Comparison of Different Treatment Schedules of Mitomycin C Intravesical Instillation in High-Risk Superficial Bladder Cancer Patients

Hong-Ray Chen; Chien-Chang Kao; Chih-Wei Tsao; Shou-Hung Tang; Meng En; Tai-Lung Cha; Guang-Huan Sun; Seng-Tang Wu; Dah-Shyong Yu

doi:10.1055/a-0750-5595

Aktuelle Urol 2019; 50(03): 292-297
DOI: 10.1055/a-0750-5595

Original Article

Comparison of Different Treatment Schedules of Mitomycin C Intravesical Instillation in High-Risk Superficial Bladder Cancer Patients

Vergleich verschiedener Behandlungsschemata einer intravesikalen Instillation von Mitomycin C bei Patienten mit oberflächlichem High-Risk-Harnblasenkarzinom

Authors

Hong-Ray Chen

Tri-Service General Hospital, Urology, National Defense Medical Center Taiwan, Taipei, Taiwan
Chien-Chang Kao

Tri-Service General Hospital, Urology, National Defense Medical Center Taiwan, Taipei, Taiwan
Chih-Wei Tsao

Tri-Service General Hospital, Urology, National Defense Medical Center Taiwan, Taipei, Taiwan
Shou-Hung Tang

Tri-Service General Hospital, Urology, National Defense Medical Center Taiwan, Taipei, Taiwan
Meng En

Tri-Service General Hospital, Urology, National Defense Medical Center Taiwan, Taipei, Taiwan
Tai-Lung Cha

Tri-Service General Hospital, Urology, National Defense Medical Center Taiwan, Taipei, Taiwan
Guang-Huan Sun

Tri-Service General Hospital, Urology, National Defense Medical Center Taiwan, Taipei, Taiwan
Seng-Tang Wu

Tri-Service General Hospital, Urology, National Defense Medical Center Taiwan, Taipei, Taiwan
Dah-Shyong Yu

Tri-Service General Hospital, Urology, National Defense Medical Center Taiwan, Taipei, Taiwan

Abstract

Objective This study was performed to compare the efficacy of intravesical mitomycin C (MMC) instillation for the prophylaxis of Ta or T1 high-risk nonmuscle invasive bladder cancer (NMIBC) using different schedules.

Materials and methods This retrospective cohort study was conducted on 152 patients treated with intravesical MMC from April 2009 to September 2016. The mean follow-up time was 32.67 months. All patients underwent a complete transurethral resection of bladder tumor (TURBT) and postoperative instillation of MMC within 24 h. The patients were divided into 4 treatment groups: Group 1 was followed-up without any maintenance MMC dose treatment; Group 2 received an MMC instillation once per week for the first 8 weeks; Group 3 received an MMC instillation once per week for the first 8 weeks, and once per month for the following 6 months; and Group 4 received an MMC instillation once per week for the first 8 weeks, and once per month for the following 12 months.

Results The overall recurrence rate was 27.6 %. Group 1 had a significantly high (p < 0.05) recurrence rate of 50 %, while there was no difference in the recurrence rate between the last 3 schedules (Group 2:15 %; Group 3: 24.1 %; group 4: 27.2 %). Moreover, the recurrence rates of Ta or T1 tumors, and low-grade or high-grade tumors were not statistically different among these patient groups.

Conclusion Our comparison of the different schedules of intravesical MMC instillation revealed a significantly higher recurrence rate with one MMC instillation post-TURBT than in patients with a maintenance dose of 8 weeks, 6 months, and 12 months. The time of the MMC maintenance schedule exhibited no significant differences between 8 weeks and 12 months. Thus, we conclude that for T1 or Ta high-risk NMIBC, MMC instillation can be performed once after TURBT, followed by a maintenance treatment once per week for 8 weeks.

Zusammenfassung

Ziel Diese Studie erfolgte zum Vergleich der Wirksamkeit einer intravesikalen Instillation von Mitomycin C (MMC) zur Prävention eines nicht muskelinvasiven Ta- oder T1-High-Risk-Harnblasenkarzinoms (NMIBC) unter Verwendung verschiedener Schemata.

Material und Methoden Diese retrospektive Kohortenstudie wurde bei 152 Patienten durchgeführt, die zwischen April 2009 und September 2016 mit einer intravesikalen MMC-Injektion behandelt wurden. Der mittlere Nachbeobachtungszeitraum lag bei 32,67 Monaten. Alle Patienten unterzogen sich einer vollständigen transurethralen Resektion des Blasentumors (TURBT), an die sich innerhalb von 24 Stunden eine postoperative Instillation von MMC anschloss. Die Patienten wurden in 4 Behandlungsgruppen unterteilt: Bei Gruppe 1 erfolgte die Nachbeobachtung ohne MMC-Erhaltungsdosis; Gruppe 2 erhielt in den ersten 8 Wochen einmal pro Woche eine MMC-Instillation; Gruppe 3 erhielt in den ersten 8 Wochen einmal pro Woche und in den darauffolgenden 6 Monaten einmal pro Monat eine MMC-Instillation; Gruppe 4 erhielt in den ersten 8 Wochen einmal pro Woche und in den darauffolgenden 12 Monaten einmal pro Monat eine MMC-Instillation.

Ergebnisse Die allgemeine Rezidivrate lag bei 27,6 %. Gruppe 1 zeigte eine signifikant hohe (p < 0,05) Rezidivrate von 50 %, während sich bei den Rezidivraten der übrigen 3 Schemata kein Unterschied fand (Gruppe 2: 15 %; Gruppe 3: 24,1 %; Gruppe 4: 27,2 %). Darüber hinaus zeigte sich zwischen diesen Patientengruppen kein statistischer Unterschied bei den Rezidivraten von Ta- oder T1-Tumoren sowie niedrig- oder hochgradigen Tumoren.

Schlussfolgerung Unser Vergleich der verschiedenen Schemata einer intravesikalen MMC-Instillation ergab bei einer einzigen MMC-Instillation nach TURBT eine signifikant höhere Rezidivrate als bei Patienten, die nach 8 Wochen, 6 Monaten und 12 Monaten eine Erhaltungsdosis erhielten. Zeitlich fanden sich beim MMC-Erhaltungsschema keine signifikanten Unterschiede zwischen der 8. Woche und dem 12. Monat. Daraus folgern wir, dass bei T1- oder Ta-High-Risk-NMIBC nach TURBT einmalig eine MMC-Instillation mit anschließender Erhaltungstherapie mit einmal wöchentlicher Verabreichung über 8 Wochen durchgeführt werden kann.

Keywords

bladder - Mitomycin C - intravesical instillation - high-risk - urothelial cell carcinoma

Schlüsselwörter

Blase - Mitomycin C - intravesikale Instillation - hohes Risiko - Urothelzellkarzinom

Full Text

References

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