CURRENT INSIGHTS IN THE TREATMENT OF SUPERFICIAL TRANSITIONAL-CELL CARCINOMA OF THE BLADDER

Patients with superficial transitional cell carcinoma of the bladder ( Ta, Tl, Tis) can nowadays be subdivided in different risk groups for t umor recurrence and progression, based on prognostic factors, which ha ve been obtained from the results of clinical Phase III trials. For ad juvant therapy a choice can be made between intravesical instillations with chemotherapeutic or immunotherapeutic agents. The optimal treatm ent schedule and time to start intravesical therapy is not known. None of the investigated chemotherapeutic agents turned out to be superior in delaying tumor recurrence. Intravesical immunotherapy, using bacil lus Calmette Guerin (BCG). seems to be as effective and maybe superior in high-risk groups in delaying tumor recurrence compared to chemothe rapeutic agents. The side effects, however, are a disadvantage. The ex act working mechanism of BCG and its antitumor effect is not known. In the field of recognizing patients at risk for recurrence or progressi ve disease, biological markers have been identified. In daily practice these markers cannot be used yet. Using all these different treatment options, it is important to obtain in formation on the impact of thes e treatment schedules on the quality of life: especially if the treatm ent results do not differ. A start has been made to imply questionnair es in superficial bladder cancer studies.