Restricted accessResearch articleFirst published online 2021-12
Early Photodynamic Diagnosis Cystoscopy After Bacillus Calmette–Guérin (BCG) Induction for High-Risk Nonmuscle Invasive Bladder Cancer Significantly Increased the Detection of BCG Refractory Tumors
To compare the detection rate of Bacillus Calmette–Guérin (BCG) refractory tumors between white light cystoscopy (WL-C) and Photodynamic Diagnosis cystoscopy (PDD-C).
Materials and Methods:
We performed a monocentric retrospective study that included all consecutive patients with high-risk nonmuscle-invasive bladder cancer (NMIBC) diagnosed from January 2017 to January 2021. All patients had an initial transurethral resection of bladder tumor (TURBT) with photodynamic diagnosis ± restaging TURBT if needed, followed by full-dose BCG induction. Within 8 weeks following BCG induction, all patients had both WL-C and PDD-C under general anesthesia ± TURBT in case of suspicious lesion. The primary end point was the detection of bladder cancer (BC) at post-BCG cystoscopy.
Results:
A total of 136 consecutive patients met inclusion criteria. Initial BC characteristics were: 35.6% of T1 tumor, 92.6% high grade, and 48.6% associated CIS. BC was diagnosed in 33/136 cases (24%) at early PDD-C after BCG induction: 77% Ta, 23% T1, 56% associated CIS, 68% high grade, and 6% muscle-invasive bladder cancer. Sensibility and Specificity of WL-C and PDD-C: 41% vs 91% (p < 0.001) and 86% vs 75% (p = 0.001). PDD-C detected 16 additional tumors: 81.3% Ta, 18.7% T1, 75% associated CIS, and 75% high grade.
Conclusions:
Systematic use of PDD after BCG induction increased the detection of BCG-refractory tumors and led to significant modification in the treatment of high-risk NMIBC. Future studies are needed to evaluate long-term oncologic benefit of early PDD reevaluation and its cost-effectiveness.
Get full access to this article
View all access options for this article.
References
1.
FerlayJ, SoerjomataramI, DikshitR, et al.Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN2012. Int J Cancer, 2015; 136:E359–E386.
2.
BabjukM, BurgerM, CompératEM, et al.European Association of Urology Guidelines on non-muscle-invasive bladder cancer (TaT1 and carcinoma in situ)—2019 update. Eur Urol, 2019; 76:639–657.
3.
ChangSS, BoorjianSA, ChouR, et al.Diagnosis and treatment of non-muscle invasive bladder cancer: AUA/SUO guideline. J Urol, 2016; 196:1021–1029.
4.
FlaigTW, SpiessPE, AgarwalN, et al.Bladder cancer, version 3.2020, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2020; 18:329–354.
5.
MaurizioB, LaurenceC, KarlheinzK, et al.Variability in the recurrence rate at first follow-up cystoscopy after TUR in stage Ta T1 transitional cell carcinoma of the bladder: A combined analysis of seven EORTC studies. Eur Urol, 2002; 41:523–531.
6.
SarosdyMF, LammDL. Long-term results of intravesical Bacillus Calmette-Guerin therapy for superficial bladder cancer. J Urol, 1989; 142:719–722.
7.
SylvesterRJ, van der MeijdenAP, WitjesJA, KurthK. Bacillus Calmette-Guerin versus chemotherapy for the intravesical treatment of patients with carcinoma in situ of the bladder: A meta-analysis of the published results of randomized clinical trials. J Urol, 2005; 174:86–91; discussion 91–92.
8.
DaneshmandS, PatelS, LotanY, et al.; Flexible Blue Light Study Group Collaborators. Efficacy and safety of blue light flexible cystoscopy with hexaminolevulinate in the surveillance of bladder cancer: A phase III, comparative, multicenter study. J Urol, 2018; 199:1158–1165.
9.
RouprêtM, PignotG, Masson-LecomteA, et al.Recommandations françaises du Comité de cancérologie de l'AFU—actualisation 2020–2022: tumeurs de la vessie [French ccAFU guidelines—update 2020–2022: bladder cancer]. Prog Urol, 2020; 30(12S):S78–S135. (French).
10.
DaneshmandS, SchuckmanAK, BochnerBH, et al.Hexaminolevulinate blue-light cystoscopy in non-muscle-invasive bladder cancer: Review of the clinical evidence and consensus statement on appropriate use in the USA. Nat Rev Urol, 2014; 11:589–596.
11.
Di StasiSM, De CarloF, PagliaruloV, MaseduF, VerriC, CelestinoF, RiedlC. Hexaminolevulinate hydrochloride in the detection of nonmuscle invasive cancer of the bladder. Ther Adv Urol, 2015; 7:339–350.
12.
