INTRAVESICAL BCG OR EPIRUBICIN PROPHYLAXIS IN SUPERFICIAL BLADDER-CANCER

Intravesical therapy has proved to be an effective adjuvant treatment for certain patients with superficial stage Ta and T1 transitional-cel l carcinoma of the urinary bladder. The initial clinical stage and gra de, the multifocality of the disease and the history of previous tumor recurrences remain the main determinant factors in survival. Intraves ical chemoprophylaxis with cytotoxic agents has been demonstrated to a chieve an acceptable reduction in short- and intermediate-term tumor r ecurrence rates, but has no proven ability to prevent disease progress ion or prolong survival, On the other hand, intravesical bacillus Calm ette-Guerin (BCG) prophylactic treatment may confer increased response rates when compared with intravesical chemotherapy, especially in pat ients with high-grade and stage neoplasms. Clinical trials have demons trated that BCG provides long-term protection from tumor recurrence, a nd there is some evidence that it may favorably alter the progression rate of the disease with prolongation of survival. Despite the effecti veness of the existent intravesical therapeutic schemes, these are emp irical and insufficient for many patients, while the selection of the most appropriate antineoplastic regimen is a subject of continuous inv estigation. Among the several cytotoxic agents used today, epirubicin has been recently shown to be at least as effective as its parent adri amycin in the adjuvant local chemotherapy of superficial bladder tumor s but with fewer adverse reactions. This review summarizes recent adva nces in intravesical epirubicin prophylactic treatment of transitional -cell carcinoma and the expanding role of intravesical BCG immunothera py in the prophylactic treatment of selected patients with superficial bladder cancer.