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Fluorescent diagnosis… and surgery?
Hi everyone!
“Fluorescence cystoscopy has been proven to enhance the detection of superficial bladder cancer lesions, both papillary and CIS, with an apparent influence on recurrence and progression rate.” http://www.touchbriefings.com/pdf/1599/witjes_lr.pdf
Is this innovative method just for diagnosing or can it be also used for performing surgery?
Does it make such a big difference to use this “blue/green light” rather than the traditional white light used in cystoscopy? (Not many clinics/hospitals seem to have adopted it yet…)
Many thanks and kind regards
Gabriel
My father is a male, 65, nonsmoker. Hematuria 01/08 TURB: T1 G3 widespread bladder+prostatic urethra; 3-month BCG.
Clean until 02/11: small TURB with no biopsy; 06/11 tumour detected TURB 08/11: awaiting biopsy, prostatic adenoma removed. Biopsies show both were benign. (…)9 Replies-
Hi Gabriel,
Narrow Band Imaging is what the major cancer centers seem to use as it does not require a waiting period of one hour as does the Hexvix. The dye has to be administered and the patient must wait one hour before the cystoscopy or TURB to take place.
This from Drs at Memorial Sloan
http://www.ncbi.nlm.nih.gov/pubmed/20707789
pat -
Having been researching the use of fluorescent light/dyes I’ve come to the conclusion that they are much more effective than white light. And it is not just the companies behind it who say this – there are numerous university studies using different solutions that confirm the effectiveness of fluorescent diagnoses: http://www.esru.be/sites/default/files/02_DE_WITTE_-_Photodiagnosis_and_photodynamic_therapy.pdf
Why isn’t its usage more widespread?
1. More expensive?
2. It takes longer – patient turnaround in surgery?
3. Ignorance?I can’t access some of the later medical papers but would love to see some of your opinions on this. Thank you!
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article excerpt:
In April 2011 a new publication on Hexvix® in British Journal of Urology (BJUI) was published. This study confirm the results from a large prospective international study published in the Journal of Urology in November 2010. The results of the trial demonstrate that Hexvix identified lesions, including residual tumours, that were not detected with white light alone in 49% of the patients. It also demonstrated that the improved detection of lesions resulted in a significant reduction in tumour recurrence within 12 months. [8] [9]
On 12th May 2011 it was announced results from a clinical study included retrospective follow up from 526 patients in a prospective randomized Phase III trial in 28 centers in EU and North America. After a follow-up period up to 5.5 years, the number of patients who have experienced recurrence of their bladder cancer is lower, and the time it takes before the recurrence occurs is longer when they had Hexvix-guided fluorescence cystoscopy. [10]8 http://urotoday.com/bladder-cancer-1038/fluorescence-guided-transurethral-resection-of-bladder-tumours-reduces-bladder-tumour-recurrence-due-to-less-residual-tumour-tissue-in-t-at1-patients-a-randomized-two-centre-study-abstract.html Fluorescence-guided transurethral resection of bladder tumours reduces bladder tumour recurrence due to less residual tumour tissue in Ta/T1 patients A randomized two-centre study
9 http://www.newsweb.no/newsweb/search.do?messageId=278275 British Journal of Urology publishes paper on Hexvix®
10 http://www.medicalnewstoday.com/releases/225061.php Hexvix(R)/Cysview™ Demonstrates Long Term Benefit: Results From 5.5 Year Follow Up Of Recurrence Of Bladder Cancer
[edit]
My father is a male, 65, nonsmoker. Hematuria 01/08 TURB: T1 G3 widespread bladder+prostatic urethra; 3-month BCG.
Clean until 02/11: small TURB with no biopsy; 06/11 tumour detected TURB 08/11: awaiting biopsy, prostatic adenoma removed. Biopsies show both were benign. (…)
Gabriel, your question is answered on the first page on the Hexvix site which says it is not licensed in the US. So white light is the standard practice in the US. I believe the fluorescent exam is being tested at some sites in the US in preparation for approval by the FDA but I am not certain.
I think many of us would agree that we would want the best light available especially anyone who has CIS which is very hard to detect by the current methodology.
Volunteer Coordinator
ABLSC
Dear all,
I was wondering whether you consider fluorescent surgery important or not in the US?
I understand you do not use Hexvix, but do you use any alternatives to this?
http://www.hexvix.com/Is the traditional white light still standard practice? I’ve read fluorescent practice is normally more targeted, meaning a surgeon doesn’t have to guess what to scratch.
In our case, the surgeon – who is supposed to be the best at the hospital – apologised for perforating the bladder by saying “I know I scratched a bit too much, I just wanted to make sure it was as superficial as it seemed”…
Research shows fluorescent surgery is more precise.
Any comments or experienced views?
Best wishes
Gabriel
My father is a male, 65, nonsmoker. Hematuria 01/08 TURB: T1 G3 widespread bladder+prostatic urethra; 3-month BCG.
Clean until 02/11: small TURB with no biopsy; 06/11 tumour detected TURB 08/11: awaiting biopsy, prostatic adenoma removed. Biopsies show both were benign. (…)
Dear Joris
Apparently Hexvix has been introduced in Spain during 2007. Fortunately the hospital we’re going to has already incorporated it.
Thanks for your info
Gabriel
My father is a male, 65, nonsmoker. Hematuria 01/08 TURB: T1 G3 widespread bladder+prostatic urethra; 3-month BCG.
Clean until 02/11: small TURB with no biopsy; 06/11 tumour detected TURB 08/11: awaiting biopsy, prostatic adenoma removed. Biopsies show both were benign. (…)
Hi,
Hexvix is not used much in the US, as it is still in clinical trials, but it is well worth looking into. There is more info here: http://blcwebcafe.org/hexvix.aspAll the best,
>Joris
Thank you Pat!
My father is a male, 65, nonsmoker. Hematuria 01/08 TURB: T1 G3 widespread bladder+prostatic urethra; 3-month BCG.
Clean until 02/11: small TURB with no biopsy; 06/11 tumour detected TURB 08/11: awaiting biopsy, prostatic adenoma removed. Biopsies show both were benign. (…)gabriel…the Hexvix is used mainly in Europe….but i do know that Dr. Harry Herr of Memorial Sloan is using a similar devise that is in trial. Its particularly good at finding CIS and used for diagnostic purposes….Pat
Hi again
Has anyone in this forum used this method or heard of someone who has?
My family is very keen to know as we need to make a choice between hospitals.
Many thanks
My father is a male, 65, nonsmoker. Hematuria 01/08 TURB: T1 G3 widespread bladder+prostatic urethra; 3-month BCG.
Clean until 02/11: small TURB with no biopsy; 06/11 tumour detected TURB 08/11: awaiting biopsy, prostatic adenoma removed. Biopsies show both were benign. (…)Sign In to reply.
