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Thomas Flaig, MD

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Can Photodynamic-Guided Surgery in Non–Muscle-Invasive Bladder Cancer Reduce Recurrences?

By: Gavin Calabretta, BS
Posted: Tuesday, October 11, 2022

Although photodynamic diagnosis–guided transurethral resection of bladder tumor (TURBT) may provide better diagnostic accuracy and more complete tumor resection over traditional white light–guided TURBT, it did not comparatively reduce recurrence rates in patients with non–muscle-invasive bladder cancer, according to Emma Hall, PhD, of The Institute of Cancer Research, London, and colleagues. The trial’s results, which were published in NEJM Evidence, further suggested that photodynamic diagnosis was not cost-effective in comparison with white light–guided TURBT.

The randomized phase III, open-label study split 426 patients from 22 U.K. National Health Service hospitals into respective treatment groups for photodynamic diagnosis (n = 209) and white light–guided (n = 217) TURBT. All individuals had suspected first diagnosis of intermediate- to high-risk non–muscle-invasive bladder cancer. Those with low-risk disease, imaging evidence of muscle invasion or upper-tract involvement, metastases, or other contraindications were excluded.

After a median follow-up of 44 months, 86 patients in the photodynamic diagnosis cohort had recurrences, compared with 84 in the white light group (hazard ratio = 0.94; 95% confidence interval [CI] = 0.69–1.28; P = .70). The 3-year recurrence-free rate was 57.8% (95% CI = 50.7%–64.2%) in the photodynamic diagnosis cohort, compared with 61.6% (95% CI = 54.7%–67.8%) in the white light group. Adverse events were reported in less than 2% of participants, occurring in similar rates between groups. Of note, photodynamic diagnosis–guided TURBT was more costly than white light–guided TURBT over a 3-year follow-up, and there was no evidence supporting a difference in quality-adjusted life years.

Disclosure: For full disclosures of the study authors, visit evidence.nejm.org.


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