Intraoperative prophylactic intravesical chemotherapy to reduce bladder recurrence following radical nephroureterectomy

Freifeld, Yuval; Ghandour, Rashed; Singla, Nirmish; Woldu, Solomon L.; Bagrodia, Aditya; Lotan, Yair; Rapoport, L.; Gazimiev, Magomet; Delafuente, Karen; Kulangara, Rohan; Robyak, Haley; Petros, Firas; Raman, Jay D.; Matin, Surena F.; Margulis, Vitaly

doi:10.1016/j.urolonc.2020.05.002

Cited by 16 publications

(15 citation statements)

References 18 publications

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“…The majority of their cohort, 81% received intra-operative IVC compared to 19% who received post-operative IVC (38). Similar BTR rates were noted in those who received intra-operative versus post-operative IVC instillations (18% 12 month BTR for intra-operative IVC group, 28% for the post-operative IVC group, P=0.365) (38). On multivariate analysis, tumor focality was the only independent predictor of BTR.…”

Section: Timing Of Perioperative Ivc Administrationmentioning

confidence: 65%

Section: Timing Of Perioperative Ivc Administrationmentioning

confidence: 99%

“…A multi-center retrospective analysis of 137 patients who received intra-operative or post-operative MMC or gemcitabine were evaluated for BTR (38). The majority of their cohort, 81% received intra-operative IVC compared to 19% who received post-operative IVC (38). Similar BTR rates were noted in those who received intra-operative versus post-operative IVC instillations (18% 12 month BTR for intra-operative IVC group, 28% for the post-operative IVC group, P=0.365) (38).…”

Section: Timing Of Perioperative Ivc Administrationmentioning

confidence: 99%

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Predicting and Decreasing Bladder Tumor Recurrence Following Nephroureterectomy

et al. 2022

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Following radical nephroureterectomy for upper tract urothelial carcinoma, bladder tumor recurrence is a common event occurring in up to 22-47% of cases within the first post-operative year. In this review, we summarize the current knowledge on predictors of bladder tumor recurrence after radical nephroureterectomy and methods for reducing the risk of bladder tumor recurrence. Risk factors can be classified as modifiable and non-modifiable. Of these, the treating urologist has the greatest potential to decrease bladder tumor recurrence by focusing on treatment specific risk factors. Procedures which may decrease the risk of bladder tumor recurrence include limiting diagnostic ureteroscopy with biopsy to cases with equivocal diagnosis, use of perioperative intravesical chemotherapy, and complete distal ureterectomy with bladder cuff excision. Ongoing studies evaluating the timing and choice of intravesical chemotherapy during/after radical nephroureterectomy may help to further reduce bladder tumor recurrence in the future.

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Section: Timing Of Perioperative Ivc Administrationmentioning

confidence: 65%

Section: Timing Of Perioperative Ivc Administrationmentioning

confidence: 99%

Section: Timing Of Perioperative Ivc Administrationmentioning

confidence: 99%

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Predicting and Decreasing Bladder Tumor Recurrence Following Nephroureterectomy

et al. 2022

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“…In addition to postoperative intravesical instillation, would clinicians apply intraoperative intravesical chemotherapy for UUT-UC patients during surgery? After searching electronic databases, a meta-analysis identifying two related studies was conducted, and the results suggested that the intraoperative instillation group was associated with a decrease in the risk of bladder recurrence compared with the postoperative instillation group (RR, 2.64; 95% CI, 1.20–5.83; p =0.016) [ 53 , 54 ]. Moriarty et al proposed the safety of intraoperative instillation, which can ensure the earliest and safest delivery method while eliminating the concerns of delaying instillation due to extravasation [ 55 ].…”

Section: Discussionmentioning

confidence: 99%

Assessment of Therapeutic Benefit and Option Strategy on Intravesical Instillation for Preventing Bladder Cancer Recurrence after Radical Nephroureterectomy in Patients with Upper Urinary Tract Urothelial Carcinoma

