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Intraoperative prophylactic intravesical chemotherapy to reduce bladder recurrence following radical nephroureterectomy
- Source :
- Urologic Oncology: Seminars and Original Investigations. 38:737.e11-737.e16
- Publication Year :
- 2020
- Publisher :
- Elsevier BV, 2020.
-
Abstract
- Purpose Single, postoperative instillation of prophylactic intravesical chemotherapy (pIVC) is effective in reducing bladder cancer recurrences following radical nephroureterectomy (RNU). Despite high level evidence, pIVC is underutilized. Intraoperative pIVC (I-pIVC) may be easier and safer to implement than postoperative pIVC (P-pIVC). We aimed to evaluate the efficacy of I-pIVC during RNU. Materials and methods Retrospective analysis of patients undergoing RNU and I-pIVC or postoperative pIVC (P-pVC) with 20 to 40 mg mitomycin-C or 1 to 2 g gemcitabine. Recurrence rates were evaluated using the Kaplan-Meier curves and log rank test. Cox regression was used for univariable and multivariable analysis. Results One hundred and thirty-seven patients were included in the final analysis. 81% (111/137) had I-pIVC and 19% (26/137) had P-pIVC. In the I-pIVC group higher rates of HG, muscle invasive disease and gemcitabine use were observed. Overall, 74% (101/137) and 26% (36/137) had mitomycin-C and gemcitabine instillations, respectively. Within 12 months 14% (19/137) of the patients experienced bladder recurrence. Median time to bladder recurrence was 7 months (range 3–27). Twelve months bladder recurrence-free survival rates were 82% for the I-pIVC group, and 72% for the P-pIVC group ((log rank P = 0.365). Conclusions I-pIVC during RNU may reduce bladder recurrence rates. Bladder recurrence rates are comparable to those reported using postoperative instillations. Intraoperative instillations may be easier to implement and may increase usage rates.
- Subjects :
- Male
medicine.medical_specialty
Mitomycin
Urology
030232 urology & nephrology
Nephroureterectomy
Intraoperative Period
03 medical and health sciences
0302 clinical medicine
Humans
Medicine
Aged
Retrospective Studies
Carcinoma, Transitional Cell
Antibiotics, Antineoplastic
Bladder cancer
Ureteral Neoplasms
business.industry
Proportional hazards model
Mitomycin C
Muscle invasive
Middle Aged
medicine.disease
Kidney Neoplasms
Gemcitabine
Log-rank test
Administration, Intravesical
Urinary Bladder Neoplasms
Oncology
030220 oncology & carcinogenesis
Level evidence
Female
Neoplasm Recurrence, Local
business
Intravesical chemotherapy
medicine.drug
Subjects
Details
- ISSN :
- 10781439
- Volume :
- 38
- Database :
- OpenAIRE
- Journal :
- Urologic Oncology: Seminars and Original Investigations
- Accession number :
- edsair.doi.dedup.....1eb7820ff7b30e10f2de830d3e06026f
- Full Text :
- https://doi.org/10.1016/j.urolonc.2020.05.002