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Office Fulguration Confirmed as Valuable Procedure for Selected Recurrent Papillary Tumors: Presented at AUA

By Jill Stein

CHICAGO, IL -- April 29, 2003 -- Cystodiathermy conducted in the physician's office is safe and effective for treatment of selected patients with recurrent small low-grade papillary bladder tumors, according to data presented here April 28^th at the 2003 Annual Meeting of the American Urological Association.

The study was conducted by a group from Memorial Sloan-Kettering Cancer Center in New York. Dr. Amanda North, who is now with Montefiore Hospital in New York, reported the findings.

Her group prospectively followed 267 consecutive patients with superficial bladder cancer undergoing routine office surveillance cystoscopy during a recent 2-year period.

All patients completed their initial treatment and at least 6 months of surveillance without tumor recurrence.

"Flexible cystoscopy is an established method of performing office surveillance in patients with superficial bladder cancer," Dr. North explained. "Low-grade superficial papillary tumors can be identified by endoscopy, and such tumors rarely progress in stage. Although recurrent papillary tumors are usually treated with transurethral resection under anesthesia, small papillary tumors may be treated in the office using cystodiathermy."

At Memorial Sloan-Kettering, physicians have been performing office fulguration for 15 years. However, the safety and efficacy of the technique had never been shown in a clinical trial.

In the study, selection criteria for fulguration included the presence of fewer than 5 low grade-appearing papillary tumors, less than 0.5 cm tumor size, negative urine cytology, and the patient's wish to undergo an office-based treatment.

Of study subjects, 75.4% were men. The median age was 61.1 years, 65.5% had a history of intravesical therapy, 13.9% had a history of upper tract tumor, and 75.5% had a history of recurrent cancer. Seventy-five percent were current or former smokers.

One hundred twenty-three patients (46%) developed at least 1 tumor recurrence at a median 2.6 years of follow-up, Dr. North said. Seventy-four (60%) of the 123 patients who had a recurrence underwent office fulguration. The other 53 (40%) patients had conventional transurethral resection under general anesthesia.

Results showed no difference in disease-specific survival or disease progression in the group that underwent the office procedure compared with the control group that underwent the standard transurethral resection.

Among high-risk patients with low-grade papillary recurrences, those who underwent office cystodiathermy did not risk disease progression and had a better overall survival.

Flexible cystodiathermy in the office is a safe and effective method for treating small low-grade recurrent superficial papillary tumors in appropriately selected patients, Dr. North said. "If there is any question that the tumor might be invasive or that there might be some carcinoma in situ, patients should be taken to the operating room," she added.

The next step in the research is to compare the cost-effectiveness of the procedure with that of the standard transurethral resection, she said.


[Study title: Efficacy of Office Fulguration for Recurrent Low Grade Papillary Bladder Tumors Under 0.5 centimeters (CM). Abstract 1002]

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