Decaestecker Karel, Lumen Nicolaas, Ringoir Annelies, Oosterlinck Willem
Department of Urology, Ghent University Hospital, Ghent, Belgium.
Urol Int. 2016;96(1):14-9. doi: 10.1159/000377639. Epub 2015 Mar 14.
The efficacy of intravesical chemotherapy in abolishing small papillary recurrences of non-muscle-invasive bladder cancer (NMIBC), the disease-free interval in responders and patients' preferences were explored.
When a small (≤1 cm) papillary recurrence of a NMIBC was diagnosed, the patient could choose between immediate transurethral resection of the bladder (TURB) or four weekly intravesical instillations with mitomycin C (MMC) or epirubicin (ERC). Control cystoscopy was scheduled 2-3 weeks after the last instillation. Complete remission was defined as total disappearance of all papillary tumours and negative cytology.
25 patients with 47 recurrence episodes were recruited from February 2003 until August 2011. The median follow-up was 35 months. After exclusion of 2 patients with intolerance to the instillations, 45 study episodes could be analysed. All patients to whom this was proposed preferred the instillations over immediate TURB. Complete, partial and no response was seen in 23 (51%), 6 (13%) and 16 (36%) out of 45 episodes, respectively. The median disease-free interval after complete remission was 16 months (95% confidence interval 9-24).
Small papillary recurrences of NMIBC completely disappear in about half of the cases receiving four weekly bladder instillations with MMC or ERC. This is followed by a disease-free interval. Intravesical chemotherapy was preferred by all patients over immediate TURB.
探讨膀胱内化疗消除非肌层浸润性膀胱癌（NMIBC）小乳头状复发灶的疗效、缓解者的无病生存期及患者的偏好。
当诊断出NMIBC出现小（≤1 cm）乳头状复发时，患者可选择立即行经尿道膀胱肿瘤切除术（TURB），或每周一次膀胱内灌注丝裂霉素C（MMC）或表柔比星（ERC），共4周。在最后一次灌注后2 - 3周安排对照膀胱镜检查。完全缓解定义为所有乳头状肿瘤完全消失且细胞学检查阴性。
从2003年2月至2011年8月招募了25例患者，共47次复发。中位随访时间为35个月。排除2例对灌注不耐受的患者后，可分析45次研究病例。所有被建议的患者均更倾向于灌注而非立即行TURB。45次病例中，分别有23例（51%）、6例（13%）和16例（36%）出现完全缓解、部分缓解和无反应。完全缓解后的中位无病生存期为16个月（95%置信区间9 - 24）。
约一半接受MMC或ERC每周一次膀胱灌注4周的NMIBC小乳头状复发灶可完全消失，随后进入无病生存期。所有患者均更倾向于膀胱内化疗而非立即行TURB。
