Re-treatment by intravesical therapy in recurring patients affected by intermediate risk non-muscle invasive bladder cancer (NMIBC)

Rosalinda Allegro, Darvinio Melloni, Vincenzo Serretta, Francesco Sommatino, Valentina Billone

Risultato della ricerca: Otherpeer review


Introduction & Objectives: Up to 70% of patients affected by intermediate riskNMI-BC recur after intravesical therapy (IT). The majority of them will be retreatedby IT. The therapeutic strategy for these patients is not well defined. BCG isadvocated when intravesical chemotherapy (ICH) fails. However, some patientsare retreated by ICH and some others repeat BCG adopted as the first treatment.Not many studies have been published on second line IT. A retrospective analysison 179 intermediate-risk patients undergoing re-treatment by IT is presented.Materials & Methods: The clinical files of patients affected by NMI-BC recurringafter TUR and IT and retreated by IT were reviewed. The patients not receivingat least 6 instillations of BCG or ICH after the first diagnosis and again after theTUR of the first recurrence were excluded. Only mitomycin c and epirubicin wereaccepted as chemotherapy. Only intermediate-risk tumours with a recurrenceriskscore between 5 and 9 according to the EORTC Risk Tables and in absenceof Tis were selected. A multivariate analysis was performed for recurrence-freeinterval (RFI) and progression considering, first line IT (BCG versus ICH), previousrecurrence free interval, tumour’s T-category, G-grade, multiplicity, second line IT(BCG versus ICH) and maintenance regimen.Results: The study included 179 patients. The first line IT was ICH in 131 (73.2%)and BCG in 48 (26.8%) patients. The median RFI was 16 months. At recurrence,BCG in 83 (46.4%) and ICH in 96 (53.6%) patients were administered, withmaintenance of at least 12 months in 31% and 38% of patients respectively. Of the48 patients previously treated by BCG, 40 (83.3%) received BCG again, while ofthe 131 previously treated by ICH, 88 (67.2%) received ICH again and 43 (32.8%)BCG. Thus, only 8 patients received ICH at recurrence after BCG. At a medianfollow-up of 29 months, 65 (36.3%) patients recurred with a median RFI of 15months, 25 (30.1%) and 40 (41.7%) after BCG and ICH respectively. Thirteenpatients showed progression at a median interval of 19 months. At multivariateanalysis no statistically significant correlation was detected among the consideredparameters. Surprisingly, no statistical difference emerged in terms of RFI betweenfirst and second line IT (16 versus 15 months), and between patients receivingBCG or ICH as second line therapy at recurrence after ICH (=0.28).Conclusions: No reduction in RFI emerged in patients with intermediate-risk NMIBCrecurring after a first cycle of intravesical therapy and retreated by intravesicalchemotherapy or BCG. In patients recurring after intravesical chemotherapy,intravesical chemotherapy and BCG, as a second line therapy, resulted equallyeffective in preventing recurrence.
Lingua originaleEnglish
Numero di pagine2
Stato di pubblicazionePublished - 2011

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