[Intravesical chemotherapy of superficial bladder tumors]

Abstract

It has been reported that the intravesical instillation therapy had response rates ranging from 60 to 70% for bladder cancer and we could expect its significant efficacy, in terms of clinical benefits with quick response and lower medical cost, in patients of superficial and papillary peduncular tumors with multiple diseases and in diameter of maximum 1 cm. The intravesical instillation should be performed 2-3 times/week and within 2-3 weeks for the purpose to reach the clinical objectives. In order to enhance the efficacy of the intravesical instillation therapy, combined use of multiple anticancer agents or multidisciplinary treatments have been tried, in combination with systemic administration, radiotherapy, hyperthermia and hydro pressure therapy, which obtained remarkable clinical results. However, a comparative study has never been carried out among these treatments. It's a practical treatment that the intravesical instillation is given as an adjuvant therapy after TUR. In case of prophylactic purpose, the frequency and the period are still under discussion on the administration of the drugs. These is no clear idea yet which is optimal, a short period of administration for 1-2 weeks or a longer period for 2-5 years. Adriamycin and mitomycin-C have been commonly used for the intravesical instillation therapy of bladder cancer. BCG has recently had a good clinical response not only for therapeutic purpose of carcinoma in site but also for the prophylactic purpose with its intravesical instillation. Many studies indicated that the intravesical instillation therapy alone could not inhibit recurrence of bladder cancer under the current situation when the incidence of tumor and mechanism of recurrence are not yet clarified completely in epidemiological points of view. For improvement of treatment of bladder cancer, further fundamental studies must be developed and also a randomized trial is clinically needed, taking in consideration backgrounds of the patients, for evaluation of efficacy of bladder cancer treatment.