Setting a new standard for topical therapy of upper-tract transitional-cell carcinoma: BCG and interferon-alpha2B

We report our office-based technique and results of BCG and interferon-alpha2B (BCG-IFN) for upper-tract transitional-cell carcinoma (TCC).

Papillary lesions were ablated endoscopically after biopsy. Office flexible cystoscopy was performed, and a 0.038-inch guidewire or Glidewire was advanced into the renal pelvis. A 5F ureteral catheter was placed over the wire, and a free flow of urine was confirmed. Half-strength BCG + 50 million units of IFN was infused under low pressure for 1 hour. The ureteral catheter was removed, and patients were instructed to void 1 hour later.

Between 2000 and 2006, 10 patients with a median age of 72 years were treated with BCG-IFN for upper-tract TCC in 11 renal units. Follow-up ureteroscopy with or without biopsy was performed after a 6-week induction to evaluate response. Complete responders were placed on a maintenance regimen. With a median follow-up of 24 months, 8 patients (80%) demonstrated a complete response (CR) to therapy, and 2 had a partial response (decrease in tumor size, number, or both). Six patients with a CR have continued on maintenance therapy. There were no side effects or complications with the instillation therapy.

We describe a safe, minimally invasive, and effective office-based technique for upper-tract BCG-IFN instillation.