3/2007Intravesical chemotherapy and BCG instillation in superficial bladder cancer treatment

MARIA MAGDALENA BUJNOWSKA-FEDAK (Katedra i Zakład Medycyny Rodzinnej Akademii Medycznej we Wrocławiu;Kierownik: prof. dr hab. med. Andrzej Steciwko)

Summary
From the clinical point of view the urinary bladder cancer can be divided into two forms: superficial bladder cancer (not infiltrating a muscular coat) and invasive bladder cancer – infiltrating a muscular coat. In case of superficial bladder cancer the treatment is directed especially into prevention of progression and reoccurrence of the disease. The standard therapy involves Trans Urethral Resection of a tumor (TURB) and complementary intravesical therapy (cytostatics, BCG) in patients with high risk of reoccurrence (Tis, T1, Ta–G3). The aim of the intravesical therapy is elimination of tumor remains and prevention of reoccurrence. One-time intravesical application of chemotherapeutic performed within 6 hours from trans-urethral resection of a tumor, enables decreasing the relapse incidence at rate of 50%. In purpose to provide the efficacy of intravesical treatment, the therapeutic should be administered in high doses, so it is in a long-lasting and effective contact with a bladder epithelium. The ideal remedy should also be characterized by insignificant absorption, which prevents the adverse effects; similarly it should not be locally irritant. Intravesical BCG immunotherapy is recognized as the most effective method in the treatment of high risk superficial bladder cancer and, simultaneously, it is recognized as most efficacious form of immunotherapy in cancer treatment. There is some interesting research into usage of recombined BCG strain, which excretes cytokines, e.g. GM-CSF, gamma interferon, IL-12 or IL-2. Intravesical chemotherapy is currently one of the best methods of complementary therapy in superficial bladder cancer as well. The most effective therapeutic is mitomycin in this case.

Key words: superficial urinary bladder cancer, intravesical therapy