APPARENT FAILURE OF CURRENT INTRAVESICAL CHEMOTHERAPY PROPHYLAXIS TO INFLUENCE THE LONG-TERM COURSE OF SUPERFICIAL TRANSITIONAL-CELL CARCINOMA OF THE BLADDER
Dl. Lamm et al., APPARENT FAILURE OF CURRENT INTRAVESICAL CHEMOTHERAPY PROPHYLAXIS TO INFLUENCE THE LONG-TERM COURSE OF SUPERFICIAL TRANSITIONAL-CELL CARCINOMA OF THE BLADDER, The Journal of urology, 153(5), 1995, pp. 1444-1450
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.