Outcomes of Adjuvant Intravesical Mitomycin-C Treatment in Non-Muscle Invaziv High-Grade Bladder Cancer: Singe center experience

INTRODUCTION: The aim of the present study is to evaluate and report the clinical efficiacy of adjuvant intravesical mitomycin-c in the treatment of non-muscle invaziv high-grade bladder cancer patients of a tertiary single health-care center.
METHODS: Electronic records of the patients who had undergone endoscopic treatment of bladder tumors between Jan 2012 and Dec 2018 are retrospectively reviewed. Data of the patients who were diagnosed with non-invasive high-grade urothelial carcinoma are further evaluated if adjuvant intravesical mitomycin-c therapy had been initiated and included in the study. Patient demographics, cystoscopy findings, pathological findings, and outpatients record are included in the analysis.
RESULTS: Total of 54 patients included in this study. Among them 50 patients had pT1 disease while 4 patients had pTa disease. None of the patients in this cohort had carcinoma-in-situ. Mean tumor diameter was 1.4 cm. Mean time from initial transurethral resection to the application of the adjuvant therapy was 2 weeks (1-4 weeks). Mean follow-up time was 21 months. During the follow-up, tumor progression was observed in 14 (26%) patients, high-grade tumor recurrence was observed in 22 (41%) patients, and low-grade tumor recurrence was observed in 4 (7%) patients. Among the 22 patients who had high-grade recurrence, 6 patients had also tumor progression during the follow-up
DISCUSSION AND CONCLUSION: Non-invasive high-grade bladder cancer holds significant risk of stage progression and recurrence. The contemporary clinical guidelines endorse adjuvant intravesical BCG treatment in the management of non-muscle invasive bladder cancer. Due to our results, adjuvant intravesical mitomycin-c therapy can be considered as a accomplished alternative.

Kas Invazyonu Yapmamýþ Yüksek Dereceli Mesane Kanserinde Adjuvan Intravezikal Mitomisin-C Uygulamasý: Tek Merkez Deneyimi

GÝRÝÞ ve AMAÇ: Kas invazyonu yapmamýþ yüksek dereceli mesane kanserlerinin tedavisinde adjuvan intravesikal mitomisin-c tedavisinin sonuçlarýný bildirmek
YÖNTEM ve GEREÇLER: Kliniðimizde Ocak 2012 ile Aralýk 2018 tarihleri arasýnda mesane kanseri nedeniyle endoskopik tedavi uygulanmýþ hastalarýn patolojileri geriye dönük olarak deðerlendirildi. Kas invazyonu yapmamýþ ve yüksek dereceli ürotelyal tümörü olan hastalarýn hastane baþvuru kayýtlarý incelenerek adjuvan intravezikal mitomisin-c tedavisi almýþ olan hastalarýn bilgileri çalýþmaya dahil edildi. Hastalarýn demografik verileri, sistoskopi bulgularý, patolojik bulgular ve poliklinik baþvuru kayýtlarý incelenerek analize dahil edildi.
BULGULAR: Toplam 54 hasta istatistiksel analize dahil edildi. Bu hastalar içinde 50 hastada patolojik evre T1 saptanýrken 4 hastada patolojik evre Ta saptandý. Hiçbir hastada karsinoma in situ varlýðý tespit edilmedi. Ortalama tümör boyutu 1.4 cm olarak bulundu. Adjuvan tedavi baþlanmasý için endoskopik tedavi sonrasýndaki bekleme süresi ortalama 2 (1-4) haftaydý. Ortalama takip süresi 21 ay olarak saptandý. Takiplerde evre ilerlemesi hastalarýn 14'ünde (%26) görülürken yüksek dereceli nüks 22 hastada (%41), düþük dereceli nüks 4 hastada (%7) görüldü. Nüks görülen 22 hastanýn 6'sýnda ayný zamanda ilerleme de görüldü.
TARTIÞMA ve SONUÇ: Kas invazyonu yapmamýþ yüksek dereceli mesane kanseri daha ileri evreye ilerleme ve nüks ihtimali yüksek bir kanser türüdür. Kýlavuzlarda ilk önerilen adjuvan tedavi seçeneði intravezikal Bacillus-Calmette-Guérin suþu uygulamasýdýr. Bizim sonuçlarýmýza göre mitomycin-c tedavisi de adjuvan intravezikal tedavi için baþarýlý bir alternatif olarak deðerlendirilebilir.