Abstract:
Objective To analyze the long-term results of high-dose hydroxycamptothecin (HCPT) immediate intravesical instillation combined with conventional intravesical instillations for preventing postoperative recurrence of non-muscle invasive bladder cancer.
Methods The clinical data of 167 patients with intermediate and high-risk urothelial tumor of the bladder treated with transurethral resection of bladder tumor (TUR-Bt) were reviewed. A total of 116 males and 51 females were identified, with a median age of 51 years, and diagnosed pathologically. Seventy-one patients had pathological stage of Ta and 96 had T1. Sixty-six had grade 1, 50 had grade 2, and 51 had grade 3. Intravesical instillation of 40 mg HCPT was immediately administered postoperatively and retained in the bladder for 20 to 30 min. Conventional intravesical instillations were performed 1 wk post-TUR-Bt. HCPT (40 mg) were given once a wk for 8 wk, then monthly for 10 months, and retained for 2 h at each instance.
Results One hundred and fifty-five patients were followed up. The mean follow-up time was 92 months (72 months to 112 months). The 1-, 2-, and 5-year recurrence rates were 23.2%, 31.6%, and 41.3%, respectively. The long-term prognostic factors of recurrence were grades, stages, numbers, and diameters of tumors. The incidence rates of grades Ⅰ, Ⅱ, and Ⅲ local toxic effects were 13.5%, 3.2%, and 1.9%, respectively. No grade Ⅳ local toxic effects were observed. Only grade Ⅰ systemic toxic effects were seen in our series, with an incidence rate of 1.3%.
Conclusion Immediate instillation combined with conventional instillations of high-dose HCPT is effective for long-term prevention of post-operative recurrence of non-muscle invasive bladder cancer. This procedure could be tolerated by most patients, with few side effects.
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