Postoperative Adjuvant Intravesical Instillation Therapy with BCG, Epirubicin and Thiotepa in Superficial Transitional Cell Carcinoma of Urinary Bladder

Abstract

From December, 1993 to June 1995, a total of 65 patients (40 male and 25 female; age range from 38 to 81 years old, mean 64) with urinary bladder transitional cell carcinoma (13 stage T0, 43 stage T1, 6 stage T2, 3 stage T3a) received adjuvant intravesical instillation therapy after TURBT (transurethral resection of bladder tumor). Among them, 22 were treated with epirubicin, 28 with thiotepa and 15 with BCG (Bacillus Calmette-Guerin, Caunnaught strain, Canada). They were followed with cystoscopy and urine cytology at regular therr-month intervals. The overall local recurrence rates were 27.2%, 28.5%, and 13.3% in the epirubicin, thiotepa and BCG groups, respectively (p＞0.05). Only one patient, in the BCG group, dropped out of therapy because of urosepsis. Complicatoins were more severe and common in the BCG group, including dysuria (93.3%), hematuria (60%), frequency (46.7%) and fever with chills (40%). Patients who had failed previous intravesical chemotherapy recurred equally in the therapeutic groups of epirubicin (40%) and thiotepa (30.8%), but were not found in the BCG group, while the tumor recurrence rate for patients with fresh bladder tumor were 26.7%, 16.7%, and 13.3% among the groups given thiotepa, epirubicin and BCG, respectively. The preliminary result, with limited short-term follow-up, implied that BCG may provide the lowest recurrence rate among the three therapeutic groups at the expense of relatively severe, but self-limiting, side effects on the urinary bladder.