Early Single-Instillation Chemotherapy Has No Real Benefit and Should Be Abandoned in Non-Muscle-Invasive Bladder Cancer

Context: Most bladder tumours recur after a transurethral resection (TUR). The European Association of Urology (EAU) guidelines recommend a single immediate instillation of chemotherapy after every TUR of a suspected Ta/T1 bladder tumour. Objective: To provide a review of the results of a single immediate instillation of chemotherapy and to draw attention to alternative treatment strategies. Evidence acquisition: The author reviewed data from published clinical bladder cancer studies from 1976 to 2008 on single instillation. Evidence synthesis: A single immediate postoperative instillation results in less recurrence compared with TUR alone. It seems, however, that between 20 and 50 patients have to be treated to prevent one harmless, small-sized recurrence if the EAU guidelines are followed. There is no evidence that the instillation has any impact on progression, quality of life, and economy. Conclusions: it is recommended that single instillations should not be used outside of clinical trials. The EAU guidelines should be revised. (c) 2009 European Association of Urology. Published by Elsevier B.V. All rights reserved.