The ablative effect of quarter dose bacillus Calmette-Guerin on a papillary marker lesion of the bladder

Purpose: Low dose bacillus Calmette-Guerin (BCG) for stage TaT1 transitiona l cell carcinoma of the bladder has been given in various studies with the aim of decreasing side effects while maintaining the same efficacy as full dose bacillus Calmette-Guerin. However, its application in clinical practic e remains controversial. We examined the ablative activity and incidence of side effects of intravesical quarter dose BCG given for a papillary marker lesion of the bladder. Materials and Methods: Included in our study were 44 patients with primary or recurrent, multiple but no more than 10 lesions of stage pTaT1, grades 1 to 2 transitional cell carcinoma of the bladder. Intravesical treatment be gun 14 days after the complete transurethral resection of all visible tumor s except 1 marker lesion no larger than 1 cm. consisted of instillations of 30 mg. Connaught strain BCG diluted in 50 ml. saline once weekly for 6 con secutive weeks. Two weeks after the last instillation any residual tumor wa s completely resected. In cases of complete disappearance of the marker les ion deep biopsy of the tumor area was done. Urine cytology was also perform ed. Results: There was a complete response in 27 of the 44 patients (61%), no r esponse in 12 (27%) and progression to carcinoma in situ in 1 (2%), while t he response was not evaluable in 4. Local side effects included dysuria in 54% of cases and macroscopic hematuria in 39%. Neither BCG induced infectio n nor BCG sepsis was observed. Conclusions: Quarter dose BCG has a clear ablative effect on superficial bl adder cancer with a 61% response rate. Phase III trials are now required to compare its efficacy and toxicity to those of full, dose BCG.