Results of CALIBER: A phase II randomised feasibility trial of chemoablation versus surgical management in low risk non-muscle invasive bladder cancer

TULA in recurrent non‐muscle invasive bladder cancer

“…On the other hand, a major concern with TULA would be the lack of biopsy with a small risk of grade progression (to Grade 3) and stage progression (to T1 or T2); although, it is reassuring that the EORTC risk tables suggest that risk of progression at one year in the LR NMIBC group is extremely low at 1%. A further concern is that a recent randomised trial of chemoablation in LR NMIBC (CALIBER) showed a surprisingly high biopsy‐proven three‐month recurrence rate ( ie residual disease) in the surgical control arm of 20%, many of who had ablation/fulguration rather than resection/excision, which raised concerns about incomplete destruction of a tumour with ablation compared to complete excision. In any case, the NICE bladder cancer guidelines recommend discharge of LR NMIBC patients who are recurrence‐free after 12 months.…”

“…A further practical issue is that recurrent LR NMIBC patients suitable for TULA are also the group that are most likely to benefit from a single post‐procedure instillation of mitomycin (EORTC recurrence score of <5, level of evidence 1a). Given the concerns around ablation leading to incomplete tumour destruction, it therefore makes sense to include a single instillation of chemotherapy following TULA for maximum benefit. This, in turn, further limits the use of TULA to a dedicated flexible cystoscopy list manned by trained and experienced staff.…”