Bacillus Calmette-Guerin Intravesical Therapy in Superficial Bladder Cancer: The Early Experience of Comparison of 6 Week Course and Modified 6 3 Maintenance Therapy / 대한비뇨기과학회지

ABSTRACT

PURPOSE: Bacillus Calmette-Guerin(BCG) immunotherapy is the treatment of choice for adjuvant therapy of superficial bladder cancer. The outcomes of a 6 week course of BCG immunotherapy was compared with those of a modified 6 3 maintenance therapy. MATERIALS AND METHODS: Between January 2001 and June 2007, 123 patients with a superficial bladder cancer were treated with a transurethral resection of the bladder tumor(TURBT) and intravesical BCG. For the 93 patients, BCG was administered over a six week course. For the remaining 30 patients, BCG was administered for six weeks followed by three weekly instillations at 3, 6, 12, 18, 24 and 36 months. The recurrence rate, time to recurrence and progression rate were assessed and analyzed. RESULTS: In the six week therapy group, the overall recurrence rate, mean recurrence interval and median follow up was 31.2%(29/93), 15.9 months and 19.4 months, respectively. The recurrence rate according to stage and grade was 27.6%(8/29), 33.9%(21/62) and 0%(0/2) on Ta, T1 and carcinoma in situ(CIS), respectively, and 29.6%(21/71), 40%(8/20) in low grade and high grade, respectively. Five cases in the T1 high grade and 1 case in T1 low grade group progressed to T2. In maintenance therapy, the overall recurrence rate, mean recurrence interval and median follow up was 16.7%(5/30), 16.4 months and 24.8 months, respectively. The recurrence rate according to stage and grade was 14.3%(1/7), 14.3%(3/21) and 50%(1/2) on Ta, T1, CIS, respectively, and 15.0%(3/20), 12.5%(1/8) in low grade and high grade, respectively. One case in the CIS sub group progressed to T4a. CONCULSIONS These results show a lower recurrence rate in the modified 6 3 maintenance therapy group than in the 6 week therapy group. Therefore, modified 6 3 maintenance therapy is more effective for preventing a recurrence in a superficial bladder cancer than 6 week therapy.