Photodynamic diagnosis of non-muscle invasive bladder cancer using hexaminolevulinic acid.

Department of Urology, Emergency County Hospital of Craiova, Romania.
Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie (Impact Factor: 0.62). 01/2011; 52(1):123-7.
Source: PubMed

ABSTRACT Bladder cancer (BC) is the most common tumor of the urinary tract. White light cystoscopy (WLC) is currently considered the standard investigation for diagnosis of bladder tumors. Recent studies suggest that using exogenous fluorescence (photodynamic diagnosis, PDD) can improve its diagnostic sensitivity and specificity.
Our study aims to analyze the value of using fluorescent cystoscopy (PDD) in the diagnosis and treatment of non-muscle invasive bladder cancer (NMIBC).
The study designed as a prospective randomized clinical trial was conducted over a 12 months period and included 44 patients with primitive NMIBC diagnosed and treated in our department in 2009. Twenty-two patients were included in the study group (PDD), while 22 patients were diagnosed and treated by conventional methods (WLC).
There were no statistically significant differences between the two groups regarding age, sex, place of origin, smoking history, clinical symptoms or presence of urological history as well as tumor size, location or number. Fluorescence cystoscopy examination identified 25.8% more tumors than the conventional examination (p=0.004). We demonstrated a significant reduction of tumor recurrence rates at 3, 6, 9 and 12 months by using PDD (HR=0.3271, 95% CI 0.1091-0.9809; p=0.0461).
The use of PDD in patients with NMIBC results in significant improvement of the efficiency of their initial diagnosis cystoscopy (by over 25%). We demonstrated improved patient prognosis and quality of life following conservative TUR treatment of these tumors by significantly reducing the tumor recurrence rate (by 9-27%) in the first year of follow-up.

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    ABSTRACT: BACKGROUND: Studies on hexaminolevulinate (HAL) cystoscopy report improved detection of bladder tumours. However, recent meta-analyses report conflicting effects on recurrence. OBJECTIVE: To assess available clinical data for blue light (BL) HAL cystoscopy on the detection of Ta/T1 and carcinoma in situ (CIS) tumours, and on tumour recurrence. DESIGN, SETTING, AND PARTICIPANTS: This meta-analysis reviewed raw data from prospective studies on 1345 patients with known or suspected non-muscle-invasive bladder cancer (NMIBC). INTERVENTION: A single application of HAL cystoscopy was used as an adjunct to white light (WL) cystoscopy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We studied the detection of NMIBC (intention to treat [ITT]: n=831; six studies) and recurrence (per protocol: n=634; three studies) up to 1 yr. DerSimonian and Laird's random-effects model was used to obtain pooled relative risks (RRs) and associated 95% confidence intervals (CIs) for outcomes for detection. RESULTS AND LIMITATIONS: BL cystoscopy detected significantly more Ta tumours (14.7%; p<0.001; odds ratio [OR]: 4.898; 95% CI, 1.937-12.390) and CIS lesions (40.8%; p<0.001; OR: 12.372; 95% CI, 6.343-24.133) than WL. There were 24.9% patients with at least one additional Ta/T1 tumour seen with BL (p<0.001), significant also in patients with primary (20.7%; p<0.001) and recurrent cancer (27.7%; p<0.001), and in patients at high risk (27.0%; p<0.001) and intermediate risk (35.7%; p=0.004). In 26.7% of patients, CIS was detected only by BL (p<0.001) and was also significant in patients with primary (28.0%; p<0.001) and recurrent cancer (25.0%; p<0.001). Recurrence rates up to 12 mo were significantly lower overall with BL, 34.5% versus 45.4% (p=0.006; RR: 0.761 [0.627-0.924]), and lower in patients with T1 or CIS (p=0.052; RR: 0.696 [0.482-1.003]), Ta (p=0.040; RR: 0.804 [0.653-0.991]), and in high-risk (p=0.050) and low-risk (p=0.029) subgroups. Some subgroups had too few patients to allow statistically meaningful analysis. Heterogeneity was minimised by the statistical analysis method used. CONCLUSIONS: This meta-analysis confirms that HAL BL cystoscopy significantly improves the detection of bladder tumours leading to a reduction of recurrence at 9-12 mo. The benefit is independent of the level of risk and is evident in patients with Ta, T1, CIS, primary, and recurrent cancer.
    European Urology 04/2013; · 10.48 Impact Factor
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    ABSTRACT: To conduct a meta-analysis of randomized controlled trials (RCTs) to assess the therapeutic outcome of fluorescence cystoscopy (FC) guided transurethral resection (TUR) in non-muscle invasive bladder cancer (NMIBC). Relevant RCTs were identified from electronic database (MEDLINE, Embase and the Cochrane Library). The proceedings of relevant congress were also searched. The primary parameters were recurrence rate, the time to fist recurrence, recurrence free survival rate (RFS) and progression rate. 12 RCTs including 2258 patients, which were identified for analysis in our study. Our study showed that the FC group have lower recurrence rate than the white light cystoscopy (WLC) group with statistically significant difference (OR: 0.5; p<0.00001). The time of the FC group first recurrence delayed significantly 7.39 weeks than WLC group (MD: 7.39 weeks; p<0.0001). There was a statistically significant difference in favor of FC in RFS at 1 yr (HR: 0.69; p<0.00001) and 2 yrs (HR: 0.65; p=0.0004). However, the FC group cannot significantly reduce the rate of progression into muscle invasive bladder cancer compared with the WLC group (OR: 0.85; p=0.39). FC guided TUR was demonstrated to be an effective procedure for delaying recurrence of NMIBC. Unfortunately, FC guided TUR could not significantly decrease the rate of progression into muscle invasive bladder cancer.
    PLoS ONE 01/2013; 8(9):e74142. · 3.53 Impact Factor
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    ABSTRACT: Hexaminolevulinate (HAL) is an ester derivative of 5-aminolevulinate, and is used in conjunction with blue light (fluorescence) cystoscopy (BLC) to detect bladder cancer. In various studies, HAL-BLC was generally a better detection method than the gold standard method of white light cystoscopy (WLC), as assessed by endpoints including additional lesions (at both the lesion and patient levels) not detected by WLC, higher detection rates, and more complete treatment decisions as a result of improved detection. HAL-BLC in addition to WLC was associated with reduced tumor recurrence rates compared with WLC alone in randomized trials with up to 2 years' follow-up. HAL-BLC was generally well tolerated, and the most common adverse events (i.e. hematuria, dysuria, and bladder spasm) were also the most common adverse events in the WLC alone group, and were expected as a result of the resection procedure. Although its impact on disease progression and survival rates is not yet known, HAL-BLC is a valuable addition to WLC for the diagnosis of bladder cancer in patients who are suitable candidates for its use.
    Molecular diagnosis & therapy. 11/2013;

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