Long-term decrease in bladder cancer recurrence with hexaminolevulinate enabled fluorescence cystoscopy.

Abstract

PURPOSE:

We assessed the impact of hexaminolevulinate fluorescence cystoscopic detection of papillary, nonmuscle invasive bladder cancer on the long-term recurrence rate.

MATERIALS AND METHODS:

Long-term followup was assessed in 551 participants enrolled in a prospective, randomized study of fluorescence cystoscopy for Ta or T1 urothelial bladder cancer. In the original study 280 patients in the white light cystoscopy group and 271 in the fluorescence cystoscopy group were followed with cystoscopy for 3, 6 and 9 months after initial resection or until recurrence. A study extension protocol was done for long-term followup of these patients.

RESULTS:

Followup information was obtained for 261 of the 280 patients (93%) in the white light group and 255 of the 271 (94%) in the fluorescence group. Median followup in the white light and fluorescence groups was 53.0 and 55.1 months, and 83 (31.8%) and 97 patients (38%) remained tumor free, respectively. Median time to recurrence was 9.4 months in the white light group and 16.4 months in the fluorescence group (p = 0.04). The intravesical therapy rate was similar in the 2 groups (46% and 45%, respectively). Cystectomy was done in 22 of 280 cases (7.9%) in the white light group and in 13 of the 271 (4.8%) in the fluorescence group (p = 0.16).

CONCLUSIONS:

Hexaminolevulinate fluorescence cystoscopy significantly improves long-term bladder cancer time to recurrence with a trend toward improved bladder preservation.

• Authors: H Barton Grossman, Arnulf Stenzl, Yves Fradet, Lance A Mynderse, Martin Kriegmair, J Alfred Witjes, Mark S Soloway, Alexander Karl, Maximilian Burger
• Journal: The Journal of urology (J Urol) Vol. 188 Issue 1 Pg. 58-62 (Jul 2012) ISSN: 1527-3792 [Electronic] United States
• PMID: 22583635 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial)
• Copyright: Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Chemical References

• Carbon Radioisotopes
• Photosensitizing Agents
• Aminolevulinic Acid
• 5-aminolevulinic acid hexyl ester

Topics

• Aged
• Aminolevulinic Acid (analogs & derivatives)
• Canada (epidemiology)
• Carbon Radioisotopes
• Cystoscopy (methods)
• Diagnosis, Differential
• Europe (epidemiology)
• Female
• Fluorescence
• Follow-Up Studies
• Humans
• Male
• Morbidity (trends)
• Neoplasm Invasiveness (diagnosis)
• Neoplasm Recurrence, Local (diagnosis, epidemiology)
• Neoplasm Staging (methods)
• Photosensitizing Agents
• Prospective Studies
• Reproducibility of Results
• Time Factors
• United States (epidemiology)
• Urinary Bladder Neoplasms (diagnosis, surgery)