CHOICE OF ADJUVANT INTRAVESICAL THERAPY IN RECURRING INTERMEDIATE-RISK NMI-BC

Risultato della ricerca: Other

Abstract

Objective: The therapeutic strategy for patients affected byintermediate risk non-muscle invasive bladder cancer (NMIBC)recurring after intravesical therapy is not definitivelyestablished. Only few studies have been published on secondlineintravesical therapy. BCG is advocated when intravesicalchemotherapy fails and is often repeated. On the other hand,some patients that suffer recurrence repeat intravesicalchemotherapy. A retrospective analysis of 179 intermediateriskpatients submitted to second-line intravesical therapy isreported. Patients and Methods: The clinical files of patientsaffected by intermediate risk NMI-BC and submitted tosecond-line adjuvant intravesical therapy were reviewed.Patients not receiving at least six instillations of BCG orintravesical chemotherapy after the first diagnosis and againafter the transurethral resection (TUR) of the first recurrencewere excluded. Only mitomycin c and epirubicin wereaccepted as chemotherapy. Only patients with intermediaterisktumors with a recurrence-risk score between 5 and 9according to the EORTC risk tables and in absence of Tis wereselected. A multivariate analysis was performed forrecurrence-free survival (RFS) and progression, consideringfirst line intravesical therapy (BCG versus ICH), previousrecurrence-free interval, tumor T category, G grade,multiplicity, second-line intravesical therapy (BCG versusICH) and maintenance regimen. Results: The study included179 patients. Chemotherapy was administered as first-linetherapy in 131 (73.2%) and BCG in 48 (26.8%) patients.Second-line therapy was represented by BCG in 83 (46.4%)and chemotherapy in 96 (53.6%) patients, with maintenanceof at least 12 months in 31% and 38% of patients, respectively.Of the 48 patients previously treated by BCG, 40 (83.3%)received BCG again, while of the 131 previously treated bychemotherapy, 88 (67.2%) repeated it and 43 (32.8%) receivedBCG. At a median follow-up of 29 months after the secondTUR, 65 (36.3%) patients experienced recurrence, 25 (30.1%)and 40 (41.7%) after BCG and chemotherapy, respectively.Thirteen patients showed progression at a median interval of19 months. At multivariate analysis, no statistically significantcorrelation was detected. Surprisingly, no statistical differenceemerged in terms of recurrence-free interval between first- andsecond-line therapy and between BCG and chemotherapy assecond-line therapy at recurrence after chemotherapy (p=0.28)Conclusion: Almost 65% of patients experiencing recurrenceafter intravesical chemotherapy received intravesical therapyagain. No difference in efficacy was detected between firstandsecond-line therapies or between BCG and chemotherapygiven at recurrence after chemotherapy.
Lingua originaleEnglish
Pagine1818-1819
Numero di pagine2
Stato di pubblicazionePublished - 2011

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