Weekly intravesical bacillus Calmette-Guerin [BCG] alternating with epirubicin in Ta and T1 urothelial bladder cancer: an approach to decrease BCG toxicity

Bacillus Calmette-Guerin [BCG] therapy is the standard treatment for nonmuscle-invasive bladder cancer [NMIBC]. However, its toxicity is a major concern. If we reduce the number of BCG doses by half and replace the second half with epirubicin, we may have a lower toxicity while maintaining the same efficacy of BCG. To test this hypothesis, we conducted this study as an update of our previous report. The study included 607 patients with Ta and T1 NMIBC between January 1994 and December 2008. After transurethral resection of bladder tumor [TURBT], the patients received weekly doses of 120 mg BCG alternating with 50 mg epirubicin for six weeks [three weekly doses of each]. Maintenance was given. Recurrence, progression rates, and toxicity were assessed. End points were progression, recurrence, and cancer-specific survival. A total of 532 patients were eligible for evaluation [mean age: 58 years; median follow-up: 45 months]. Of these, 291 [55%] were free, 157 [29.5%] showed recurrence, and 84 [15.8%] showed muscle-invasive progression. Toxicity developed in 221 patients. These were mild in the majority [167], whereas 10 developed hematuria, 30 severe cystitis, and five systemic complications. The rate of permanent therapy discontinuation was 3.8%. SPSS package version 16 and Kaplan-Meier curves were used to evaluate survival. Reducing the frequency of BCG instillations by half and replacing the second half with epirubicin results in a similar efficacy and a lower toxicity compared with historical cases receiving BCG alone. However, further trials are required to support these results

Survival after primary and deferred cystectomy for stage T1 transitional cell carcinoma of the bladder

The optimal time of cystectomy for nonmuscle invasive bladder cancer [NMIBC] is controversial. This study aims at comparing cancer-specific survival in primary versus deferred cystectomy for T1 bladder cancer. Between 1990 and 2004, a retrospective cohort of 204 patients was studied. Primary cystectomy at the diagnosis of NMIBC was performed in 134 patients [group 1] and deferred cystectomy was done after failed conservative treatment in 70 [group 2] Both groups were compared regarding patient and tumor characteristics and cancer-specific survival. Cancer-specific survival was calculated using the Kaplan-Meier method. Mean follow-up was 79 and 66 months, respectively, in the two groups. Tumor multiplicity was more frequent in group 2; otherwise, both groups were comparable in all characteristics. The definitive stage was T1 in all patients. Although the 3-year [84% in group 1 vs. 79% in group 2], 5-year [78% vs. 71%] and 10-year [69% vs. 64%] cancer-specific survival rates were lower in the deferred cystectomy group, the difference was not statistically significant. In group 2, survival was significantly lower in cases undergoing more than three transurethral resections of bladder tumors [TURBT] than in cases with fewer TURBTs. Cancer-specific survival is statistically comparable for primary and deferred cystectomy in T1 bladder cancer, although there is a non-significant difference in favor of primary cystectomy. In the deferred cystectomy group, the number of TURBTs beyond three is associated with lower survival. Conservative treatment should be adopted for most cases in this category