title: Intravesical chemotherapy for intermediate risk non-muscle invasive bladder cancer recurring after a first cycle of intravesical adjuvant therapy.
abstract: BACKGROUND
  The therapeutic strategy in intermediate risk (IR) non-muscle invasive bladder cancer (NMIBC) recurring after intravesical therapy (IT) is not well defined. Most patients are usually retreated by Bacillus Calmette-Guerin (BCG).
  
  
  OBJECTIVE
  To evaluate the efficacy of intravesical chemotherapy (ICH) given at recurrence after the first cycle of ICH in IR-NMIBC recurring 6 months or later.
  
  
  METHODS
  Retrospective analysis of the efficacy of ICH given after previous IT.
  
  
  METHODS
  The clinical files of IR-NMIBC patients recurring later than 6 months after transurethral resection (TUR) and IT and retreated by IT were reviewed. The patients should be at intermediate risk both initially and at the first recurrence. BCG should have been given at full dose. Cytology and cystoscopy were performed 3 monthly for 2 years and then 6 monthly.
  
  
  METHODS
  The RFS was estimated by the Kaplan-Meier method and the differences between treatment groups were compared by log-rank test. Mann Whitney U-test was used to compare the parameters' distribution for median time to recurrence. Multivariate Cox proportional hazards models were used.
  
  
  RESULTS
  The study included 179 patients. The first IT was ICH in 146 (81.6%) and BCG in 33 (18.4%), re-IT was ICH in 112 (62.6%) and BCG in 67 (37.4%) patients. Median time to recurrence was 18 and 16 months after first and second IT (P = 0.32). At 3 years, 24 (35.8%) and 49 (43.8%) patients recurred after BCG and ICH, respectively (P = 0.90). No difference in RFS was found between BCG and ICH given after a first cycle of ICH (P = 0.23).
  
  
  CONCLUSIONS
  Re-treatment with ICH could represent a legitimate option to BCG in patients harboring IR-NMIBC recurring after TUR and previous ICH. Prospective trials are needed.
authors: Department of Surgical and Oncological Sciences, Section of Urology, University of Palermo, Palermo, Italy.
authors: Vincenzo
authors: V
authors: Serretta
authors: Department of Surgical and Oncological Sciences, Section of Urology, University of Palermo, Palermo, Italy.
authors: Francesco
authors: F
authors: Sommatino
authors: Department of Surgical and Oncological Sciences, Section of Urology, University of Palermo, Palermo, Italy.
authors: Cristina Scalici
authors: CS
authors: Gesolfo
authors: Department of Sciences for Health Promotion, Section of Anatomic Pathology, University of Palermo, Palermo, Italy.
authors: Vito
authors: V
authors: Franco
authors: Department of Surgical and Oncological Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy.
authors: Giuseppe
authors: G
authors: Cicero
authors: Department of Statistics, Gruppo Studi Tumori Urologici (GSTU) Foundation, Palermo, Italy.
authors: Rosalinda
authors: R
authors: Allegro
keywords: Bacillus Calmette-Guerin; intermediate risk; intravesical chemotherapy; non muscle invasive bladder cancer; recurrence
references: Eur Urol. 2007 Oct;52(4):1123-29
references: 17383080
references: Eur Urol. 2008 Apr;53(4):709-19
references: 18207317
references: Eur Urol. 2012 Dec;62(6):1088-96
references: 22959049
references: J Urol. 2011 Dec;186(6):2158-67
references: 22014799
references: Eur Urol. 2013 Oct;64(4):639-53
references: 23827737
references: Eur Urol. 2006 Mar;49(3):466-5; discussion 475-7
references: 16442208
references: Eur Urol. 2007 Oct;52(4):951-3; discussion 953-4
references: 17374437
references: Eur Urol. 2011 Jul;60(1):32-6
references: 21497431
references: Eur Urol. 2010 May;57(5):766-73
references: 20034729
references: BJU Int. 2010 Jul;106(2):212-7
references: 20070299
references: Eur Urol. 2009 Aug;56(2):257-8; discussion 258-9
references: 19427109
references: Eur Urol. 2013 Mar;63(3):462-72
references: 23141049
references: J Urol. 2002 Nov;168(5):1964-70
references: 12394686
references: BJU Int. 2013 Oct;112(6):742-50
references: 23452187