Regarding non-muscle-invasive bladder cancer and adjuvant chemo/immunotherapy, which of the following statement is FALSE?A) Recent evidence suggests no statistically significant benefit from early postoperative chemotherapeutic instillation in patients with large or recurrent tumours (i.e., intermediate risk) or in those with high-risk NMIBC
The effect of early instillation can be explained by the destruction of circulating tumour cells free within the bladder immediately after TUR, or as an ablative effect (chemoresection) of the residual tumour cells at the resection site. In all single instillation studies, the instillation was administered within 24 hours. In absolute values, the reduction was 11.7% (from 48.4% to 36.7%), which implies a 24.2% decrease in the corresponding relative risk. The majority (80%) of patients in this EORTC meta-analysis showing the benefit of single, immediate instillation of intravesical chemotherapy after TURBT had a single tumour.
No prospective data are available showing that the single instillation significantly reduces recurrence rates in patients with recurrent tumours. Nevertheless, there is significant evidence from one subgroup analysis that an immediate instillation might have an impact on the repeat instillation regimen for treatment of patients who are at intermediate- and high-risk of recurrence.
Immediate instillation of chemotherapy has no reported influence on the progression rate or overall survival of patients with NMIBC. Mitomycin C, epirubicin and doxorubicin have all shown a beneficial effect, and none is superior.