Improved Detection and Treatment of Bladder Cancer Using Hexaminolevulinate Imaging: A Prospective, Phase Iii Multicenter Study

Jocham, Dieter; Witjes, Fred; Wagner, Sigrid; Zeylemaker, Bram; Moorselaar, Jeroen van; Grimm, Marc‐Oliver; Muschter, R.; Popken, G.; König, Frank; Knüchel, Ruth; Kurth, K. H.

doi:10.1097/01.ju.0000169257.19841.2a

Cited by 284 publications

(213 citation statements)

References 15 publications

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“…This finding stands in contrast to previous reports and to integrated results from two fluorescence cystoscopy registration studies (with optimal conditions such as high-risk patients, trained investigators, and review pathology) where only 38% of CIS lesions were detected with normal WLC [13,14], and a recent multicentre prospective study found that CIS was missed in 32% of patients by initial WLC [9]. How can we explain the discrepancy between our results and those of others?…”

Section: Discussioncontrasting

confidence: 56%

Bladder cancer in cystoscopically normal‐appearing mucosa: a case of mistaken identity?

et al. 2010

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Study Type – Diagnosis (exploratory cohort) Level of Evidence 2bOBJECTIVETo test the frequency of malignancy in normal‐appearing urothelium in patients with high‐risk bladder cancer, as biopsy of normal‐appearing mucosa using standard white‐light cystoscopy (WLC) reportedly shows carcinoma in situ (CIS) in some patients with bladder tumours.PATIENTS AND METHODSCold‐cup biopsies of normal‐appearing mucosa were obtained by two experienced oncological urologists from 63 patients during transurethral resection of bladder cancers. Each biopsy labelled as ‘normal’ was interpreted by two expert uropathologists.RESULTSEach of the biopsies in all 63 patients was interpreted by both urological pathologists as showing normal or benign histology, except that one showed focal CIS.CONCLUSIONSBladder urothelium appearing normal to expert urological oncologists using standard WLC rarely shows CIS when biopsies are evaluated by experienced uropathologists.

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Section: Discussioncontrasting

confidence: 56%

Bladder cancer in cystoscopically normal‐appearing mucosa: a case of mistaken identity?

et al. 2010

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“…There is increasing consensus that so called early recurrence may in fact arise from residual tumor left behind at resection or from the growth of previously undetected microscopic lesions. (Brausi et al, 2002;Filbeck et al, 2002;Babjuk et al, 2005;Jocham et al, 2005;Mostafid and Brausi, 2012).…”

Section: Introductionmentioning

confidence: 99%

Feasibility of Photodynamic Diagnosis for Challenging TUR-Bt Cases Including Muscle Invasive Bladder Cancer, BCG Failure or 2^nd-TUR

Takai¹,

Inamoto²,

Komura³

et al. 2015

Asian Pacific Journal of Cancer Prevention

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Background: Despite widely adopted standard methods for follow-up including cystoscopy plus cytology, recurrence rates of non muscle-invasive bladder cancer (NMIBC) have not improved over the past decades, still ranging from 60% through 70%. Hence, widely acceptable surveillance strategies with excellent sensitivity are needed. Early recurrence has led to the development of a novel cystoscopy technique utilizing photodynamic diagnosis (

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“…3 In addition, several reports document that this technique is cost effective. 7,8 Nevertheless, the 9 month follow-up in this study has raised questions about the potential long-term patient benefit of this technique.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5] In this technique, hexaminolevulinate is administered intravesically 1 hour prior to cystoscopy and bladder tumor resection. The drug is converted locally to porphyrins that selectively accumulate in malignant cells.…”

Section: Introductionmentioning

confidence: 99%

957 Long-term reduction in bladder cancer recurrence with hexaminolevulinate enabled fluorescence cystoscopy

Burger¹,

Stenzl²,

Mynderse³

et al. 2012

European Urology Supplements

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Purpose-We assessed the impact that hexaminolevulinate fluorescence cystoscopic detection of papillary, non-muscle invasive bladder cancer has on long-term recurrence rates.Materials and Methods-Long-term follow-up was assessed in 551 participants enrolled in a prospective, randomized study of fluorescence cystoscopy for Ta or T1 urothelial bladder cancer. In the original study, 280 patients in the white light cystoscopy group and 271 in the fluorescence cystoscopy group were followed with cystoscopy for 3, 6, and 9 months following the initial resection or until recurrence. A study extension protocol obtained long-term follow-up of these patients.Results-Follow-up information was obtained for 261 of the 280 (93%) participants in the white light group and 255 of the 271 (94%) participants in the fluorescence group. Median follow-up in the white light and fluorescence groups were 53.0 and 55.1 months, respectively. In the white light and fluorescence groups, 83 (31.8%) and 97 (38%) of the participants remained tumor free, respectively. The median recurrence free survival was 9.6 months in the white light group and 16.4 months in the fluorescence group, p = 0.04. The rates of intravesical therapy were similar in the white light (46%) and fluorescence groups (45%). Cystectomy was performed in 22/280 (7.9%) in the white light group and 13/271 (4.8%) in the fluorescence group, p = 0.16.Conclusions-Hexaminolevulinate fluorescence cystoscopy significantly improves long-term bladder cancer recurrence free survival with a trend towards improved bladder preservation. NIH Public Access

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Improved Detection and Treatment of Bladder Cancer Using Hexaminolevulinate Imaging: A Prospective, Phase Iii Multicenter Study

Abstract: HAL imaging is more effective than standard white light cystoscopy for detecting bladder tumors and lesions. This leads to improved treatment in a significant number of patients (p <0.0001).

Cited by 284 publications

References 15 publications

Bladder cancer in cystoscopically normal‐appearing mucosa: a case of mistaken identity?

Bladder cancer in cystoscopically normal‐appearing mucosa: a case of mistaken identity?

Feasibility of Photodynamic Diagnosis for Challenging TUR-Bt Cases Including Muscle Invasive Bladder Cancer, BCG Failure or 2^nd-TUR

957 Long-term reduction in bladder cancer recurrence with hexaminolevulinate enabled fluorescence cystoscopy

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Improved Detection and Treatment of Bladder Cancer Using Hexaminolevulinate Imaging: A Prospective, Phase Iii Multicenter Study

Abstract: HAL imaging is more effective than standard white light cystoscopy for detecting bladder tumors and lesions. This leads to improved treatment in a significant number of patients (p <0.0001).

Cited by 284 publications

References 15 publications

Bladder cancer in cystoscopically normal‐appearing mucosa: a case of mistaken identity?

Bladder cancer in cystoscopically normal‐appearing mucosa: a case of mistaken identity?

Feasibility of Photodynamic Diagnosis for Challenging TUR-Bt Cases Including Muscle Invasive Bladder Cancer, BCG Failure or 2nd-TUR

957 Long-term reduction in bladder cancer recurrence with hexaminolevulinate enabled fluorescence cystoscopy

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Feasibility of Photodynamic Diagnosis for Challenging TUR-Bt Cases Including Muscle Invasive Bladder Cancer, BCG Failure or 2^nd-TUR