title: Bladder cancer: current optimal intravesical treatment.
abstract: Superficial bladder cancer can be treated surgically, but patients are at high risk for recurrence. Tumors are categorized as low, intermediate, and high-risk based on grade, stage, and pattern of recurrence. Low-risk tumors are best treated with a single instillation of chemotherapy (thiotepa, doxorubicin, or mitomycin) (Lamm, 2002). Though effective, the toxicity of bacillus Calmette-Guerin immunotherapy (BCG) restricts its use to treat higher-grade tumors. Intermediate risk tumors can be treated with chemotherapy as well, but will often require immunotherapy. High-risk tumors are best treated with intravesical BCG using a 3-week maintenance schedule. Side effects of BCG immunotherapy can be decreased by logarithmic reductions in dose. Patients who fail BCG may be rescued with BCG plus interferon alfa or radical cystectomy.
authors.affiliation: BCG Oncology, PC, Phoenix, AZ, USA.
authors.forename: Donald L
authors.initials: DL
authors.lastname: Lamm
authors.forename: William R
authors.initials: WR
authors.lastname: McGee
authors.forename: Kaye
authors.initials: K
authors.lastname: Hale
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage* / Q000009:adverse effects; D000283:Administration, Intravesical; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001500:BCG Vaccine / Q000008:administration & dosage* / Q000009:adverse effects; D015653:Cystectomy; D004317:Doxorubicin / Q000008:administration & dosage / Q000031:analogs & derivatives; D004334:Drug Administration Schedule; D015251:Epirubicin / Q000008:administration & dosage; D006801:Humans; D016898:Interferon-alpha / Q000008:administration & dosage; D016685:Mitomycin / Q000008:administration & dosage; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D024802:Nurse's Role; D018579:Patient Selection; D012307:Risk Factors; D016879:Salvage Therapy / Q000379:methods; D015996:Survival Rate; D013852:Thiotepa / Q000008:administration & dosage; D017211:Treatment Failure; D014481:United States / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000451:nursing
chemical_list: D000276:Adjuvants, Immunologic; D000970:Antineoplastic Agents; D001500:BCG Vaccine; D016898:Interferon-alpha; C016163:valrubicin; D015251:Epirubicin; D016685:Mitomycin; D004317:Doxorubicin; D013852:Thiotepa