This is a prospective, multi-centre randomised trial comparing between cTURBT plus 1-year BCG therapy, and ERBT plus 1-year BCG therapy, in patients with intermediate-risk or high-risk NMIBC.
All patients who are diagnosed to have bladder tumour(s) upon flexible cystoscopy will be screened for study eligibility. Imaging will be arranged to rule out any upper urinary tract malignancy. Patients are randomised to receive either transurethral ERBT or cTURBT with an allocation ratio of 1:1. A single dose of intravesical mitomycin C will be instilled according to the EAU guidelines, i.e. in all patients except those with a prior recurrence rate of more than one recurrence per year, or those with an EORTC recurrence score of ≥5. All patients will be followed up at our outpatient clinic and the pathology results will be reviewed. Routine second-look TURBT will be arranged within 2-6 weeks after the first operation should there be any indications as stated in the EAU guidelines. For patients in the intermediate or high-risk groups, 1-year of intravesical BCG therapy will be offered. Surveillance flexible cystoscopy will be performed at a 3-month interval until 2 years after the index surgery, and then every 6 months for another 3 years. Biopsy will be taken and TURBT will be offered if there is any suspicious tumour recurrence noted during surveillance cystoscopy.Primary outcome is recurrence-free survival at 2 years.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
732
Conventional TURBT is performed by resecting the bladder tumour in a piecemeal manner with a top-down approach. The bladder tumour specimen is fragmented during the procedure and whether a complete resection has been achieved is determined by the operating surgeon's judgment intra-operatively.
This surgical technique resects the bladder tumour underneath the submucosal plane, and the bladder tumour can be removed in one piece.
Prince of Wales Hospital
Hong Kong, Hong Kong
North District Hospital
Sheung Shui, Hong Kong
Rate of recurrence-free survival
Time frame: At Year 2
Rate of progression-free survival
Time frame: At Year 2
Cancer-specific survival
Time frame: At Year 2
Overall survival
Time frame: At Year 2
Adverse Events
By CTCAE V5.0
Time frame: On Day 30 after operation
Detrusor muscle sampling rate
Time frame: On Day 30 after operation
Day of hospital stay
Time frame: On Day 30 after operation
Total operation time
Time frame: On Day 30 after operation
Yuen Chun Jeremy TEOH
CONTACT
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