The Clinical Prognostic Factors of Patients with Superficial Bladder Cancer to a Second Course of Intravesical Bacillus Calmette-Guerin

Park, Seok Chan; Cho, In Rae; Park, Seok San

Abstract

PURPOSE: When combined with transurethral resection, intravesical Bacillus Calmette-Guerin(BCG) is effective in delaying recurrence and progression of superficial bladder cancer including carcinoma in situ. Dose schedules vary and the optimum regimen has not been defined. And criteria for selection of patients who may benefit from an additional course of BCG have not yet been established. In an attempt to identify patients who are likely to respond, we analyzed our experience in patients with superficial bladder cancer treated with a subsequent course of BCG therapy
MATERIALS AND METHODS
From June 1989 until June 1996, 74 patients with superficial bladder tumor were treated under protocol at our institution with intravesical BCG. Of 74 patients who received an initial once a week for 6 week and once a month for 3-month of intravesical BCG(course 1) for superficial transitional cell carcinoma of the bladder, 21 were treated another course(course 2).
RESULTS
First course of BCG was successful in 43(64.1%) of 67 patients treated for prophylaxis and 3(42.8%) of treated for carcinoma in situ. Of 28 patients who failed the initial treatment course, 21 were given an additional BCG therapy. Subsequent progression of disease(muscle infiltration, metastasis or local progression) occurred in 3 patients(14.2%). Of 18 patients(85.7%) without progression 11(52.3%) had a complete response and 7(33.3%) had new tumors, and they were rendered free of disease after transurethral resection. The median duration of response to course 1 of intravesical BCG was shorter for patients with disease progression or recurrence after course 2 than for those with no progression or recurrence(13.8 and 21.3 months, p<0.05). The median intenal between course 1 and 2 of intravesical BCG was 18 months. The internal from course 2 of intravesical BCG to progression or recurrence correlated with the duration of response to course 1 of treatment(p<0.05).
CONCLUSIONS
Our analysis indicate that the usefulness of a subsequent course of intravesical BCG for the treatment of new tumors is related to the duration of response to course 1. Patients with a long-lasting response to the initial course of BCG(18 months or more) are likely to benefit from another course.