title: Intravesical bacillus Calmette-Guerin immunotherapy after previous prostate radiotherapy for high-grade non-muscle-invasive bladder cancer.
abstract: OBJECTIVE
  Intravesical bacillus Calmette-Guerin (BCG) immunotherapy is a standard treatment for high-grade non-muscle-invasive bladder cancer (NMIBC). We evaluated outcomes of BCG therapy for NMIBC in patients with a previous history of prostate cancer (CaP) radiotherapy (RT).
  
  
  METHODS
  A retrospective review of patients with a history of CaP RT who subsequently underwent treatment with intravesical BCG for high-grade NMIBC was performed. Patients were categorized as "BCG success" or "BCG failure" (defined as stage progression or recurrent/persistent disease). We evaluated factors related to the radiotherapy (type, interval to BCG), bladder cancer (clinical stage, immunotherapy type, and course), and patient comorbidities, to identify factors associated with BCG failure.
  
  
  RESULTS
  From 1996 to 2008, 26 patients with high-grade NMIBC received intravesical BCG immunotherapy after CaP RT. At a mean follow-up of nearly 5 years, 13 patients (50%) were successfully managed with one or more induction courses of BCG with or without the addition of interferon alpha. Twelve (46%) eventually required cystectomy for disease recurrence or progression, of which half had pathologically advanced disease (≥pT3). Clinical stage was similar between BCG success and failure patients (P = 0.40). Those who failed immunotherapy were more likely to have had a longer interval between RT and BCG induction (5.8 vs. 2.4 years, P = 0.02).
  
  
  CONCLUSIONS
  Approximately 50% of patients with NMIBC who were previously exposed to prostate radiation had a durable response to intravesical BCG. For non-responders, extravesical progression was common.
authors.affiliation: Department of Urology, Loyola University Medical Center, Maywood, IL 60153, USA. manoj.rao@gmail.com
authors.forename: Manoj V
authors.initials: MV
authors.lastname: Rao
authors.forename: Chandy
authors.initials: C
authors.lastname: Ellimoottil
authors.forename: Timothy
authors.initials: T
authors.lastname: Sondej
authors.forename: Robert C
authors.initials: RC
authors.lastname: Flanigan
authors.forename: Marcus L
authors.initials: ML
authors.lastname: Quek
mesh_terms: D000283:Administration, Intravesical; D000368:Aged; D001500:BCG Vaccine / Q000627:therapeutic use*; D015897:Comorbidity; D015653:Cystectomy; D018450:Disease Progression; D006801:Humans; D007167:Immunotherapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000150:complications / Q000628:therapy*
chemical_list: D001500:BCG Vaccine