Feasibility of early intravesical instillation chemotherapy after transurethral resection of the bladder : a prospective evaluation in a consecutive series of 210 cases

OBJECTIVE: Early instillation chemotherapy (less than 6 h after tumour resection) is an accepted adjuvant treatment after transurethral resection of non-muscle-invasive papillary bladder tumours. Because most studies have reported on selected patients fulfilling specific eligibility criteria, this study investigated the feasibility of this therapy in a non-selected, consecutive series of patients who had undergone transurethral surgery to the bladder at a single institution. MATERIAL AND METHODS: All transurethral resections of the bladder were prospectively evaluated. In patients with assumed non-muscle-invasive papillary bladder cancer, resection was followed by early instillation of 50mg epirubicin. Practical problems, staging and cystoscopic follow-up were systematically registered and evaluated. RESULTS: From October 2002 to February 2005, 210 transurethral resections (including 31 diagnostic biopsies) were performed in 163 patients (median age at resection 73.8 years). The following pathological T-stages were found: pT0 27.6%, pTa 39.0%, pT1 8.6%, < or =pT2 19.0% and pTis 5.7%. Patients received early instillation chemotherapy in 110 cases, which was generally well tolerated, but was prevented in four patients by intense bleeding or perforation. The treatment decision was correct in 82.8% and positively correlated with the experience of the treating urologist. Cumulative incidence rates of first postoperative tumour recurrence in the pTa group at 6, 12 and 24 months were 6.7, 24.5 and 52.0%, respectively. CONCLUSION: Early instillation chemotherapy with epirubicin after transurethral resection of bladder tumours is generally feasible and usually has no major side-effects, but evaluation of intraoperative T-stage can be a problem and depends on experience.