OBJECTIVE To evaluate the effect of hexaminolevulinate (HAL)-induced
fluorescence during resection of noninvasive bladder cancer on tumor
recurrence compared with resection under white light.
METHODS Between 2008 and 2010, 102 consecutive patients with suspected
bladder cancer were randomized to undergo transurethral resection with
either conventional white light or combination of white light and
HAL-induced fluorescence. Difference in tumor recurrence rate and
recurrence-free survival between the 2 groups was evaluated. Subgroup
analysis on recurrence-free survival was performed for different tumor
parameters.
RESULTS Cystoscopy at 3 months revealed tumor recurrence in 6 of 45
(13.3%) patients of the white light group compared with only 1 of 41
patients of the HAL group (2.4%) (P < .001). The recurrence-free rates
in white light patients at 12 and 18 months were 56.3% and 50.6%,
respectively, compared with 91% and 82.5% in HAL patients (P = .0006).
In subgroup analyses, recurrence-free survival was similar between the 2
groups when solitary tumors were treated (P = .3525). However, the HAL
group had a favorable recurrence-free survival compared with the white
light group when multifocal tumors (P < .001), primary tumors (P =
.0237), recurrent tumors (P = .0189), nonaggressive (papillary
urothelial neoplasm of low malignant potential and low grade) tumors (P
= .0204), or aggressive ( high grade and carcinoma in situ) tumors (P =
.0134) were treated.
CONCLUSION HAL significantly aids resection of non-muscle-invasive
bladder cancer with the result of reduction in tumor recurrence rates.
UROLOGY 80: 354-360, 2012. (c) 2012 Elsevier Inc
