APPARENT FAILURE OF CURRENT INTRAVESICAL CHEMOTHERAPY PROPHYLAXIS TO INFLUENCE THE LONG-TERM COURSE OF SUPERFICIAL TRANSITIONAL-CELL CARCINOMA OF THE BLADDER

During the 4 decades since the first introduction of intravesical chem otherapy, 3,899 patients were enrolled in 22 randomized prospective co ntrolled studies. Of these 22 studies 13 reported a statistically sign ificant benefit of intravesical chemotherapy. With varying followup, t he reported decrease in the incidence of patients with tumor recurrenc e averaged only 14% (range -3 to +43%). Unfortunately, long-term (5-ye ar) studies show no decrease in the incidence of recurrent tumor. Main tenance chemotherapy has failed to improve these results and data sugg est that a single early postoperative instillation may, in fact, be mo st effective. Among 10 studies that include progression data none show ed decreased tumor progression, and overall among 2,011 randomized pat ients progression occurred in 7.5% of those receiving intravesical che motherapy and 6.9% of those treated by surgery alone. Since intravesic al chemotherapy has been demonstrated in animal models to be carcinoge nic, these data raise the concern that intravesical chemotherapy might possibly be carcinogenic in humans. In the absence of demonstrated lo ng-term benefit we question the advisability of routine prophylactic i ntravesical chemotherapy.