[Role of BCG in T1G3 bladder transitional cell carcinoma (TCC): our experience]

High grade superficial TCC of the bladder (T1 G3) has an important risk of recurrence and/or progression (40%) after TUR-B and a low survival rate (57% at 3 years, 50% at 10 years). Intravescical treatment with BCG seems to be able to reduce these rates. 64 patients with T1 G3 vescical TCC underwent a "second look" TUR-B. 9/64 patients presented locally advanced tumor (T2-3) or persistent high risk superficial TCC (T1 G3 + Tis) and underwent to early cistectomy. BCG intravescical therapy has been performed in the remaining 55 patients: 10 of them had not been evaluated because local or sistemic toxicity and consequent early interruption of treatment. BCG Pasteur was given weekly at the dose of 75 mg for two cycles of 6 weeks with a rest period of 6 weeks between the two cycles and then monthly for one year and every three months during next two years too. After the first 6 weeks 43/45 patients resulted tumor-free and 2/45 presented persistent Tis: after the second 6 weeks-cycle of BCG, two other patients had evidence of vescical TCC (one T2 G3 and the other T1 G3); all these four patients were submitted to radical cystectomy or radiotherapy. Of the reamining 41 patients, 28 presented had no recurrences, nowadays living and tumor-free; 3 presented local neoplastic progression and dead; relapsed in T1 G2 and are living NED after local chemotherapy. At a mean follow-up of 18 months, the total amount of recurrences is 17/45 (38%), progression rate is 4/45 (8.8%), exitus 5/45 (11%) and living NED are 28/45 (62%). In our opinion local BCG treatment for T1 G3 bladder cancer, after TUR--B, seems to be able to reduce the risk of recurrence and mortality.