Examining the Efficacy of a Single Dose of Chemotherapy After Removing Bladder Tumours
by Jeni Crockett-Holme
Keywords: Bladder cancer, Chemotherapy, Surgery, Tumour
Tumours in the lining of the urinary bladder that have not grown into the bladder wall are referred to as non–muscle-invasive bladder cancer. These tumours are typically treated by surgical removal. In addition, European and US medical guidelines recommend giving a single dose of chemotherapy immediately after bladder tumour removal in patients who are not at high risk of recurrence.
Administration of this postoperative dose of chemotherapy is controversial. It is not always given after surgery, and some studies have raised questions about its effectiveness in patients with a moderate (intermediate) risk of recurrence. More information is needed about which patients benefit from a single dose of chemotherapy given immediately after bladder cancer surgery.
Individual patient data from 11 studies were reviewed for more than 2000 patients with non–muscle invasive bladder cancer . All patients had their bladder tumours removed surgically, and approximately half received a single dose of chemotherapy immediately after surgery.
The data showed that a single postoperative dose of chemotherapy reduced the risk of recurrence after bladder tumour removal and suggested that it was most effective when given within 2 hours after surgery. However, a single dose of chemotherapy was not effective in patients whose cancer kept coming back more than once per year or in patients with multiple, large tumours.
Moreover, a single dose of chemotherapy was not found to adequately control cancer growth in patients with an intermediate risk of recurrence. These results support European recommendations that, in intermediate-risk patients, a single dose of chemotherapy should be followed by additional doses of chemotherapy or immunotherapy.
As expected for a single postoperative dose of chemotherapy, it did not reduce the risk of cancer progression or increase survival over the long term.
Treatment with a single dose of chemotherapy
The decision of whether to use a single dose of chemotherapy after bladder tumour removal should be based on the individual patient’s history of recurrence and the size and number of tumours at the time of surgery. This information can help clarify recommendations for treatment.
This review showed that patients with a low risk of bladder cancer recurrence were the most likely to benefit from a single dose of chemotherapy after surgery. Its administration in patients with an intermediate risk of recurrence should be followed by additional doses of chemotherapy or immunotherapy. However, single-dose chemotherapy was not effective and is not recommended in patients with frequently recurring tumours or in patients with multiple, large bladder tumours.
 Sylvester RJ, Oosterlinck W, Holmang S, et al. Systematic review and individual patient data meta-analysis of randomized trials comparing a single immediate instillation of chemotherapy after transurethral resection with transurethral resection alone in patients with state pTa–pT1 urothelial carcinoma of the bladder: which patients benefit from the instillation? Eur Urol 2016;69:231–44.