Real-life Experience: Early Recurrence With Hexvix Photodynamic Diagnosis–assisted Transurethral Resection of Bladder Tumour vs Good-quality White Light TURBT in New Non–muscle-invasive Bladder Cancer

doi:10.1016/j.urology.2015.04.015

Urology

Volume 86, Issue 2, August 2015, Pages 327-331

https://doi.org/10.1016/j.urology.2015.04.015 Get rights and content

Objective

To compare early recurrence between good-quality white-light transurethral resection of bladder tumor (GQ-WLTURBT) and photodynamic diagnosis–assisted (PDD) transurethral resection of bladder tumor (TURBT) in a real-life controlled setting.

Methods

A prospective controlled study was conducted commencing with a planned prospective cohort of patients with new tumors undergoing white-light TURBT in 2007-2008. Previously defined principles of GQ-WLTURBT for standardization and comparison of TURBT techniques, which are (1) cystoscopic mapping using a bladder diagram, (2) documented complete resection of the tumor, (3) resection performed or supervised by an experienced surgeon, (4) presence of detrusor muscle in the specimen, and (5) patient receiving mitomycin C within 24 hours of the resection, were applied. This was followed by a prospective cohort of new patients undergoing PDD-TURBT in 2009-2011. Only patients with new non–muscle-invasive bladder cancer (NMIBC) deemed to have had complete first TURBT were included for analysis. Tumor features and findings at first check cystoscopy and early re-TURBT (in high-risk NMIBC) were evaluated. Early recurrence (for calculating recurrence rate at first follow-up cystoscopy) was defined as pathologically confirmed tumor on early re-TURBT or recurrence at the first check cystoscopy. Comparison was analyzed between GQ-WLTURBT and good-quality PDD-TURBT (GQ-PDDTURBT).

Results

A total of 808 patients were evaluated. The overall RRFFCs for GQ-WLTURBT and GQ-PDDTURBT were 30.9% and 13.6%, respectively (odds ratio = 2.9; 95% CI = 1.6-5.0; P <.001), with statistically significant lower recurrence rates in low- and intermediate-risk NMIBC after GQ-PDDTURBT.

Conclusion

Hexvix PDD-assisted TURBT is associated with a significantly lower risk of early recurrence compared with GQ-WLTURBT in a real-life clinical setting.

Section snippets

Methods

On the basis of recommendations of the Scottish Intercollegiate Guidelines Network guidelines,⁶ it was decided, in 2006, that we were going to introduce Hexvix (Hexaminolevilinate) PDD-assisted TURBT for all new bladder cancers into our service, and this service was to commence in April 2009. We therefore decided to use the prospective data collected on WL-TURBT in the next 2 years (ie, 2007 and 2008) to form the baseline or control cohort to compare and measure the benefits (or otherwise) of

Results

A total of 808 new bladder tumor patients were included, of whom 370 had PDD-TURBT and 438 had WL-TURBT. Patient and tumor demographics are described in Table 1. The proportion of intermediate-risk tumors appears higher in the PDD cohort.

The overall RRFFC (including residual disease at early re-TURBT in HR-NMIBC) for GQ-WLTURBT and GQ-PDDTURBT was 48 of 155 (30.9%) and 26 of 191 (13.6%), respectively (odds ratio = 2.9; 95% confidence interval = 1.6-5.0; P <.001). PDD-assisted TURBT was

Comment

Early recurrence after TURBT is most often the result of missed lesions or inadequate resection at the time of the initial TURBT, with tumor behavior, rarely, being a confounding factor. It is by improving tumor detection and enhancing tumor clearance that PDD-assisted TURBT is thought to effect its benefits.4, 7

To date, several randomized, controlled trials (RCTs) comparing PDD and white-light–assisted bladder tumor resections have established increased diagnostic sensitivity and lower

Conclusion

Hexvix PDD-TURBT is associated with a significant 56% reduction in early recurrence when compared with GQ-WLTURBT in our nontrial, “real-life” setting representing improvements in outcomes within the same service.

Acknowledgments

The authors thank other colleagues in the Edinburgh Urological Cancer Group, Mr Prasad Bollina, Mr Alan McNeill, and Mr Anthony Riddick. They also thank Dr Alison MacKay, Ms Narelle Gregor, and specialist registrars in the department who have carried out surveillance cystoscopy for patients in this study.

