Intravesical chemotherapy for superficial carcinoma of the bladder

Abstract

Intravesical chemotherapy has been shown to be of value in the treatment of superficial transitional cell carcinoma of the bladder, not only in the prevention of recurrence but possibly progression of the disease to higher stage as well. At the Department of Surgery, National University of Singapore from 1980 to 1986 we had used intravesical chemotherapy for multiple or recurrent superficial carcinoma of bladder in 45 patients. Of these, 21 patients had associated carcinoma in situ. Initially, thiotepa was used as the main intravesical chemotherapeutic agent. Since 1984, mitomycin C was introduced. The schedule used is 30 mg in 30 mg of water, and left in the bladder for 2 hours weekly for 4 weeks. Intermittent courses were given when deemed necessary on follow-up cystoscopy at 3 to 6 months. Patients were deemed to have good response if there was no evidence of tumour on cytology and biopsy at follow-up cystoscopy. Eleven patients had thiotepa only, of these 4 had good response, 4 were stable and 3 had progression of disease to higher stage. Thirty-four patients had mitomycin therapy. Thirteen of them following thiotepa treatment. Twenty-one patients (64%) had good response to therapy. Three patients (9%) had progression of disease, requiring cystectomy. Of those who responded to therapy, none had developed muscle invasive disease so far with mean follow-up of 43 months. Of the group of patients treated with mitomycin, no patient developed myelosuppression.(ABSTRACT TRUNCATED AT 250 WORDS)