Results of long-term follow-up of patients with superficial bladder carcinoma treated with intravesically applied bacillus Calmette-Guerin vaccine according to the schedule of 6 weekly + 6 monthly instillations.

BACKGROUND: The efficacy of bacillus Calmette-Guerin (BCG) immunotherapy in the prevention of local recurrence and disease progression in patients with superficial bladder cancer is very well documented. This study reports the effect of BCG on disease-specific and overall survival. PATIENTS AND METHODS: In this retrospective trial, we have analyzed 170 patients with stage Ta and T1 superficial bladder cancer. Patients in the control group (87 patients) we followed-up only (median follow-up of 119 months) and treated surgically or with other oncologic modalities when progression of disease was diagnosed. The BCG group consisted of 83 patients treated with 6 weekly followed by 6 monthly instillations, and they have been followed-up of median 124 months. RESULTS: Patients receiving BCG had statistically significant better 10-year disease specific survival (83% vs. 69%, P = 0.03). At the same time point, the local recurrence rate was 48 % and the progression rate 19% for patients treated with BCG, while 77% (P < 0.001) and 38% (P = 0.007) were results in control group. Despite numerically better in the BCG group, overall survival is not significantly different in the 2 groups (P = 0.14). CONCLUSION: BCG immunotherapy significantly increases the disease-specific survival in patients with superficial bladder carcinoma.

[Lipomatosis pelvis]. / Lipomatosis pelvis.

The article is a discussion of three cases of lipomatosis in the pelvis and of the surgical treatment undertaken in each case. In the first two cases, fatty tissue compressed the lower uriunary tract, and in the third, the rectosigmoid intestine. In the third case, the patient was also diagnosed as having a malignant rectum polyp. In all three cases, the diagnosis by ultrasound, intravenous urography and rectoscopy was confirmed by CT. All three patients underwent surgery. The first patient was erroneously surgicaly treated in another clinic. The operation involved resection of the terminal part of ureters and, on the antireflux principle, the reimplantation of ureters into the bladder. The patient's condition seriously deteriorated in a short time. In the second case, we removed some fatty tissue from the patient's pelvis and performed ureteroileocutaneostomy. At present, 14 years since the operation, the patient's condition is good. The third patient had malignant rectum polyp, so we removed a large part of fatty tissue and performed resection of the anorectum and the distal part of the sigmoid colon, together with "anus praeter naturalis unipolaris sigmoidalis". The patient's condition, 10 years since the operation, is good.

Immunoprophylactic intravesical application of bacillus Calmette-Guerin after transurethral resection of superficial bladder cancer.

AIM: To evaluate the effect of intravesical instillation of Bacillus Calmette-Guerin (BCG) in the prevention of recurrence and progression of the superficial bladder cancer. METHODS: Between February 1989 and May 1994, 170 patients with histologically proven superficial transitional cell carcinoma of the bladder stage Ta and T1 were assessed as eligible for 6-week + 6-month protocol of intravesical BCG instillation at the Split University Hospital. All patients underwent complete transurethral resection of the tumor, which established tumor size, histology, stage, and absence of muscle invasion. Out of 170 patients offered to receive intravesical BCG instillations, 80 agreed to undergo the treatment (BCG group), and 90 refused it (control group). The median duration of follow-up was 64 months (range, 16-128). RESULTS: The BCG group had lower incidence rates of recurrence (12 vs 26 events per 100 patient-years in controls, p<0.001) and progression (3.0 vs 6.6 events per 100 patient-years in controls, p=0.017, large-sample one-sample binomial test in both cases) than the control group, but similar mean intervals to first recurrence or progression. The 5-year recurrence-free rates were 55% in BCG patients and 31% in controls, and in case of progression, 86% and 70%, respectively. Cox regression showed that the independent predictors of recurrence were tumor size (p<0.001), absence of BCG treatment (p=0.002), and patient age (p=0.05). The single independent predictor of tumor progression was absence of BCG treatment, but only in case of tumor grade III (roughly doubling the relative risk of the event). CONCLUSION: Our data suggest that BCG intravesical instillation, using 6 week + 6 month scheme, prevents against recurrence and progression of superficial bladder tumors. This treatment should be especially advocated in patients with advanced grade tumors, but the scheme remains to be evaluated against other BCG treatment schemes.