PROPHYLAXIS OF SUPERFICIAL BLADDER-CANCER WITH A MODIFIED INTRAVESICAL EPIRUBICIN TREATMENT SCHEDULE

A controlled prospective trial on 99 eligible patients evaluated the e fficacy of intravesical epirubicin administration as prophylaxis again st tumor recurrences after complete endoscopic resection of superficia l bladder cancer. The treatment schedule consisting of an initial 6- o r 8-week course of instillations, followed by single maintenance doses (to the responders) at follow-up examinations, was modified in those of the initial responders who were at high risk for recurrence and who received an additional separate 4-week course of therapy. Sixty perce nt of the epirubicin-treated patients and 41 % of the controls (who un derwent resection alone) remained free of recurrences for a mean follo w-up of 32.1 months, but the difference was not significant. However, in terms of relative risk for recurrences (recurrence rate per 100 pat ient-months and disease-free interval), comparisons between the two gr oups of patients revealed a significant benefit of epirubicin, overall as well as for those with a history of previous tumor recurrences, mu ltifocal disease, and stage Ta and grade 2 neoplasms. Drug-induced tox icity was acceptable.