Document Detail


The schedule and duration of intravesical chemotherapy in patients with non-muscle-invasive bladder cancer: a systematic review of the published results of randomized clinical trials.
MedLine Citation:
PMID:  18207317     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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:
Richard J Sylvester; Willem Oosterlinck; J Alfred Witjes
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Review     Date:  2008-01-15
Journal Detail:
Title:  European urology     Volume:  53     ISSN:  0302-2838     ISO Abbreviation:  Eur. Urol.     Publication Date:  2008 Apr 
Date Detail:
Created Date:  2008-02-26     Completed Date:  2008-06-26     Revised Date:  2013-06-06    
Medline Journal Info:
Nlm Unique ID:  7512719     Medline TA:  Eur Urol     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  709-19     Citation Subset:  IM    
Affiliation:
EORTC Data Center, Brussels, Belgium. richard.sylvester@eortc.be <richard.sylvester@eortc.be>
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MeSH Terms
Descriptor/Qualifier:
Administration, Intravesical
Antineoplastic Agents / administration & dosage*
Chi-Square Distribution
Drug Administration Schedule
Humans
Neoplasm Recurrence, Local / prevention & control
Neoplasm Staging
Randomized Controlled Trials as Topic
Risk Factors
Time Factors
Urinary Bladder Neoplasms / drug therapy*
Grant Support
ID/Acronym/Agency:
5U10 CA11488-37/CA/NCI NIH HHS; U10 CA011488-37/CA/NCI NIH HHS
Chemical
Reg. No./Substance:
0/Antineoplastic Agents
Comments/Corrections

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