title: 15-year experience on intravesical therapy of T1G3 urinary bladder cancer: a conservative approach.
abstract: OBJECTIVE
  To report the recurrence, progression and survival in patients with T1G3 transitional cell carcinoma (TCC) of the urinary bladder treated with sequential intravesical bacillus Calmette-Guérin (BCG) and chemotherapeutic agents (doxorubicin or epirubicin) on long-term follow up.
  
  
  METHODS
  Between July 1988 and September 1999, all patients in a single center with T1G3 bladder TCC, after complete transurethral resection (TURBT), received either 81 mg of Connaught strain BCG or 50 mg of doxorubicin or epirubicin as adjuvant therapy. A conservative approach was adopted whereby those with superficial recurrences were eligible to crossover, even repeatedly, until progression to muscle invasion. Recurrence, progression and disease-specific survival were analyzed.
  
  
  RESULTS
  There were 36 patients included, with 26 males and 10 females. The mean age was 71.6 years (range 53-85 years). Final analysis was made at a median follow-up of 23.5 months (range 0-125 months) for recurrence, 33 months (range 0-125 months) for progression and 45.5 months (range 3-125 months) for survival. Sixteen (44.4%) patients showed recurrence. Nine (25%) of these 16 patients progressed. Five (13.9%) of those who progressed died of TCC. The 10 year Kaplan-Meier estimates for recurrence-free survival, progression-free survival and disease-specific survival were 48, 68 and 81%, respectively. Figures with this conservative approach were comparable to those with more aggressive approaches reported in the literature.
  
  
  CONCLUSIONS
  Adjuvant intravesical therapy with either BCG or a chemotherapeutic agent (doxorubicin or epirubicin) and crossover on recurrence was an effective conservative treatment for T1G3 bladder TCC.
authors.affiliation: Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China. drmcheng@hotmail.com
authors.forename: Chi Wai
authors.initials: CW
authors.lastname: Cheng
authors.forename: Siu Foon Peter
authors.initials: SF
authors.lastname: Chan
authors.forename: Lung Wai
authors.initials: LW
authors.lastname: Chan
authors.forename: Chi Kwok
authors.initials: CK
authors.lastname: Chan
authors.forename: Chi Fai
authors.initials: CF
authors.lastname: Ng
authors.forename: Ho Yuen
authors.initials: HY
authors.lastname: Cheung
authors.forename: Shu Yin Eddie
authors.initials: SY
authors.lastname: Chan
authors.forename: Wai Sang
authors.initials: WS
authors.lastname: Wong
authors.forename: Fernand Mac-Moune
authors.initials: FM
authors.lastname: Lai
authors.forename: Miu Ling
authors.initials: ML
authors.lastname: Li
mesh_terms: D000283:Administration, Intravesical; D000368:Aged; D000369:Aged, 80 and over; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage*; D001500:BCG Vaccine / Q000627:therapeutic use*; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D018450:Disease Progression; D004317:Doxorubicin / Q000008:administration & dosage*; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000628:therapy; D016016:Proportional Hazards Models; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*
chemical_list: D000903:Antibiotics, Antineoplastic; C087507:BCG Connaught; D001500:BCG Vaccine; D015251:Epirubicin; D004317:Doxorubicin