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Real-world experience with 5-aminolevulinic acid for photodynamic diagnosis of bladder cancer (2nd report): Reduced bladder recurrence after PDD-TURBT
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Citation Excerpt :
The postoperative recurrence rate was 13.6% among 370 patients who underwent HAL-TURBT and 30.9% among 438 patients who underwent GQ-WL-TURBT. TURBT under adjunct PDD thus significantly reduced the postoperative recurrence rate [6]. A subsequent prospective controlled study found that during a 3-year follow-up of real-life experience, HAL-TURBT using intravesical administration resulted in significantly better outcomes as compared with WL-TURBT [7].
Photodynamic diagnosis (PDD) with administration of oral aminolevulinic acid (ALA) prior to transurethral resection of bladder tumor (TURBT) can now be used for non-muscle invasive bladder cancer (NMIBC) in clinical settings in Japan. Since ALA was first marketed, a limited number of reports have described PDD-TURBT outcomes, and the effects of resecting false-positive tissue on outcomes have not been clarified.
This study compared tumor recurrence among NMIBC patients who underwent TURBT under either white light cystoscopy (WL) or PDD. In addition, the frequency of recurrence was compared between patients with or without false-positive lesions at the time of PDD-TURBT.
The frequency of recurrence in NMIBC patients (cumulative number of recurrences/cumulative number of follow-up days, number of recurrences/10,000 days), including progression to muscle-invasive bladder cancer (MIBC), was 12.80 in the WL-TURBT group and 5.82 in the PDD-TURBT group (p < 0.05). Tumor recurrence after TURBT was seen in 29 of 88 patients (33.0%) in the WL-TURBT group and 21 of 105 patients (20.0%) in the PDD-TURBT group (p < 0.05). Mean (± standard deviation) time to first recurrence was 249 ± 140 days in the WL-TURBT group and 419 ± 219 days in the PDD-TURBT group (p < 0.05). The frequency of recurrence in PDD-TURBT-group NMIBC patients was significantly lower in patients with resection of false-positive tissue (4.19/10,000 days) than in those without (9.00/10,000 days, p < 0.05).
The frequency of recurrence was lower and the time to recurrence was longer in the PDD-TURBT group than in the WL-TURBT group. The frequency of recurrence decreased with resection of false-positive resection.
A concise review on cancer treatment methods and delivery systems
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The ultimate purpose of current cancer research is to develop a comprehensive treatment for cancer. Recent studies have shown an increased interest in investigating the capacity of delivery systems and pharmaceutical conjugations for cancer treatment. However, in spite of all these efforts, few attempts have been made to summarize this growing body of work. This review discusses the wide range of recently developed cancer treatment methods, highlighting the latest advances in the development of delivery technologies. This study begins with looking at traditional strategies in cancer therapy, continued by the current potential nano-carriers introducing the novel designed systems. The comprehensive deduction of various applied methods considering the clinical progress also presented. The challenges involved in those promoted cancer treatments are then discussed, to provide a clear perspective on the future of effective delivery and treatment methods.
Predicting Grade and Stage at Cystoscopy in Newly Presenting Bladder Cancers—a Prospective Double-Blind Clinical Study
2017, Urology
Citation Excerpt :
As a part of a series of prospective studies on bladder cancer, this study included only consecutive patients with new bladder tumors to associate clinical grade and stage with tumor histology. The patients were from the cohorts of our study (from 2008) comparing Good Quality White Light TURBT and PDD-assisted TURBT.6 Just before resecting the tumor, using only white light cystoscopy (with standard white light, rigid cystoscopy equipment), urology consultants predicted the grade and stage and recorded these on a standard proforma along with tumor size, multiplicity, appearance, and completeness of resection.
To assess urologists' ability to predict the grade and stage of new bladder cancers from the cystoscopic features alone.
We conducted a prospective clinical study on consecutive patients who underwent transurethral resection of bladder tumor (TURBT) for new bladder cancers. Using only cystoscopic tumor morphology at the time of initial TURBT, 3 urology consultants predicted the grade and stage, recording these on a proforma along with tumor features. Predictions were compared with assessments by uropathologists, blinded to the clinical prediction. We analyzed the accuracy in (1) predicting the exact grade and stage of the cancer; (2) differentiating between low- and high-grade cancers; and (3) discerning between Ta, T1, and T2 cancers.
