[Intravesical BCG as a treatment for superficial and in situ transitional cell carcinoma of the bladder]

Intravesical BCG is already established as effective therapy in the management of superficial bladder cancer. However, varying results have been obtained with different BCG strains; these are ascribed to variations in their immunogenicity. The locally available BCG strain which contains approximately 1.2 x 10(9) colony-forming units per 120 mg was used for intravesical instillation in 27 patients with recurrent superficial transitional cancer of the bladder. Ten of the 13 patients who received BCG prophylactically to reduce or stop recurrencies completed therapy and 7 (70%) were in remission after 1 or 2 courses with a mean follow-up of 2 years. Fourteen patients received BCG therapeutically for in situ carcinoma. Thirteen of these patients completed therapy and 9 (69%) responded favourably after 1 or 2 courses of BCG for a mean follow-up period of 23 months. Adverse effects of the treatment were mild and well tolerated except in a patient who received radiotherapy. Although 21 patients experienced irritable bladder symptoms only 1 discontinued treatment as a direct result. The only other patient in whom treatment had to be stopped, developed severe polyarthritis after 3 instillations. A statistically significant reduction in the number of recurrences (P less than 0.001) was experienced by the patients who received BCG prophylactically. Although this is a very limited study, the locally available BCG strain exhibited therapeutic activity. It is cost-effective and warrants further study.