ALTERNATING MITOMYCIN-C AND BACILLUS-CALMETTE-GUERIN INSTILLATION PROPHYLAXIS FOR RECURRENT PAPILLARY (STAGES TA TO T1) SUPERFICIAL BLADDER-CANCER

Purpose: We attempted to prove if alternating chemoprophylactic and im munoprophylactic instillations improved efficacy and decreased toxicit y in patients with recurrent superficial bladder cancer. Materials and Methods: A total of 188 patients with rapidly recurring stage Ta or T 1 cancer was randomly treated with mitomycin C (group 1) or alternatin g mitomycin C and Pasteur strain bacillus Calmette-Guerin (BCG) instil lations (group 2) for 2 years. Mean followup was 34 months. Results: M edian times to initial recurrence were 12 months in group 1 and 7 mont hs in group 2 (p=0.976), and treatment failed in 21.5% and 18.9%, resp ectively. Recurrence rates during the instillation period were 1.01 in group 1 and 0.86 in group 2 (p=0.376). There was no difference in the disease-free interval between the 2 groups (p=0.976). Instillations w ere discontinued because of adverse effects in 6 cases (6%) in both gr oups. Conclusions: Efficacy of alternating mitomycin C and BCG was equ al to mitomycin C monotherapy, and both methods were effective in prop hylaxis of recurrent papillary bladder cancer. Less toxicity occurred in the alternating treatment group compared to earlier BCG monotherapy results.