management of non-invasive bladder tumours with doxorubicin intravesical instillation after transurethral resection

Evaluation of the intravesical instillation of doxorubicin for its effect on disease recurrence for patients with non-invasive bladder tumour. The trial was performed at Al Assad University Hospital in Lattakia, Syria and included patients with non-invasive bladder tumours who were managed with transurethral resection and induction and maintenance therapy with intravesical doxorubicin. They were followed up by cystoscopy every 3 months for 2 years and every 6 months thereafter with special emphasis on recurrence rates. The trial included 85 patients with non-invasive bladder tumours: 23 with non-invasive papillary carcinoma [Stage Ta], 62 with tumour invading subepithelial connective tissue [Stage T1]. Twelve patients had well differentiated tumours [Grade 1], 48 were moderately differentiated [Grade 2], 25 were poorly differentiated [Grade 3]. The total recurrence rate was 23%. The rates of recurrence were 56% in Grade 3 and 0% in Grade 1. The recurrence rate was 41% in patients with large tumours versus 17% in those with small tumours; 44% in those with multiple tumours compared to 18% in those with solitary tumours; 30% of Stage Ta tumours recurred and 21% of Stage T1 tumours. In short term follow-up, our rate of recurrence was 23% compared to 54% in multicentre international studies without the intravesical adjuvant; thus adjuvant intravesical doxorubicin was shown to reduce the recurrence of superficial bladder cancer. Tumour grade, size and number were shown to be prognostic factors for recurrence