BurgerM, GrossmanHB, DrollerM, et al.Photodynamic diagnosis of non-muscle-invasive bladder cancer with hexaminolevulinate cystoscopy: A meta-analysis of detection and recurrence based on raw data. Eur Urol, 2013; 64:846–854.
13.
TadristA, Gondran-TellierB, McManusR, et al. Primary complete transurethral resection of bladder tumor using photodynamic diagnosis for high-risk nonmuscle invasive bladder cancer: Is a restaging photodynamic transurethral resection really necessary? J Endourol 2021 [Epub ahead of print].
14.
PietzakEJ. The impact of blue light cystoscopy on the diagnosis and treatment of bladder cancer. Curr Urol Rep, 2017; 18:39.
15.
LotanY, BivalacquaTJ, DownsT, et al.Blue light flexible cystoscopy with hexaminolevulinate in non-muscle-invasive bladder cancer: Review of the clinical evidence and consensus statement on optimal use in the USA—Update 2018. Nat Rev Urol, 2019; 16:377–386.
16.
RinkM, BabjukM, CattoJW, et al.Hexylaminolevulinate-guided fluorescence cystoscopy in the diagnosis and follow-up of patients with non-muscle-invasive bladder cancer: A critical review of the current literature. Eur Urol, 2013; 64:624–638.
17.
InoueK, FukuharaH, ShimamotoT, et al.Comparison between intravesical and oral administration of 5-amimolevulinic acid in the clinical benefit of photodynamic diagnosis for nonmuscle invasive bladder cancer. Cancer, 2012; 118:1062–1074.
18.
BuiTT, SchellhammerPF. Additional Bacillus Calmette-Guérin therapy for recurrent transitional cell carcinoma after an initial complete response. Urology, 1997; 49:687–690; discussion 690–691.
19.
DalbagniG, HerrHW. Current use and questions concerning intravesical bladder cancer group for superficial bladder cancer. Urol Clin North Am, 2000; 27:137–146.
20.
de ReijkeTM, KurthKH, SylvesterRJ, et al.Bacillus Calmette-Guerin versus epirubicin for primary, secondary or concurrent carcinoma in situ of the bladder: Results of a European Organization for the research and treatment of cancer—Genito-urinary group phase III trial (30906). J Urol, 2005; 173:405–409.
21.
SolsonaE, MaderoR, ChantadaV, et al.Sequential combination of mitomycin C plus Bacillus Calmette-Guerin (BCG) is more effective but more toxic than BCG alone in patients with non-muscle-invasive bladder cancer in intermediate- and high-risk patients: Final outcome of CUETO 93009, a randomized prospective trial. Eur Urol, 2015; 67:508.
22.
MoralesA, HerrH, SteinbergG, et al.Efficacy and safety of MCNA in patients with nonmuscle invasive bladder cancer at high risk for recurrence and progression after failed treatment with Bacillus Calmette-Guerin. J Urol, 2015; 193:1135.
23.
HerrHW, SoganiPC. Does early cystectomy improve the survival of patients with high risk superficial bladder tumors?. J Urol, 2001; 166:1296–1299.
24.
ArendsTJH, NativO, MaffezziniM, et al.Results of a randomised controlled trial comparing intravesical chemohyperthermia with mitomycin C vs. Bacillus Calmette-Guérin for adjuvant treatment of patients with intermediate- and high-risk non- muscle-invasive bladder cancer. Eur Urol, 2016; 69:1046–1052.
25.
SteinbergRL, ThomasLJ, BrooksN, et al.Multi-institution evaluation of sequential gemcitabine and docetaxel as rescue therapy for nonmuscle invasive bladder cancer. J Urol, 2020; 203:902–909.
26.
PackiamVT, LammDL, BarocasDA, et al.An open label, single-arm, phase II multicenter study of the safety and efficacy of CG0070 oncolytic vector regimen in patients with BCG-unresponsive non-muscle-invasive bladder cancer: Interim results. Urol Oncol, 2018; 36:440–447.
27.
BreeKK, BrooksNA, KamatAM. Current therapy and emerging intravesical agents to treat non-muscle invasive bladder cancer. Hematol Oncol Clin North Am, 2021; 35:513–529.
28.
TanWS, PanchalA, BuckleyL, et al.Radiofrequency-induced thermo-chemotherapy effect versus a second course of Bacillus Calmette-Guérin or institutional standard in patients with recurrence of non-muscle-invasive bladder cancer following induction or maintenance bacillus Calmette-Guérin therapy (HYMN): A phase iii, open-label, randomised controlled trial. Eur Urol, 2019; 75:63–71.
29.
HahnNM, NecchiA, LoriotY, et al.Role of checkpoint inhibition in localized bladder cancer. Eur Urol Oncol, 2018; 1:190–198.
