SAN DIEGO, CA USA (UroToday.com) - Dr. Leonard Gomella, chairman of department of urology at Thomas Jefferson University Hospital, Philadelphia, PA, presented a multi-institutional study reviewing the available clinical data for blue light (BL) cystoscopy with hexaminolevulinate on the detection of papillary (Ta/T1) and CIS tumors, and on tumor recurrence.
Authors conducted a meta-analysis on 1 293 raw patients’ data from eight prospective studies. Studies included consecutively enrolled patients with known or suspected non-muscle invasive bladder cancer, and used BL cystoscopy with hexaminolevulinate as an adjunct to white light (WL) cystoscopy in randomized groups or within-patient comparison. Intention-to-treat populations (n=790) were used for detection analysis and per protocol for recurrence (n=634).
In 21.3% of patients, at least one additional Ta/T1 tumor was detected only with BL (p < 0.001; event rate=0.217 (0.193-0.247)). In initial and recurrent sub-groups, lesions were seen only with BL in 16.8% and 24.8% of patients, respectively (p < 0.001). In patients who had received prior BCG or chemotherapy, lesions were seen only under BL in 25% (48/192) patients (p < 0.001). In those patients who had at least one CIS lesion at diagnosis, CIS lesions were seen only with BL in 23.8% of patients, while no CIS lesions were seen with white light (p < 0.001; ER=0.246 (0.196-0.304)).
BL cystoscopy detected significantly more Ta tumors (13.2%; p < 0.001), than WL cystoscopy. Authors saw benefit particularly in high-risk (p=0.007) and intermediate-risk Ta patients (p < 0.001) and in T1 patients with initial cancer (11.2%; p=0.003). Moreover, a significant benefit in patients who had received prior BCG or chemotherapy (p < 0.001) was seen. Risk ratios for recurrence were reported lower in the sub-groups of patients with T1 or CIS (p=0.052, RR=0.696), and those with Ta (p=0.004, RR=0.804).
This meta-analysis concluded that BL cystoscopy with hexaminolevulinate added to WL cystoscopy assists the detection of bladder tumors at both patient and tumor level. Perhaps future studies reporting on cost/benefit ratios, as well as 5- and 10- year follow-up studies can better define which subgroup of patients can benefit from BL cystoscopy and whether or not outcomes can be altered in these patients.
Presented by Leonard Gomella, H. Barton Grossman, Michael Droller, Jorg Schmidbauer, Gregers Hermann, Octavian Dragoescu, Eleanor Ray, Alfred Witjes, Alexander Karl, Arnulf Stenzl, Yves Fradet, Juan Burgues, and Dieter Jocham at the American Urological Association (AUA) Annual Meeting - May 4 - 8, 2013 - San Diego Convention Center - San Diego, California USA
Reported for UroToday.com by Reza Mehrazin, MD
Click HERE to view the poster from this session