15-year experience on intravesical therapy of T1G3 urinary bladder cancer: a conservative approach

Objective: To report the recurrence, progression and survival in patients with T1G3 transitional cell carcinoma (TCC) of the urinary bladder treated with sequential intravesical bacillus Calmette–Guerin (BCG) and chemotherapeutic agents (doxorubicin or epirubicin) on long-term follow up. Methods: Between July 1988 and September 1999, all patients in a single center with T1G3 bladder TCC, after complete transurethral resection (TURBT), received either 81 mg of Connaught strain BCG or 50 mg of doxorubicin or epirubicin as adjuvant therapy. A conservative approach was adopted whereby those with superficial recurrences were eligible to crossover, even repeatedly, until progression to muscle invasion. Recurrence, progression and diseasespecific survival were analyzed. Results: There were 36 patients included, with 26 males and 10 females. The mean age was 71.6 years (range 53–85 years). Final analysis was made at a median follow-up of 23.5 months (range 0–125 months) for recurrence, 33 months (range 0–125 months) for progression and 45.5 months (range 3–125 months) for survival. Sixteen (44.4%) patients showed recurrence. Nine (25%) of these 16 patients progressed. Five (13.9%) of those who progressed died of TCC. The 10 year Kaplan–Meier estimates for recurrence-free survival, progression-free survival and disease-specific survival were 48, 68 and 81%, respectively. Figures with this conservative approach were comparable to those with more aggressive approaches reported in the literature. Conclusions: Adjuvant intravesical therapy with either BCG or a chemotherapeutic agent (doxorubicin or epirubicin) and crossover on recurrence was an effective conservative treatment for T1G3 bladder TCC.