Fan

Teng

Sun

et al. 2022

Journal of Oncology

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Objective. Upper urinary tract urothelial carcinoma (UUT-UC) is a very aggressive disease, characterized by 22%–50% of patients suffering from subsequent bladder recurrence after radical nephroureterectomy (RNU). Although the therapy of intravesical instillation is reported to be effective in preventing bladder recurrence, no study had been reported in Northeast China. The findings relating to the clinical effectiveness of intravesical instillation after RNU are somewhat controversial, and the best efficacy and least adverse effects of instillation drugs have not been widely accepted. Here, we aimed at evaluating the efficacy of intravesical instillation for the prevention intravesical recurrence systematically. Methods. In this retrospective cohort study, from October 2006 to September 2017, 158 UUT-UC patients underwent RNU were divided into 4 groups: epirubicin (EPB) instillation group, hydroxycamptothecin (HCPT) instillation group, bacillus Calmette–Guerin (BCG) instillation group, and noninstillation group. Cox univariate and multivariate analyses were employed to identify the risk factors for intravesical recurrence-free survival (IVRFS). The nomogram model was also applied to predict patient outcomes. Subsequently, to evaluate the clinical significance of intravesical instillation comprehensively, several databases including PubMed, Ovid, and Embase were searched and data from published studies with our results were combined by direct meta-analysis. Moreover, a network meta-analysis comparing instillation therapies was conducted to evaluate the clinical efficacy of different instillation drugs. Results. In our retrospective cohort study, the Kaplan–Meier survival curve demonstrated noninstillation groups were associated with worsened IVRFS. Meanwhile, multivariate analysis indicated that intravesical instillation was independent protective factors for IVRFS (hazard ratio [HR] = 0.731). Moreover, calibration plots, receiver operating characteristic (ROC) curves, area under the curve (AUC) values, and the C-index showed the priority of nomogram’s predictive accuracy. Next, direct meta-analysis including 19 studies showed that intravesical instillation could prevent the recurrence of bladder cancer with a pooled risk ratio (RR) estimate of 0.53. Subgroup analysis by study type, year of intravesical recurrence, first instillation time, and instillation times also confirmed the robustness of the results. Moreover, intraoperative instillation was associated with a decrease in the risk of bladder recurrence compared with postoperative instillation. Then, a network meta-analysis including 7 studies indicated that pirarubicin (THP) (surface under the cumulative ranking curve [SUCRA] = 89.2%) is the most effective therapy to reduce the risk of bladder recurrence, followed by BCG (SUCRA = 83.5%), mitomycin C (MMC) (SUCRA = 53.6%), EPB (SUCRA = 52.6%), and HCPT (SUCRA = 5.1%) after the analysis of the value ranking. Conclusions. A maintenance schedule of intravesical instillation prevents the recurrence of bladder cancer after RNU in UUT-UC patients effectively. Large, prospective trials are needed to further confirm its value. Compared with other chemotherapy regimens, THP may be a promising drug with favorable efficacy to prevent bladder recurrence. As included studies had moderate risk of bias, the results of network meta-analysis should be applied with caution.

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“…'s [17 ▪▪ ] MMC prospective trial and of Freifeld et al . 's [18 ▪ ] retrospective study with MMC or gemcitabine, the efficacy, feasibility, and safety of intraoperative intravesical instillation to the UUT have also shown significantly better results than postoperative intravesical instillation in reducing the post-RNU recurrence of UTUC.…”

Section: Intravesical Instillationmentioning

confidence: 99%

Drug instillation in the management of urinary tract urothelial carcinoma

Kim

Lerner

2022

Current Opinion in Urology

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Purpose of reviewThis article aimed to investigate the efficacy of drug instillation therapy in preventing the recurrence of postsurgical upper urinary tract urothelial carcinoma (UTUC) by reviewing recently published research articles.Recent findingsSeveral clinical trials have shown new potential forms of postsurgical intracavitary and intravesical drug instillation methodologies with better efficacy and less toxicity for use in UTUC. With the improvement of endoscopic imaging techniques and laser sciences, diverse attempts in drug instillation have shown an improved recurrence rate after kidney-sparing surgery in low-grade, low-tumor burden cancers in the upper urinary tract. A gel-form type of mitomycin-C in intracavitary instillation further reduced recurrence rates in UTUC. Other studies have compared different drug instillation methodologies with varying initiation times and timed instillation. They have shown that early instillation with multiple rounds resulted in better protective effects for recurrence rates before, during, and after surgery.SummaryA new gel-form of intracavitary instillation of mitomycin-C, the timing of drug instillation, and refining techniques can result in better recurrence-free survival of patients with UTUC after surgery. Further large-scale prospective clinical trials are needed to validate these new forms of drugs and methodologies to change the therapeutic guidelines of UTUC.

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Intraoperative prophylactic intravesical chemotherapy to reduce bladder recurrence following radical nephroureterectomy

Cited by 16 publications

References 18 publications

Predicting and Decreasing Bladder Tumor Recurrence Following Nephroureterectomy

Predicting and Decreasing Bladder Tumor Recurrence Following Nephroureterectomy

Assessment of Therapeutic Benefit and Option Strategy on Intravesical Instillation for Preventing Bladder Cancer Recurrence after Radical Nephroureterectomy in Patients with Upper Urinary Tract Urothelial Carcinoma

Drug instillation in the management of urinary tract urothelial carcinoma

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