OBJECTIVES: Intravesical chemotherapy has been studied in randomized clinical trials for >30 yr; however, the optimal schedule and duration of treatment are unknown. The objective is to determine the effect of schedule and duration of intravesical chemotherapy on recurrence in patients with stage Ta T1 bladder cancer. METHODS: A systematic review was conducted of the published results of randomized clinical trials that compared intravesical instillations with respect to their number, frequency, timing, duration, dose, or dose intensity. RESULTS: One immediate instillation after transurethral resection (TUR) is recommended in all patients. In low-risk patients, no further treatment is recommended before recurrence. In patients with multiple tumors, one immediate instillation is insufficient treatment. Additional instillations may further reduce the recurrence rate; however, no recommendations can be made concerning their optimal duration. A short intensive schedule of instillations within the first 3-4 mo after an immediate instillation may be as effective as longer-term treatment schedules (grade C). Instillations during > or =1 yr in intermediate-risk patients seem advisable only when an immediate instillation has not been given (grade C). Higher drug concentrations and optimization of the drug's concentration in the bladder may provide better results (grade C). CONCLUSIONS: The optimal schedule and duration of intravesical chemotherapy after an immediate instillation remain unknown. Future studies should focus on the eradication of residual disease after TUR and the prevention of late recurrences.
OBJECTIVES: Intravesical chemotherapy has been studied in randomized clinical trials for >30 yr; however, the optimal schedule and duration of treatment are unknown. The objective is to determine the effect of schedule and duration of intravesical chemotherapy on recurrence in patients with stage Ta T1 bladder cancer. METHODS: A systematic review was conducted of the published results of randomized clinical trials that compared intravesical instillations with respect to their number, frequency, timing, duration, dose, or dose intensity. RESULTS: One immediate instillation after transurethral resection (TUR) is recommended in all patients. In low-risk patients, no further treatment is recommended before recurrence. In patients with multiple tumors, one immediate instillation is insufficient treatment. Additional instillations may further reduce the recurrence rate; however, no recommendations can be made concerning their optimal duration. A short intensive schedule of instillations within the first 3-4 mo after an immediate instillation may be as effective as longer-term treatment schedules (grade C). Instillations during > or =1 yr in intermediate-risk patients seem advisable only when an immediate instillation has not been given (grade C). Higher drug concentrations and optimization of the drug's concentration in the bladder may provide better results (grade C). CONCLUSIONS: The optimal schedule and duration of intravesical chemotherapy after an immediate instillation remain unknown. Future studies should focus on the eradication of residual disease after TUR and the prevention of late recurrences.
Authors: D A Tolley; M K Parmar; K M Grigor; G Lallemand; L L Benyon; J Fellows; L S Freedman; K M Grigor; R R Hall; T B Hargreave; K Munson; D W Newling; B Richards; M R Robinson; M B Rose; P H Smith; J L Williams; P Whelan Journal: J Urol Date: 1996-04 Impact factor: 7.450
Authors: H Huland; G Klöppel; I Feddersen; U Otto; W Brachmann; H Hubmann; J Kaufmann; W Knipper; F Lantzius-Beninga; E Huland Journal: J Urol Date: 1990-07 Impact factor: 7.450
Authors: T Ueda; S Naito; A Iguchi; K Sagiyama; Y Osada; A Ariyoshi; T Omoto; J Kumazawa Journal: Cancer Chemother Pharmacol Date: 1992 Impact factor: 3.333
Authors: William B Tabayoyong; Ashish M Kamat; Michael A O'Donnell; James M McKiernan; Mohamed D Ray-Zack; Joan Palou; Maurizio Brausi; Peter C Black; Stephen B Williams Journal: Eur Urol Focus Date: 2018-09-03
Authors: Christian Bolenz; Christel Weiss; Melanie Wenzel; Ute Gabriel; Annette Steidler; Andreas Becker; Edwin Herrmann; Lutz Trojan; Maurice Stephan Michel Journal: J Cancer Res Clin Oncol Date: 2008-10-22 Impact factor: 4.553
Authors: Ashish M Kamat; Richard J Sylvester; Andreas Böhle; Joan Palou; Donald L Lamm; Maurizio Brausi; Mark Soloway; Raj Persad; Roger Buckley; Marc Colombel; J Alfred Witjes Journal: J Clin Oncol Date: 2016-01-25 Impact factor: 44.544