Reducing Recurrence after TURBT

Continuous administration of fluoroquinolones for three months. Following endoscopic resection, Level 1 evidence exists to show that a single, prophylactic instillation of intravesical mitomycin C results in a significant reduction (up to 39%) of tumor recurrence.1  For patients with high...

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Continuous administration of fluoroquinolones for three months. Following endoscopic resection, Level 1 evidence exists to show that a single, prophylactic instillation of intravesical mitomycin C results in a significant reduction (up to 39%) of tumor recurrence.1  For patients with high risk disease, induction and at times maintenance intravesical therapy with bacillus Calmette-Guérin (BCG) is indicated.¹  Antiobiotic therapy has no role in decreasing chances of recurrence following TURBT. Interestingly, a recent manuscript from a group in Japan demonstrated that overnight continuous bladder irrigation (CBI) may be as effective as intravesical therapy.²  In that study, 123 patients who underwent resection of intermediate-risk tumors and received overnight CBI were compared with 115 patients who underwent treatment with intravesical mitomycin C for one year. Efficacy metrics such as time to first recurrence, frequency of recurrence, tumor progression, and cancer-specific death were the same in both groups.²  As expected, toxicity was higher in patients treated with mitomycin C.  The data are provocative, but confirmatory studies from other centers await.

1. Hall MC, Chang SS, Dalbagni G, et al.Guideline for the management of nonmuscle invasive bladder cancer (stages Ta, T1, and Tis): 2007 update. J Urol 2007;178: 2314-2330.
2. Onishi T, Sasaki T, Hoshina A, et al. Continuous saline bladder irrigation after transurethral resection is a prophylactic treatment choice for non-muscle invasive bladder tumor. Anticancer Res 2011;31:1471-1474.

The case was prepared by Alexander Kutikov, MD, of Fox Chase Cancer Center in Philadelphia.