Intraoperative prophylactic intravesical chemotherapy to reduce bladder recurrence following radical nephroureterectomy

Yuval Freifeld, Rashed Ghandour, Nirmish Singla, Solomon Woldu, Aditya Bagrodia, Yair Lotan, Leonid M. Rapoport, Magomet Gazimiev, Karen Delafuente, Rohan Kulangara, Haley Robyak, Firas G. Petros, Jay D. Raman, Surena F. Matin, Vitaly Margulis

Research output: Contribution to journalArticle

Abstract

Purpose: Single, postoperative instillation of prophylactic intravesical chemotherapy (pIVC) is effective in reducing bladder cancer recurrences following radical nephroureterectomy (RNU). Despite high level evidence, pIVC is underutilized. Intraoperative pIVC (I-pIVC) may be easier and safer to implement than postoperative pIVC (P-pIVC). We aimed to evaluate the efficacy of I-pIVC during RNU. Materials and methods: Retrospective analysis of patients undergoing RNU and I-pIVC or postoperative pIVC (P-pVC) with 20 to 40 mg mitomycin-C or 1 to 2 g gemcitabine. Recurrence rates were evaluated using the Kaplan-Meier curves and log rank test. Cox regression was used for univariable and multivariable analysis. Results: One hundred and thirty-seven patients were included in the final analysis. 81% (111/137) had I-pIVC and 19% (26/137) had P-pIVC. In the I-pIVC group higher rates of HG, muscle invasive disease and gemcitabine use were observed. Overall, 74% (101/137) and 26% (36/137) had mitomycin-C and gemcitabine instillations, respectively. Within 12 months 14% (19/137) of the patients experienced bladder recurrence. Median time to bladder recurrence was 7 months (range 3–27). Twelve months bladder recurrence-free survival rates were 82% for the I-pIVC group, and 72% for the P-pIVC group ((log rank P = 0.365). Conclusions: I-pIVC during RNU may reduce bladder recurrence rates. Bladder recurrence rates are comparable to those reported using postoperative instillations. Intraoperative instillations may be easier to implement and may increase usage rates.

Original languageEnglish (US)
JournalUrologic Oncology: Seminars and Original Investigations
DOIs
StateAccepted/In press - 2020

Keywords

  • Bladder cancer
  • Intravesical chemotherapy
  • Mitomycin C
  • Nephroureterectomy
  • Recurrence
  • Upper tract urothelial carcinoma

ASJC Scopus subject areas

  • Oncology
  • Urology

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  • Cite this

    Freifeld, Y., Ghandour, R., Singla, N., Woldu, S., Bagrodia, A., Lotan, Y., Rapoport, L. M., Gazimiev, M., Delafuente, K., Kulangara, R., Robyak, H., Petros, F. G., Raman, J. D., Matin, S. F., & Margulis, V. (Accepted/In press). Intraoperative prophylactic intravesical chemotherapy to reduce bladder recurrence following radical nephroureterectomy. Urologic Oncology: Seminars and Original Investigations. https://doi.org/10.1016/j.urolonc.2020.05.002