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Single immediate postoperative instillation of chemotherapy in patients with Ta/T1 bladder TCC Dr Charles Chabert.

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Presentation on theme: "Single immediate postoperative instillation of chemotherapy in patients with Ta/T1 bladder TCC Dr Charles Chabert."— Presentation transcript:

1 Single immediate postoperative instillation of chemotherapy in patients with Ta/T1 bladder TCC Dr Charles Chabert

2 Background 70-80% present with superficial disease BCG treatment of choice if high risk 50% recurrence but < 5% progression Sylvester et al J Urol 171, June 2004

3 Background EAU guidelines recommend single dose ? Value in low risk & multiple tumours Sylvester et al J Urol 171, June 2004

4 Materials & methods Randomised trials with primary or recurrent Ta/T1 Exclusion of CIS Sylvester et al J Urol 171, June 2004

5 Materials & Methods Primary end point: % of patients with a recurrence in the 2 treatment arms Decrease in Odds of recurrence calculated without time to recurrence Sylvester et al J Urol 171, June 2004

6 Results 12 trials considered 5 exclusions; 4 inadequate randomisation 1 included CIS 7 trials entered into Meta-analysis Sylvester et al J Urol 171, June 2004

7 Trial Characteristics Accural between Median F/U: 3.4 years ( yrs) 3 trials included only primary patients 2 trials only single tumours Sylvester et al J Urol 171, June 2004

8 Trial Characteristics 4 different drugs used Epirubicin 3 trials Mitomycin C 2 trials Thiotepa 1 trial Pirarubicin 1 trial Sylvester et al J Urol 171, June 2004

9 Patient Characteristics 1517 eligible patients from 7 trials 1476 had F/U 748 (50.7%) TUR only & 728 (49.3%) TUR + instillation Sylvester et al J Urol 171, June 2004

10 Tumour Characteristics Predominantly low risk 89.2% primary tumours 84.3% single tumours 67.9% Ta 9.5% G3 Sylvester et al J Urol 171, June 2004

11 Recurrence 629 (42.6%) of 1476 patients 362 (48.4%) TUR & 267 (36.7%) TUR + Chemo Decrease of 39% in odds of recurrence Sylvester et al J Urol 171, June 2004

12 Treatment effect similar for all agents No benefit with Thiotepa 849 single tumours: (41.5%) 47.5% TUR & 35.8% TUR + Chemo 111 multiple tumours: (74.8%) 81.5% TUR & 65.2% TUR + chemo Sylvester et al J Urol 171, June 2004 Recurrence

13 Toxicity Mild irritative bladder symptoms in 10% Systemic toxicity extremely rare Allergic skin reactions 1-3% Sylvester et al J Urol 171, June 2004

14 Summary NNT to prevent 1 recurrence: 8.5 One instillation cost effective Significantly reduces recurrence with minimal morbidity Sylvester et al J Urol 171, June 2004


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