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Transurethral Resection of Non-Muscle-Invasive Bladder Transitional Cell Cancers With or Without 5-Aminolevulinic Acid Under Visible and Fluorescent Light: Results of a Prospective, Randomised, Multicentre Study

Schumacher, Martin C.; Holmang, Sten; Davidsson, Thomas LU ; Friedrich, Bengt; Pedersen, Jorgen and Wiklund, N. Peter (2010) In European Urology 57(2). p.293-299
Abstract
Background: Fluorescent light (FL)-guided cystoscopy induced by 5-aminolevulinic acid (5-ALA) has been reported to detect more tumours compared with standard white-light (WL) cystoscopy. Most reports are from single centres with relatively few patients. Objective: To evaluate whether 5-ALA-induced FL and WL cystoscopy at transurethral resection (TUR) is superior compared with standard procedures under WL only with respect to tumour recurrence and progression in patients with non-muscle-invasive bladder cancer. Design, setting, and participants: This randomised, multicentre, observer- and pathologist-blinded, prospective phase 3 clinical trial enrolled 300 patients, and of those patients, 153 were randomised to FL cystoscopy and 147 were... (More)
Background: Fluorescent light (FL)-guided cystoscopy induced by 5-aminolevulinic acid (5-ALA) has been reported to detect more tumours compared with standard white-light (WL) cystoscopy. Most reports are from single centres with relatively few patients. Objective: To evaluate whether 5-ALA-induced FL and WL cystoscopy at transurethral resection (TUR) is superior compared with standard procedures under WL only with respect to tumour recurrence and progression in patients with non-muscle-invasive bladder cancer. Design, setting, and participants: This randomised, multicentre, observer- and pathologist-blinded, prospective phase 3 clinical trial enrolled 300 patients, and of those patients, 153 were randomised to FL cystoscopy and 147 were randomised to standard WL cystoscopy. Intervention: All patients were first inspected under WL and all lesions were recorded. Patients randomised to FL underwent a second inspection. TUR was carried out in both groups. Measurements: Control cystoscopy under WL was performed in all patients every 3 mo during the first year after randomisation and biannually thereafter. Results and limitations: At the first TUR, the mean number of resection specimens per patient was 2.5 (FL: 2.5; WL: 2.4; p = 0.37) and the resulting mean number of resected tumours was 1.7 with FL and 1.8 with WL (p = 0.85). More patients were diagnosed with carcinoma in situ (CIS) in the WL group (13%) than in the FL group (4.2%). Within-patient comparison of FL patients only showed that FL detected more lesions than WL. Tumour lesions solely detected by FL cystoscopy that would not otherwise be detected by WL cystoscopy included 52% dysplasia, 33% CIS, 18% papillary neoplasms, 13% pT1, and 7% pTa. Outcome at 12 mo did not show any difference between groups with regard to recurrence-free and progression-free survival rates. Conclusions: In this prospective, randomised, multi-institutional study, we found no clinical advantage of FL cystoscopy compared with WL cystoscopy and TUR. (c) 2009 European Association of Urology. Published by Elsevier B.V. All rights reserved. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
5-ALA, Non-muscle-invasive, Bladder cancer, Transitional cell carcinoma, Multicentre phase 3 clinical trial
in
European Urology
volume
57
issue
2
pages
293 - 299
publisher
Elsevier
external identifiers
  • wos:000273106400029
  • scopus:72149096004
ISSN
1873-7560
DOI
10.1016/j.eururo.2009.10.030
language
English
LU publication?
yes
id
a2531955-b921-4f06-9357-8b0de0ffb04c (old id 1533763)
date added to LUP
2010-01-27 14:50:49
date last changed
2018-06-17 04:25:31
@article{a2531955-b921-4f06-9357-8b0de0ffb04c,
  abstract     = {Background: Fluorescent light (FL)-guided cystoscopy induced by 5-aminolevulinic acid (5-ALA) has been reported to detect more tumours compared with standard white-light (WL) cystoscopy. Most reports are from single centres with relatively few patients. Objective: To evaluate whether 5-ALA-induced FL and WL cystoscopy at transurethral resection (TUR) is superior compared with standard procedures under WL only with respect to tumour recurrence and progression in patients with non-muscle-invasive bladder cancer. Design, setting, and participants: This randomised, multicentre, observer- and pathologist-blinded, prospective phase 3 clinical trial enrolled 300 patients, and of those patients, 153 were randomised to FL cystoscopy and 147 were randomised to standard WL cystoscopy. Intervention: All patients were first inspected under WL and all lesions were recorded. Patients randomised to FL underwent a second inspection. TUR was carried out in both groups. Measurements: Control cystoscopy under WL was performed in all patients every 3 mo during the first year after randomisation and biannually thereafter. Results and limitations: At the first TUR, the mean number of resection specimens per patient was 2.5 (FL: 2.5; WL: 2.4; p = 0.37) and the resulting mean number of resected tumours was 1.7 with FL and 1.8 with WL (p = 0.85). More patients were diagnosed with carcinoma in situ (CIS) in the WL group (13%) than in the FL group (4.2%). Within-patient comparison of FL patients only showed that FL detected more lesions than WL. Tumour lesions solely detected by FL cystoscopy that would not otherwise be detected by WL cystoscopy included 52% dysplasia, 33% CIS, 18% papillary neoplasms, 13% pT1, and 7% pTa. Outcome at 12 mo did not show any difference between groups with regard to recurrence-free and progression-free survival rates. Conclusions: In this prospective, randomised, multi-institutional study, we found no clinical advantage of FL cystoscopy compared with WL cystoscopy and TUR. (c) 2009 European Association of Urology. Published by Elsevier B.V. All rights reserved.},
  author       = {Schumacher, Martin C. and Holmang, Sten and Davidsson, Thomas and Friedrich, Bengt and Pedersen, Jorgen and Wiklund, N. Peter},
  issn         = {1873-7560},
  keyword      = {5-ALA,Non-muscle-invasive,Bladder cancer,Transitional cell carcinoma,Multicentre phase 3 clinical trial},
  language     = {eng},
  number       = {2},
  pages        = {293--299},
  publisher    = {Elsevier},
  series       = {European Urology},
  title        = {Transurethral Resection of Non-Muscle-Invasive Bladder Transitional Cell Cancers With or Without 5-Aminolevulinic Acid Under Visible and Fluorescent Light: Results of a Prospective, Randomised, Multicentre Study},
  url          = {http://dx.doi.org/10.1016/j.eururo.2009.10.030},
  volume       = {57},
  year         = {2010},
}