15-year experience on intravesical therapy of T1G3 urinary bladder cancer: a conservative approach.
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.
Cheng
Chi Wai
CW
Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China. drmcheng@hotmail.com
Chan
Siu Foon Peter
SF
Chan
Lung Wai
LW
Chan
Chi Kwok
CK
Ng
Chi Fai
CF
Cheung
Ho Yuen
HY
Chan
Shu Yin Eddie
SY
Wong
Wai Sang
WS
Lai
Fernand Mac-Moune
FM
Li
Miu Ling
ML
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*
D000903:Antibiotics, Antineoplastic; C087507:BCG Connaught; D001500:BCG Vaccine; D015251:Epirubicin; D004317:Doxorubicin