ADJUVANT LOCAL TREATMENT FOLLOWING CURATIVE TRANSURETHRAL RESECTION OF BLADDER-CARCINOMA

The majority of bladder tumors are superficial (80%), classified as st age T(A) (62%) and T1 (38%), according to the criteria of the UICC. Tr ansurethral resection is the initial treatment in bladder carcinomas. The major problem is to select those patients who are at risk for tumo r recurrence or tumor progression and who may benefit from adjuvant tr eatment modalities. The analysis of prognostic factors emphasizes the fact that patients with T(A) or well-differentiated bladder carcinoma belong to a low-risk group and need no further intravesical therapy. O n the other hand, T1 G2/3 bladder carcinoma and carcinoma in situ have to be considered as a high-risk group. We suggest that transurethral resection alone is not sufficient because these patients have an incre ased risk of local recurrence and progression. In treatment of bladder carcinoma it is reasonable to start intravesical chemotherapy (i.e. m itomycin or epirubicin or doxorubicin) or immunotherapy with BCG. So f ar there is no indication for clinical use of interferons in superfici al bladder tumors. If the tumor persists, a second cycle of BCG treatm ent or intravesical chemotherapy can be added. However, the decision f or cystectomy should be made not later than 3-4 months after the first TUR in high-risk bladder cancer patients.