|
|
 |
| |
67th Annual Meeting Abstracts
Hexaminolevulinate Fluorescence Cystoscopy Improves Detection And Resection Of Papillary Bladder Cancer Lesions And Reduces Early Recurrences
*Leonard G Gomella1, *Lance A Mynderse2, *Mark S Soloway3, *Unyime O Nseyo4, *Seth P Lerner5, *Edward M Messing6, *H. Barton Grossman7
1Thomas Jefferson University, Philadelphia, PA;2Mayo Clinic, Rochester, MO;3University of Miami School of Medicine, Miami, FL;4VA Medical Center, Gainsville, FL;5Baylor College of Medicine, Houston, TX;6University of Rochester MedicalCenter, Rochester, NY;7M.D. Anderson Cancer Center, Houston, TX
Introduction:
Fluorescence guided diagnosis using hexaminolevulinate (HAL) can identify tumors not visible under white light cystoscopy. Comparison of HAL guided and white light cystoscopy in the detection of non-muscle invasive papillary bladder cancer (NMIBCs), and its early recurrence rates were studied.
Materials & Methods:
A prospective, controlled, randomized, phase III multi-center study consisted of patients with likely recurrence within nine months of initial tumor resection. Patients having one or multiple papillary tumor recurrences, within 12 months of their last tumor diagnosis were randomized to white light or HAL fluorescence cystoscopy. All patients were first inspected under white light with visible lesions recorded. Patients randomized to HAL underwent second mapping under blue light. All suspicious areas were resected in both groups. Completeness of resection was checked in blue light for HAL group.
Follow up at 3, 6 and 9 months was with white light, with recurrence verified by histology.
Results:
766 patients were randomized. In the HAL group, 278 were diagnosed as Ta/T1. 16.9% of these patients had at least 1 additional Ta/T1 tumor detected with HAL compared to white light (p= 0.0005). 32% (13/41) of CIS patients were diagnosed only with HAL, an improvement in CIS detection rate of 46%. Significant reduction in tumor recurrence was seen in the HAL arm (n=200): 72 (36%) compared to 92 (46%) in the white light group (n=202) (p = 0.029).
Conclusions:
This is the first demonstration that HAL fluorescence cystoscopy improves detection and resection of NMIBCs, with reduced recurrence rates at nine months.
|
|
| |
|
|
| |
|
|
|
|
