[Intravesical instillation of adriamycin and other antineoplastic agents]

Although transurethral resection seems to be the primary modality in the treatment of low grade & low stage bladder carcinoma, there are circumstances in which an effective intravesical chemotherapeutic drug could be incorporated into the therapeutic modality. Intravesical chemotherapy do not any special instrument and not require great skill. Additionally, now many chemotherapeutic agents which show cytocydal effect on bladder carcinoma after a brief time instillation, can be obtained. Therefore, intravesically chemotherapy has come to be used routinely. Thio-TEPA, mitomycin C and adriamycin are most frequently used for intravesical chemotherapy and the therapeutic effectiveness has been reported. The optimal intravesical chemotherapeutic drug should possess the following properties: (1) sensitivity to transitional cell carcinoma (2) efficacy after a brief contact (3) low absorption from the bladder (4) low irritable action to the normal bladder mucosa Adriamycin meets these demands except (4), and shows clinical response by fewer instillation than thio-TEPA & mitomycin C. A 68% effectiveness has been experienced by six to nine times of instillation (adriamycin 50mg/normal saline 30ml). Carboquone, cytosine arabinoside aclacinomycin A. bleomycin and neocarzinostatin are also used. Although these intravesical chemotherapy is evaluated with the combination of hydrostatic pressure therapy and irradiation, these modalities still seem to need further study.