首页膀胱肿瘤治疗及预后证据详情

A systematic review of the efficacy of intravesical electromotive drug administration therapy for non-muscle invasive bladder cancer

原文: 2023 年 发布于 Urol Oncol 49 卷 第 2 期 211-218 浏览量:267次

作者: Melgarejo-Segura M. T. Morales-Martínez A. Yáñez-Castillo Y. Arrabal-Polo MÁ Gómez-Lechuga P. Pareja-Vílchez M. Jiménez-Moleón J. J. Martín M. A.

作者单位: Department of Urology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China. Department of Urology, Shenzhou People's Hospital, Shenzhou, China.

归属分类: 膀胱肿瘤治疗及预后证据

DOI: 10.3389/fsurg.2021.583806

关键词: Bcg Instillation Intravesical Low dose Non–muscle-invasive bladder cancer

文献简介

BACKGROUND: Non-muscle invasive bladder cancer (NMIBC) is characterized by a high rate of recurrence and progression, despite surgery and adjuvant therapies. OBJECTIVE: To analyze the published results on the effectiveness of mitomycin C (MMC) applied with an electromotive drug administration device (EMDA) in the treatment of patients with non-muscle invasive bladder tumors. METHOD: A systematic review was conducted using the PubMed and Google Scholar search platforms. We selected the studies that included the recurrence and/or progression rates or complete response rate in patients diagnosed with NMIBC according to their treatment and included MMC applied with EMDA. The last search was performed in November 2021. RESULTS: The search yielded 64 articles; 11 articles met the selection criteria. In two of the 11 selected articles, mitomycin C was applied with an EMDA device (MMC-EMDA) as an ablative treatment, avoiding surgery in 50% of the patients. In 1 of the 11 studies, the application of MMC-EMDA was used as an induction treatment using a single preoperative instillation with promising results. In the remaining 8 studies, adjuvant MMC was applied with the EMDA device; in 3 of these 8 cases, treatment with MMC-EMDA alone was applied initially. In another3 cases the same treatment was applied after nonresponse to bacillus Calmette Guerin (BCG), and in the last 2 studies, MMC-EMDA was applied in combination with the classic therapy (BCG). All the studies selected supported the efficacy and safety of MMC-EMDA in patients with intermediate and high- risk bladder cancer. In 3 studies, adjuvant therapy with MMC-EMDA was performed in nonresponders to BCG, finding that adjuvant therapy with MMC-EMDA applied to BCG nonresponders without CIS avoided or delayed surgery. CONCLUSIONS: The application of EMDA-enhanced MMC has been studied at different times of disease and with different administration protocols. It appears to delay bladder tumor recurrence and progression in certain populations. However, the methodological limitations of the published studies prevent definitive conclusions about its efficacy.

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