Does photodynamic transurethral resection of bladder tumour improve the outcome of initial T1 high‐grade bladder cancer? A long‐term follow‐up of a randomized study

• Published in: BJU international Vol. 101; no. 5; pp. 566 - 569
• Main Authors: Denzinger, Stefan, Wieland, Wolf F., Otto, Wolfgang, Filbeck, Thomas, Knuechel, Ruth, Burger, Maximilian
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.03.2008; Blackwell
• Subjects: 5‐ALA; Adult; Aged; Aged, 80 and over; Antineoplastic Agents - therapeutic use; BCG Vaccine - therapeutic use; Biological and medical sciences; bladder cancer; Cystoscopy - methods; Disease-Free Survival; Female; Fluorescence; Follow-Up Studies; Humans; Light; Male; Medical sciences; Middle Aged; Neoplasm Invasiveness; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - prevention & control; Nephrology. Urinary tract diseases; progression; Prospective Studies; recurrence rate; T1 high‐grade; Treatment Outcome; Tumors of the urinary system; Urinary Bladder Neoplasms - mortality; Urinary Bladder Neoplasms - pathology; Urinary Bladder Neoplasms - prevention & control; Urinary Bladder Neoplasms - therapy; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Nephrology; Relapse; Prognosis; T1 high-grade; progression; Transurethral route; Urology; 5-Aminolevulinic acid; Randomization; Evolution; 5-ALA; Urinary system disease; Photodynamic therapy; Rate; recurrence rate; Urinary tract disease; Malignant tumor; Bladder cancer; Long term; Bladder tumor; High grade; Treatment; Follow up study; Bladder disease; Cancer; High malignancy
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/j.1464-410X.2007.07314.x

OBJECTIVE To evaluate, in a long‐term follow‐up of T1 high‐grade bladder cancer treated in a prospective, randomized trial, whether fluorescence diagnosis (FD) increases recurrence‐free survival (RFS) or reduces progression to muscle‐invasive stages. PATIENTS AND METHODS In all, 191 patients with suspected superficial bladder cancer were treated with transurethral resection under white light (WL) or with FD; 46 presented with initial T1 high‐grade BC (WL, 25; FD, 21). There were no differences in multifocality of tumours, concomitant carcinoma in situ or tumour size in either group. RESULTS Patients were followed for a median of 7.3 (WL) and 7.5 (FD) years to evaluate RFS. In the WL group there were 11, and in the FD group three, recurrent tumours of the same stage and grade. The RFS at 4 and 8 years was 69% and 52% in the WL, and 91% and 80% in FD group, respectively. With FD, the RFS was significantly longer according to Kaplan‐Meier analysis (P = 0.025). In the WL group, three (12%), and in the FD group four (19%) patients progressed to muscle‐invasive stages (≥ T2). CONCLUSION In initial T1 high‐grade bladder cancer, FD is significantly better than conventional WL transurethral resection for RFS. However, the progression rate to muscle‐invasive disease was not reduced by FD. Thus the clinical course (progression) of T1 high‐grade bladder cancer remains unaffected by FD.