Therapy of superficial bladder carcinomas

Treatment of superficial bladder carcinoma was derived by several large ran domized trials. This group of cancers is stratified by differentiation grad e and stage in three groups of different risk profiles (Ta G1-2 vs. T1 G1-2 vs. Tis/T1 G3). Standard therapy is fractionated transurethral resection ( IUR). Adjuvant therapy after transurethral resection is not indicated in pr imary Ta G1-2 tumors because there is a low recurrence rate and no risk of tumor progression. The recurrence rate can be decreased up to 15% in recurr ent Ta or T1 G1-2 tumors by intravesical therapy with mitomycin C (20 mg/in stillation) or adriamycin (50 mg/instillation). Therapy should be limited t o early (within 24 h post-TUR) and short-term treatment (4 x weekly, 5 x mo nthly). Alternatively, patients can be treated by intravesical BCG (strain Connaught or strain RIVM). Maintenance therapy is advantageous according to recurrence rate. Tumors with great malignant ability (Tis or T1 G3) will b e treated initially with adjuvant BCG. Patients who fail are candidates for radical cystectomy within 3-6 months after initial diagnosis. There is no need - except in clinical trials - for the administration of unverified or not admitted drugs. Copyright (C) 1999 S. Karger AG. Basel.