Wong Chris Ho-Ming, Ko Ivan Ching-Ho, Leung David Ka-Wai, Yuen Steffi Kar-Kei, Chan Samson Yun-Sang, Yee Samuel Chi-Hang, Chiu Peter Ka-Fung, Ng Chi-Fai, Teoh Jeremy Yuen-Chun
SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.
SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China; Department of Urology, Medical University of Vienna, Vienna, Austria; European Association of Urology Young Academic Urologists Urothelial Cancer Working Group, Arnhem, The Netherlands.
Eur Urol Oncol. 2024 Dec;7(6):1171-1174. doi: 10.1016/j.euo.2024.05.006. Epub 2024 May 27.
The recurrence rate following endoscopic treatment of non-muscle-invasive bladder cancer (NMIBC) remains high. Standard treatment includes intravesical instillation of chemotoxic agents such as mitomycin C (MMC) to reduce recurrence. It is postulated that upfront administration of hyperthermic intravesical MMC (HIVEC) immediately after transurethral resection of bladder tumour (TURBT) may enhance its efficacy, but evidence from human trials is scant. This pilot study explored the safety of immediate intravesical MMC instillation following TURBT using a conductive HIVEC system (Combat BRS). Patients diagnosed with papillary bladder tumours scheduled for TURBT were recruited. Among 29 patients treated with HIVEC, there was minimal additional postoperative morbidity. The majority (79.3%) were discharged after a hospital stay of 1 d, and no patient required bladder irrigation. There were six grade I-II adverse events (20.7%) and one grade III event (3.4%). No recurrences were observed within 3 mo, and the 12-mo recurrence rate was 4.5%. The study findings demonstrate that immediate HIVEC MMC instillation following TURBT is safe. Further research is needed to assess long-term efficacy in comparison to standard cold MMC. PATIENT SUMMARY: Non-muscle-invasive bladder cancer is treated with tumour removal via a telescope inserted into the bladder through the urethra (called TURBT). We tested the safety of treating the bladder with a warm solution of a chemotherapy drug (mitomycin C) immediately after TURBT, as this may prevent tumour recurrence. The treatment was safe and well tolerated. Further trials are needed with more patients and longer follow-up to confirm the results.
非肌层浸润性膀胱癌（NMIBC）内镜治疗后的复发率仍然很高。标准治疗包括膀胱内灌注化学毒性药物，如丝裂霉素C（MMC），以降低复发率。据推测，在经尿道膀胱肿瘤切除术（TURBT）后立即进行热灌注膀胱内MMC（HIVEC）可能会提高其疗效，但人体试验的证据很少。这项前瞻性研究使用传导性HIVEC系统（Combat BRS）探索了TURBT后立即膀胱内灌注MMC的安全性。招募了计划接受TURBT的乳头状膀胱肿瘤患者。在29例接受HIVEC治疗的患者中，术后额外发病率极低。大多数患者（79.3%）住院1天后出院，无一例患者需要膀胱冲洗。有6例I-II级不良事件（20.7%）和1例III级事件（3.4%）。3个月内未观察到复发，12个月复发率为4.5%。研究结果表明，TURBT后立即进行HIVEC MMC灌注是安全的。需要进一步研究以评估与标准冷灌注MMC相比的长期疗效。患者总结：非肌层浸润性膀胱癌通过经尿道插入膀胱的望远镜切除肿瘤进行治疗（称为TURBT）。我们测试了TURBT后立即用化疗药物（丝裂霉素C）的温热溶液治疗膀胱的安全性，因为这可能预防肿瘤复发。该治疗安全且耐受性良好。需要更多患者和更长随访时间的进一步试验来证实结果。
