Efficacy of Bladder Intravesical Chemotherapy with Three Drugs for Preventing Non-Muscle-Invasive Bladder Cancer Recurrence

Epirubicin, gemcitabine, and pirarubicin are widely used as first-line drugs for intravesical chemotherapy to prevent tumor recurrence after transurethral bladder tumor resection for non-muscle-invasive bladder cancer (NMIBC). However, which drug is better is less discussed. A total of 335 NMIBC patients administered intravesical chemotherapy underwent transurethral bladder tumor resection (TURBT) in our hospital from October 2015 to October 2019. After TURBT, all the patients received standard intravesical chemotherapy. Through clinical data collection and telephone follow-up, the tumor recurrence and adverse reactions of all patients after bladder perfusion treatment were counted. Recurrence was defined as new tumor appearance in the bladder. Of the 335 patients who underwent intravesical chemotherapy, 109 patients received epirubicin and 114 patients and 112 patients were given gemcitabine and pirarubicin, respectively. According to the general information of the patients, the patients were divided into intermediate-risk and high-risk bladder cancer and compared separately. There was no statistical difference in clinical and pathological features between different groups ( P > 0.05 ). The recurrence rate of intermediate-risk bladder cancer patients shows no difference between three groups ( P > 0.05 ). As for the high-risk bladder cancer patients, it is found that the 1-year recurrence rate between three groups was not statistically significant ( P > 0.05 ), whereas the 2-year recurrence rate of patients given gemcitabine (9.87%) was significantly lower than that of epirubicin (25.37%) and pirarubicin (24.32%), and the difference was statistically significant ( P < 0.017 , Bonferroni adjusted P value). The Kaplan–Meier survival curves showed that the recurrence-free survival rate of patients received gemcitabine was significantly higher than that of the other two groups. Comparing the incidence of adverse reactions during the infusion of the three groups of patients, the differences were not statistically significant ( P > 0.05 ). In patients with high-risk non-muscle-invasive bladder cancer, the application of gemcitabine intravesical chemotherapy is related with a relatively lower recurrence rate but similar incidence of adverse reactions.

Efficacy of Intra-Arterial Plus Intravesical Chemotherapy for High-Risk Non-Muscle-Invasive Bladder Cancer: A Pooled Analysis

Background: The treatment for high-risk non-muscle-invasive bladder cancer (NMIBC) remains highly debated for its high recurrence and progression risk. This work aimed to verify the efficacy and toxicity of intra-arterial chemotherapy (IAC) plus intravesical chemotherapy (IVC) in high-risk NMIBC.Methods: A comprehensive online literature search was conducted in three databases to select researches related to IAC + IVC for high-risk NMIBC. All data were analyzed using the Review Manager software version 5.3. And we used the Cochrane Risk of Bias tool to assessed the quality of these enrolled researches.Results: Seven eligible original publications were enrolled in our studies with a total of 1,247 patients. Compared with the intravesical instillation, IAC + IVC therapy showed a better therapeutic effect. The total odds ratio for tumor recurrence rate, tumor progression rate, survival rate, and tumor-specific death rate was calculated as 0.51 (95% CI: 0.36–0.72; p &lt; 0.05), 0.51 (95% CI: 0.36–0.72; p &lt; 0.05), 1.75 (95% CI: 1.09–2.81; p &lt; 0.05), and 0.48 (95% CI: 0.28–0.84; p &lt; 0.05), respectively. In patients who received IAC, most of the adverse events (AEs)in the treatment were Grade I and II.Conclusion: IAC + IVC regimen for high-risk NMIBC could effectively reduce recurrence and progression and provide a better prognosis than intravesical instillation. The adverse events of IAC were mild and acceptable.

Advancements in Intravesical Chemotherapy in Non-Muscle Invasive Bladder cancer

The treatment for non-muscle-invasive bladder cancer is transurethral resection of bladder cancer followed by intravesical chemotherapy or BCG. There have been various advancements in low risk, intermediate risk, high risk, and BCG failure cases of non-muscle invasive bladder cancer. There has been increased research on hyperthermia and intravesical chemotherapy, new agents like apaziquone, use of gemcitabine in low-risk cases, and combination chemotherapy in cases of BCG failure. Combining docetaxel and gemcitabine has taken a significant stage because of BCG shortage in some parts of the world. This chapter will discuss the latest advancements in intravesical chemotherapy in low, intermediate, and high-risk patients.

Spinal Anesthesia Provides Longer Administration Time for Postoperative Intravesical Chemotherapy after TUR-B Operation

<b><i>Purpose:</i></b> The aim of this study was to investigate the tolerability of postoperative early intravesical chemotherapy session after transurethral resection of the bladder tumor (TUR-B) according to the different anesthesia types. <b><i>Methods:</i></b> The study was conducted between February 2017 and June 2020. Patients who were given intravesical mitomycin (MMC) 40 mg after TUR-B were included. Patients’ risk categories (low, medium, and high) were determined according to the European Association of Urology (EAU) risk stratification system based on the tumor number, size (&#x3c;3 and ≥3 cm), T stage (Ta and T1), and grade (low and high). Patients were divided into 2 groups according to the applied anesthesia technique as group S (spinal) and group G (general). The patients’ visual analog scale (VAS) scores were recorded every 30 min for 2 h after urethral clamping. The patients’ pain scores were recorded using the VAS questionnaire form at 30th (VAS1), 60th (VAS2), 90th (VAS3), and 120th (VAS4) min after the urethral clamping. Requirement of analgesic, urethral clamp removal time, total instillation time, and discharged urine volume were recorded. Complications and complication grade (1–5) were recorded according to the Clavien-Dindo system. <b><i>Results:</i></b> A total of 232 consecutive patients who received intravesical MMC were included. Sociodemographic characteristics of group S (<i>n</i> = 113) and group G (<i>n</i> = 119) were similar (<i>p</i> &#x3c; 0.05). There were no significant differences in tumor size, number of tumors, concomitant CIS, and T stage in both groups (<i>p</i> &#x3e; 0.05). High-grade tumors were higher in group S (23.9 vs. 11%; <i>p</i> = 0.008). Requirement of analgesic (53.9 vs. 91.5%; <i>p</i> = 0.00) and termination of therapy &#x3c;60′ (2 vs. 26%; <i>p</i> = 0.00) and &#x3c;120′ (32.7 vs. 76.4%; <i>p</i> = 0.00) were significantly lower in group S. The mean instillation time (108.05 ± 19.40 vs. 85.67 ± 24.66 min; <i>p</i> = 0.00) was found significantly higher for group S. In group G, mean VAS1–4 scores were significantly higher than in group S (<i>p</i> &#x3c; 0.05). Linear correlation analyses showed that the VAS score is correlated with the instillation time (<i>p</i> &#x3c; 0.05). The rates of minor (I–III) (7 vs. 8%; <i>p</i> = 0.706) and major (IV–V) (0.9 vs. 1.6%; <i>p</i> = 0.590) complications were similar in both groups. <b><i>Conclusion:</i></b> The patients’ tolerability of intravesical MMC treatment can be improved by spinal anesthesia. It provides longer instillation time and less pain during intravesical chemotherapy.