NEW YORK (Reuters Health) – An updated meta-analysis supports the strategy of giving intravesical chemotherapy (IVC) immediately after bladder tumor resection to reduce the risk of recurrence.
“However, contemporary methodology suggests low evidence quality for examined outcomes,” the Canadian researchers caution. “Thus RCTs with careful randomization and blinding are still warranted to clarify the usefulness of immediate postoperative IVC in this population.”
They explain that a meta-analysis published in 2004 demonstrated that IVC following transurethral resection of non–muscle-invasive bladder cancer reduces recurrences, but “adoption of this practice has been modest” because of conflicting data and the difficulties of drug administration.
Dr. Nathan Perlis, with the University of Toronto in Ontario, and colleagues therefore conducted a new meta-analysis that included more recent trial data. They identified 13 studies that included a total of 2548 patients who were randomized to receive IVC or not after transurethral resection of urothelial or transitional carcinoma.
As reported in European Urology online June 18, instillation of chemotherapy within 24 hours after resection significantly improved the recurrence-free interval by 38%; i.e., the hazard ratio was 0.62, p<0.001.
In addition, immediate IVC reduced the likelihood of early recurrence within 1 year of randomization, with an absolute risk difference of 12% (p <0.001), according to the report. This meant that the number-needed-to-treat to prevent 1 early recurrence was 9.
The team used the Grading of Recommendations, Assessment, Development, and Evaluation system to assess the quality of evidence for each outcome. This resulted in a grade of ‘very low’ for the recurrence-free interval and ‘low’ for early recurrences, mainly because of the risk of bias in the trials due to non-blinding.
“Due to the low evidence quality, it may not be suitable to rely on these results to guide clinical decisions,” Dr. Perlis and colleagues advise.
Still, they say, “The implications of our study are relevant to both patients and health systems worldwide given the high costs associated with this disease,” and they conclude that their results confirm “that IVC reduces NMIBC (non–muscle-invasive bladder cancer) recurrences when given immediately following TURBT (transurethral resection of bladder tumor) with minimal adverse events.”
Source: Immediate Post–Transurethral Resection of Bladder Tumor Intravesical Chemotherapy Prevents Non–Muscle-invasive Bladder Cancer Recurrences: An Updated Meta-analysis on 2548 Patients and Quality-of-Evidence Review
Eur Urol 2013.
