Should all superficial bladder tumors be treated with intravesical therapy?

M. S. Soloway

Research output: Contribution to journalArticle

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Abstract

After reviewing the data on intravesical therapy for treatment or prophylaxis of urothelial tumors of the bladder, several statements seem appropriate. Bladder tumors confined to the mucosa and lamina propria represent a heterogeneous group. Papillary, grade I, noninvasive tumors (Ta) may recur frequently, subjecting the patient to numerous endoscopic procedures but these patients very infrequently have tumor progression. Treatment should not be overly aggressive and result in significant morbidity. These patients should be informed that they have a choice and may decide that they would rather take the risk of subsequent endoscopic procedures and avoid the regular visits to the office for intravesical drug instillation. High grade tumors, be they confined to the mucosa or invade the lamina propria, place the patient at significant risk of recurrence and local progression and thus require careful monitoring (Jordan et al, 1987; Torti et al, 1987). Intravesical therapy should be seriously considered, either to eradicate residual malignant cells or prevent a subsequent tumor. Thiotepa is moderately effective in delaying the development of subsequent low grade tumors when used for prophylaxis. Toxicity with Thiotepa is low and the drug is not expensive. Mitomycin C is effective for the treatment of residual tumor as well as when instilled regularly following complete transurethral resection. Side effects are primarily confined to chemical cystitis with an occasional patient having a rash. BCG may be the most effective intravesical agent in the treatment of carcinoma in situ. Randomized trials comparing BCG and chemotherapy are in progress and are eagerly awaited. The frequency and severity of local and systemic side effects are somewhat greater than with chemotherapeutic agents.

Original languageEnglish
Pages (from-to)491-501
Number of pages11
JournalProgress in Clinical and Biological Research
Volume303
StatePublished - Jan 1 1989
Externally publishedYes

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Urinary Bladder Neoplasms
Mucous Membrane
Thiotepa
Neoplasms
Mycobacterium bovis
Drug Instillation
Therapeutics
Intravesical Administration
Office Visits
Cystitis
Carcinoma in Situ
Residual Neoplasm
Mitomycin
Exanthema
Morbidity
Recurrence
Drug Therapy
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Should all superficial bladder tumors be treated with intravesical therapy? / Soloway, M. S.

In: Progress in Clinical and Biological Research, Vol. 303, 01.01.1989, p. 491-501.

Research output: Contribution to journalArticle

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