Complications of intravesical chemotherapy

A variety of intravesical chemotherapeutic agents are now available for the treatment of superficial transitional-cell carcinoma of the bladder. The toxicities associated with these agents may make one more appealing than another in the face of similar efficacies. Intravesical instillations of thiotepa have resulted in incidences of leukopenia of 8% to 54%, of thrombocytopenia of 3% to 31%, and of irritative voiding symptoms of 12% to 69%. Close monitoring of blood counts prior to weekly instillations remains vital in preventing myelosuppressive complications. The complications associated with the intravesical use of mitomycin C are mainly chemical cystitis and contact dermatitis. Additionally, allergic reactions have been documented. Most of these complications respond to cessation of therapy with application of topical steroids as needed. Complications of reduced bladder capacity, bladder-wall calcifications, and myelosuppression are uncommon. Toxicities associated with the use of doxorubicin, epirubicin, and ethoglucid are almost exclusively local and usually described as mild to moderate dysuria, frequency, or urgency. Case reports of systemic reactions to doxorubicin are notable in that the patients responded well to diphenhydramine and, in one severe case, epinephrine. Other adverse effects such as reduced bladder capacity, fever, and nausea and vomiting are very uncommon. New agents, such as mitoxantrone, are undergoing phase I and phase II studies. The ideal agent, which would be highly effective and minimally toxic, remains to be developed.