1673 NATURAL HISTORY AND OUTCOME OF PATIENTS WITH HIGH RISK NON-MUSCLE INVASIVE BLADDER CANCER TREATED WITH BACILLE CALMETTE GUÉRIN A CONTEMPORARY UK SERIES

Abstract

You have accessJournal of UrologyBladder Cancer: Superficial I1 Apr 20121673 NATURAL HISTORY AND OUTCOME OF PATIENTS WITH HIGH RISK NON-MUSCLE INVASIVE BLADDER CANCER TREATED WITH BACILLE CALMETTE GUÉRIN A CONTEMPORARY UK SERIES Thomas Grant, Ian Donaldson, Nourdin Kadi, Stephen Thomas, and Hari Ratan Thomas GrantThomas Grant Nottingham, United Kingdom More articles by this author , Ian DonaldsonIan Donaldson Derby, United Kingdom More articles by this author , Nourdin KadiNourdin Kadi Derby, United Kingdom More articles by this author , Stephen ThomasStephen Thomas Derby, United Kingdom More articles by this author , and Hari RatanHari Ratan Derby, United Kingdom More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1531AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The endoscopic management of high-risk non-muscle invasive bladder cancer (NMIBC) is associated with a very high incidence of recurrence and, more worryingly, progression. This mandates intravesical treatment as per European Association of Urology (EAU) guidelines; 27 bladder instillations over 3 years. Bacillus Calmette-Guérin (BCG) is the mainstay of initial treatment of high risk NMIBC in the UK, and has been shown to reduce recurrence and progression rates. However the treatment is often poorly tolerated. Here we review the tolerability and efficacy of intravesical BCG in a cohort of patients with high-grade NMIBC in a UK teaching hospital. METHODS Between April 2006 and December 2008, 83 patients (mean age 75 years, M:F ratio 4.19) who received a first induction course of BCG for high-risk NMIBC were identified retrospectively. Response to BCG was reviewed by assessing their cystoscopic, histological and clinical outcomes. RESULTS 15 patients out of 83 completed 3 years of BCG maintenance. Of the 68 patients who stopped BCG maintenance prematurely, 17 stopped because of tumour recurrence, 3 because they required radiotherapy and 48 due to intolerance of side effects. Of these 48, 7 patients (14.58%) went on to develop a later recurrence, compared to 2 of the 15 patients (13.33%) who completed 27 instillations. Neither of these 2 recurrences required cystectomy however 3 of the 7 recurrences in patients intolerant to BCG side effects had progressed to a muscle invasive TCC and went on to have radical cystectomy. The overall survival at mean follow-up (of 55 months) was 75.90%. Cause of death was TCC-related in 13.25% of cases. CONCLUSIONS In this contemporary, representative UK series of intravesical BCG in high risk NMIBC, we found that compliance with 3 years of BCG induction and maintenance therapy was poor, and in line with previously published data. Interestingly however, at mean follow up of 55 months, the proportion of patients who stopped BCG due to intolerance of side effects had a similar rate of tumour recurrence to those who completed 27 instillations (14.58% vs 13.33% respectively). This suggests that 27 instillations may not be required for optimum efficacy of BCG in order to reduce recurrence and that regimes with shorter maintenance courses may result in better patient compliance. However in this small series it is impossible to conclude whether progression, perhaps the more important clinical outcome can also be reduced by shorter maintenance courses of BCG. Longer term follow up is of course required. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e676 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Thomas Grant Nottingham, United Kingdom More articles by this author Ian Donaldson Derby, United Kingdom More articles by this author Nourdin Kadi Derby, United Kingdom More articles by this author Stephen Thomas Derby, United Kingdom More articles by this author Hari Ratan Derby, United Kingdom More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...