD [3] . In addition, the effect of surgical experience on outcomes after TURB [4] might have been improved by education initiatives, and it is likely that technical advances for image quality and instruments for TURB have also contributed to improvements in long-term outcomes over time in population-based settings [5] .…”

Reply to Fredrik Liedberg and Johannes Bobjer’s Letter to the Editor re: Rakesh Heer, Rebecca Lewis, Thenmalar Vadiveloo, et al. A Randomized Trial of PHOTOdynamic Surgery in Non-muscle-invasive Bladder Cancer. NEJM Evid. In press. https://doi.org/10.1056/EVIDoa2200092

“…Liedberg and Bobjer for their comments relating to the recent PHOTO trial [1] , [2] . They point out that photodynamic diagnosis (PDD) is among the measures used to address the wide range of variability in recurrence rates among institutions in European Organisation for Research and Treatment of Cancer (EORTC) trials, a variability that is also noted among hospitals in Sweden [3] , [4] . The variability in recurrence rates in the EORTC review by Brausi et al [3] was most pronounced for those with multifocal tumours receiving adjuvant therapy (7–46%).…”