Intravesical chemotherapy for superficial bladder tumors category Ta/T1: who should be treated and how?

Superficial bladder cancer is the presenting feature in 75% to 80% of patients with newly diagnosed bladder carcinoma. Treatment goals are (1) to eradicate existing disease, (2) to provide prophylaxis against recurrence, and (3) to prohibit muscular invasion and metastases to lymph nodes. First-line treatment for stages Ta and T1 disease is transurethral resection (TUR). Recurrence rates with surgery alone, however, range from 40% to 80%. Study results show a statistically significant benefit in treatment results over those observed with TUR alone when adjuvant intravesical instillation of cytotoxic agents or immunomodulators is added. Patient characteristics are important factors in determining which patients might benefit from adjuvant treatment. Based on several trials reported by the European Organization for the Research and Treatment of Cancer Genitourinary Group, the following conclusions can be drawn: (1) patients with < 1 recurrence/year or with a primary solitary bladder tumor category Ta G2-3 or T1 G1-3 may benefit from a single, early instillation of a cytotoxic agent, (2) solitary Ta G1 lesions may be treated with TUR alone, (3) adjuvant therapy with cytotoxic agents should be instituted as soon as possible after TUR (this is not feasible with immunotherapy), (4) for patients treated within 6 hours after or on the day of TUR, a 6-month course of therapy is sufficient, whereas a 12-month course provides better results for patients in whom such early intravesical instillation is not feasible.