Intraoperative Intravesical Epirubicin: Implementing the Process
Intraoperative Intravesical Epirubicin: Implementing the Process
Recommended treatment for stage Ta T1 bladder cancer is instillation of a chemotherapeutic agent within 6 hours of transurethral resection of bladder tumor based on recent review of literature. This practice has been adopted by the urology department at Westmead Hospital, Sydney, Australia, where epirubicin is instilled intraoperatively. The practical implementation of the process is described.
A meta-analysis of published results of randomized clinical trials reports that "one immediate instillation of chemotherapy post-TUR decreases the risk of recurrence by 39% in patients with Ta T1 bladder cancer85It is associated with only negligible side effects and it is cost effective" (Sylvester, Oosterlincjk, & van der Meijden, 2004, p. 2188).
The mode of action of intravesical chemotherapy is "DNA synthesis inhibition with further protein synthesis inhibition" (Duque & Loughlin, 2000, p. 130). Following transurethral resection of bladder tumor (TURBT) the chemotherapeutic effect is both at the resection site on the urothelial wall as well as destroying circulating tumor cells that could implant (Sylvester et al., 2004). The concentration of the drug together with the dwell time is also a factor affecting response.
With data now clearly showing "that the greatest benefit of intravesical chemotherapy occurs when treatment is given to prevent seeding and initiated within 6 hours of tumor resection" (Lamm, McGee, & Hale, 2005, p. 323), the urology department at Westmead Hospital, Sydney, Australia, introduced the process of intraoperative instillation of epirubicin.
Recommended treatment for stage Ta T1 bladder cancer is instillation of a chemotherapeutic agent within 6 hours of transurethral resection of bladder tumor based on recent review of literature. This practice has been adopted by the urology department at Westmead Hospital, Sydney, Australia, where epirubicin is instilled intraoperatively. The practical implementation of the process is described.
A meta-analysis of published results of randomized clinical trials reports that "one immediate instillation of chemotherapy post-TUR decreases the risk of recurrence by 39% in patients with Ta T1 bladder cancer85It is associated with only negligible side effects and it is cost effective" (Sylvester, Oosterlincjk, & van der Meijden, 2004, p. 2188).
The mode of action of intravesical chemotherapy is "DNA synthesis inhibition with further protein synthesis inhibition" (Duque & Loughlin, 2000, p. 130). Following transurethral resection of bladder tumor (TURBT) the chemotherapeutic effect is both at the resection site on the urothelial wall as well as destroying circulating tumor cells that could implant (Sylvester et al., 2004). The concentration of the drug together with the dwell time is also a factor affecting response.
With data now clearly showing "that the greatest benefit of intravesical chemotherapy occurs when treatment is given to prevent seeding and initiated within 6 hours of tumor resection" (Lamm, McGee, & Hale, 2005, p. 323), the urology department at Westmead Hospital, Sydney, Australia, introduced the process of intraoperative instillation of epirubicin.
