Single Versus Long-term Intravesical Instillation Chemotherapy for Recurrence After Nephroureterectomy for Upper Tract Urothelial Carcinoma

Study Overview
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Brief Summary
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Up to 30-40% of the patients may develop bladder recurrance after radical nephroureterectomy for primary upper tract urothelial carcinoma. Bladder tumor needs transurethral resection, which is associated with costs of treatment and potential poor prognosis. Although several randomized controlled trial have shown that prophylactic intravesical chemotherapy could prevent bladder tumor recurrence, the optimal schedule and duration of treatment are unkown. The investigators want to determine the efficiacy of single instillation versus long-term intravesical instillation of pirarubicin for bladder recurrence after radical nephrouretectomy for primary upper tract urothelial carcinoma.

Official Title
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Prospective Randomized Phase II Trial: Single Instillation Versus Long-term Prophylactic Intravesical Instillation of Pirarubicin in the Prevention of Bladder Recurrence After Nephroureterectomy for Primary Upper Tract Urothelial Carcinoma

Conditions
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Intravesical Instillation

Intervention / Treatment
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* Drug: pirarubicin(THP)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: clinically diagnosed with upper tract urothelial carcinoma have no distant metastasis have an ECOG 0 to 2 expected to receive radical nephroureterectomy Exclusion Criteria: a prior history of bladder or synchronous bladder cancer administration of neoadjuvant chemotherapy the presence of severe complications deny to receive cytoscopy patients with advanced stage (T4) patients with contralateral UTUCs

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Long-term Intravesical Instillation of pirarubicin(THP)<br>A single instillation of pirarubicin (THP) plus one year long-term intravesical instillation after nephroureterectomy was performed. The ﬁrst instillation was initiated within 72-168 hours after surgery, followed by four times weekly and 11 times monthly (16 times in total in one year time) . Every time, THP 30 mg in 30 mL of normal saline was delivered into the bladder through a catheter and was retained for 30 minutes. | Drug: pirarubicin(THP)<br> <br> |
| Active Comparator: Single Intravesical Instillation of pirarubicin<br>A single intravesical instillation of THP after nephroureterectomy was performed. This instillation was initiated within 72-168 hours after surgery . THP 30 mg in 30 mL of normal saline was delivered into the bladder through a catheter and was retained for 30 minutes. | Drug: pirarubicin(THP)<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The incidence of bladder cancer in the first 12 month following nephroureterectomy | Bladder recurrence is judged on visual appearance, and histopathologic proof of recurrence was required. | 12 month | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of participants with treatment-related adverse events as assessed by CTCAE v4.0 |  | 2 day, 1 month and 12 month | 
| questionnaire for quality of life | e.g QLQ C-30 | baseline, 1 month and 12 month | 
| progression-free survival | progression-free survival | 12 month | 
| cancer-specific survival | cancer-specific survival | 12 month | 
| overall survival | overall survival | 12 month | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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urothelial cancer, bladder cancer, nephroureterectomy