Of 248 patients, 224 were suitable for analysis. The positive predictive values for low- and high-grade cancers were 85.8% and 71.3%, respectively. The overall likelihood of a consultant predicting high-grade cancers as being low grade was 16/83 (19.3%). When tumors were large (>30 mm), this likelihood dropped significantly to 7.3% (4/55) (odds ratio = 3.1, 95% confidence interval = 1.0-9.7, P = .04). Non–muscle-invasive and muscle-invasive cancers were predicted accurately in 93.4% and 85.2% patients, respectively. Six of 161 (3.7%) tumors predicted to be non–muscle-invasive bladder cancer were actually muscle invasive on histology.
For clinical purposes, in newly presenting patients with bladder cancer, urologists appear to reliably predict lower grade and muscle-invasive disease, confirming widely held belief. This allows for appropriate and efficient use of surgical expertise, available technology, and selection of participants for clinical trials on the basis of prehistology risk categories.
Is a routine second transurethral resection of the bladder still necessary after hexaminolévulinate photodynamic diagnosis-assisted TURBT?
2019, Progres en Urologie
L’objectif de notre étude était d’étudier l’impact de l’utilisation de la luminofluorescence par hexaminolévulinate (HAL), sur le taux de tumeur résiduelle (TR) à la résection de réévaluation (re-RTUV).
Parmi tous les patients opérés dans notre centre d’une RTUV entre 2012–2017, 52 avaient eu une re-RTUV après primo-RTUV jugée complète et dans un délai < 3 mois. Nous avons comparé les patients ayant eu une primo-RTUV avec cystoscopie en lumière blanche suivie d’une re-RTUV sous HAL (group A, n = 30) et les patients ayant eu une primo-résection sous HAL suivie d’une re-RTUV en lumière blanche seule (group B, n = 22). Le taux de TR à la re-RTUV, le changement de groupe pronostique et/ou de stratégie thérapeutique, les facteurs prédictifs de TR, ainsi que les survies sans récidive et sans progression ont été analysés.
Le taux de TR était de 63,3 % dans le groupe A versus 0 % dans groupe B (p < 0,001). Dans le groupe A, 16,7 % des patients ont été reclassés dans un groupe pronostique plus sévère après re-RTUV, avec un impact sur la stratégie thérapeutique versus aucun dans le groupe B. En analyse multivariée, seule l’utilisation de la luminofluorescence à la primo-RTUV était un facteur prédictif indépendant de TR (p = 0,0031).
La qualité de la primo-RTUV, quand elle est optimisée par la cystoscopie en lumière bleue, a un impact significatif sur le taux de tumeur résiduelle à la re-RTUV et peut modifier la prise en charge des patients atteints de TVNIM.
4.
The aim of our study was to assess the impact of blue light cystoscopy with hexaminolevulinate on residual tumor rates at second-look transurethral resection of the bladder (TURB).
Among all patients undergoing TURB in our center between 2012 and 2017, 52 patients had a second-look after a first complete TURB with a delay < 3 months. We compare patients with standard white light cystoscopy/TURB then second-look blue light cystoscopy/re-TURB (group A, n = 30) and patients with blue light cystoscopy/TURB at the initial procedure then white light cystoscopy/re-TURB (group B, n = 22). The residual tumor rates at second-look, restaging and changing in therapeutic strategy, as well as recurrence free survival and progression rate were compared.
Residual tumor at the time of second-look cystoscopy was detected in 42.3% of cases in our cohort, with a significant difference between the two groups (63.3% in group A versus 0% in group B, < 0.001). In group A, 16.7% (5/30) of patients had upstaging and/or upgrading at second-look cystoscopy, resulting in a change in therapeutic strategy in most cases (4/5) while none upstaging was observed in group B. In multivariate analysis, the use of luminofluorescence at the first TURB was the only independent predictive factor of residual tumor (P = 0.0031).
The quality of the initial TURB, when performed by using blue light cystoscopy, had a significant impact on the rate of residual tumor at the second-look resection and could modify therapeutic strategy of NMIBC.
4.
Absence of detrusor muscle in TUR-BT specimen – can we predict who is at highest risk?
2023, BMC Urology
Photodynamic Therapy for Bladder Cancers, A Focused Review<sup>†</sup>
2023, Photochemistry and Photobiology

View all citing articles on Scopus

: Financial Disclosure: The authors declare that they have no relevant financial interests.

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OncologyReal-life Experience: Early Recurrence With Hexvix Photodynamic Diagnosis–assisted Transurethral Resection of Bladder Tumour vs Good-quality White Light TURBT in New Non–muscle-invasive Bladder Cancer

Objective

Methods

Results

Conclusion

Section snippets

Methods

Results

Comment

Conclusion

Acknowledgments

Eur Urol Suppl

J Urol

J Urol

J Urol

Eur Urol

Am J preventative Med

Urol Clin North Am

J Urol

Eur Urol

J Urol

J Urol

Oncology
Real-life Experience: Early Recurrence With Hexvix Photodynamic Diagnosis–assisted Transurethral Resection of Bladder Tumour vs Good-quality White Light TURBT in New Non–muscle-invasive Bladder Cancer