title: Conservative treatment of diffuse carcinoma in situ of the bladder with repeated courses of intravesical therapy.
abstract: We present a series of 13 patients with diffuse carcinoma in situ (CIS) of the bladder who failed an initial induction course of intravesical therapy with Mitomycin C, thiotepa, doxorubicin or Bacillus Calmette Guérin (BCG). Cystectomy, although indicated, was, for various reasons, not performed after the first failure of intravesical therapy and all patients were subsequently treated topically with the same or different agents. Of the 7 patients treated with 2 induction courses, 6 showed a complete response during a follow-up period of 24 to 42 months. Although 1 patient initially responded completely, he developed invasive transitional cell carcinoma (TCC) Grade IV 30 months later. Among the 3 patients who underwent 3 induction courses, 2 had a complete response at 42 and 60 months of follow-up and 1 developed TCC Grade IV with muscle invasion 18 months later. Two of the 3 patients treated with 4 induction courses are free of disease at 48 and 57 months; the third developed low grade, low stage TCC. This experience suggests that the majority of patients with CIS who fail initial treatment usually respond to further treatment with the same or a different drug. The question as to whether a second course of intravesical therapy, subsequent to failure of the first course, should be given before cystectomy requires further investigation.
authors.affiliation: Department of Surgery, UCLA School of Medicine.
authors.forename: E
authors.initials: E
authors.lastname: Mukamel
authors.forename: J B
authors.initials: JB
authors.lastname: deKernion
mesh_terms: D000283:Administration, Intravesical; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001500:BCG Vaccine / Q000008:administration & dosage; D002278:Carcinoma in Situ / Q000188:drug therapy*; D004317:Doxorubicin / Q000008:administration & dosage; D006801:Humans; D008875:Middle Aged; D016685:Mitomycin; D008937:Mitomycins / Q000008:administration & dosage; D012074:Remission Induction; D013852:Thiotepa / Q000008:administration & dosage; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy*
chemical_list: D001500:BCG Vaccine; D008937:Mitomycins; D016685:Mitomycin; D004317:Doxorubicin; D013852:Thiotepa