Routine Use of Single Instillation of Epirubicin after Transurethral Resection of Bladder Tumor

To study the impact of single instillation of epirubicin (SIE) on the cancer recurrence of non-muscle invasive bladder cancer (NMIBC) after transurethral resection of bladder tumor (TURBT) in Korean patients. The major inclusion criteria were NMIBC patients. The major exclusion criteria were muscle invasive bladder cancer, metastatic bladder cancer, combined urinary upper tract tumor, and carcinoma in situ. SIE group received 50 mg epirubicin within 6 hours after TURBT. Non-SIE group did not receive epirubicin. This study enrolled a total of 214 patients diagnosed as having NMIBC during the period from October 2003 through January 2010 at the single institutions. Follow-up of the patients was conducted through January 2012. The median age of patients was 63.4 years. Of 112 evaluable patients in the SIE group, cancer recurrence rate was 33.9% and in non-SIE group, cancer recurrence rate was 62.7% (p＜0.001). The recurrence-free survival duration was longer in Group SIE compared with Group non-SIE (p＜0.001). Multivariate analysis revealed that SIE was significantly associated with cancer recurrence (HR 0.213, p＜0.001). We confirmed the impact of SIE on the cancer recurrence in the Korean patients who underwent TURBT for NMIBC. Single instillation of chemo-agent after TUR-B might be recommended in Korean patients for reduce bladder cancer recurrence and provide longer recurrence-free survival duration.

[1]  K. Koo,et al.  Epidemiology and Treatment Patterns of Urologic Cancers in Korea , 2015 .

[2]  S. Minner,et al.  The Impact of Tumor Diameter and Tumor Necrosis on Oncologic Outcomes in Patients With Urothelial Carcinoma of the Bladder Treated With Radical Cystectomy. , 2015, Urology.

[3]  J. Pow-Sang,et al.  Effect of tumor size on recurrence-free survival of upper tract urothelial carcinoma following surgical resection. , 2014, Urologic oncology.

[4]  H. J. Kim,et al.  The Direct Anti-Cancer Effect of a Single Instillation of Epirubicin after Transurethral Resection of Bladder Tumor for Non-Muscle-Invasive Bladder Cancer , 2012, Korean journal of urology.

[5]  W. Larchian,et al.  Non–Muscle-Invasive Bladder Cancer (Ta, T1, and CIS) , 2012 .

[6]  Sang Deuk Kim,et al.  Clinical significance of immediate urine cytology after transurethral resection of bladder tumor in patients with non‐muscle invasive bladder cancer , 2011, International journal of urology : official journal of the Japanese Urological Association.

[7]  M. Soloway,et al.  "Complete transurethral resection of bladder tumor": are the guidelines being followed? , 2010, Urology.

[8]  W. Kassouf,et al.  Biomarkers for detection and surveillance of bladder cancer. , 2013, Canadian Urological Association journal = Journal de l'Association des urologues du Canada.

[9]  M. Babjuk,et al.  EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder. , 2008, European urology.

[10]  S. Holmäng,et al.  A single instillation of epirubicin after transurethral resection of bladder tumors prevents only small recurrences. , 2008, The Journal of urology.

[11]  J Alfred Witjes,et al.  Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials. , 2006, European urology.

[12]  E. Kaasinen,et al.  Perioperative single dose instillation of epirubicin or interferon-alpha after transurethral resection for the prophylaxis of primary superficial bladder cancer recurrence: a prospective randomized multicenter study--FinnBladder III long-term results. , 2002, The Journal of urology.

[13]  M. Noguchi,et al.  Intravesical adjuvant chemotherapy for superficial transitional cell bladder carcinoma: results of a randomized trial with epirubicin comparing short-term versus long-term maintenance treatment , 2002, Cancer Chemotherapy and Pharmacology.

[14]  E. Kaasinen,et al.  Factors explaining recurrence in patients undergoing chemoimmunotherapy regimens for frequently recurring superficial bladder carcinoma. , 2002, European urology.

[15]  Y. Ohno,et al.  Randomized study of single early instillation of (2″R)‐4′‐O‐tetrahydropyranyl‐doxorubicin for a single superficial bladder carcinoma , 2002, Cancer.

[16]  A. Böhle.  Perioperative single dose instillation of epirubicin or interferon-alpha after transurethral resection for the prophylaxis of primary superficial bladder cancer recurrence: a prospective randomized multicenter study - Finnbladder III long-term results. , 2002, International braz j urol : official journal of the Brazilian Society of Urology.

[17]  M. Soloway,et al.  Current bladder tumor tests: does their projected utility fulfill clinical necessity? , 2001, The Journal of urology.

[18]  T. Otani,et al.  A Randomized Study of Short-v ersus Long-Term Intravesical Epirubicin Instillation for Superficial Bladder Cancer , 1998, European Urology.

[19]  T. Otani,et al.  A randomized study of short-versus long-term intravesical epirubicin instillation for superficial bladder cancer. Nagoya University Urological Oncology Group. , 1998, European urology.

[20]  H. Akaza.  New strategy of bio-chemoprevention on recurrence of superficial bladder cancer based on a hypothesis of the mechanism of recurrence. , 1997, Gan to kagaku ryoho. Cancer & chemotherapy.

[21]  A. Nabeeh,et al.  Single-dose versus multiple instillations of epirubicin as prophylaxis for recurrence after transurethral resection of pTa and pT1 transitional-cell bladder tumours: a prospective, randomized controlled study. , 1997, British journal of urology.

[22]  R Sylvester,et al.  A prospective European Organization for Research and Treatment of Cancer Genitourinary Group randomized trial comparing transurethral resection followed by a single intravesical instillation of epirubicin or water in single stage Ta, T1 papillary carcinoma of the bladder. , 1993, The Journal of urology.

[23]  G. Barbalias,et al.  Intravesical instillations of 4-epi-doxorubicin (epirubicin) in the prophylactic treatment of superficial bladder cancer: results of a controlled prospective study. , 1992, The Journal of urology.

[24]  R. J. Cersosimo,et al.  Epirubicin: a review of the pharmacology, clinical activity, and adverse effects of an adriamycin analogue. , 1986, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[25]  M. Soloway,et al.  Susceptibility of urothelium to neoplastic cellular implantation. , 1975, Urology.