Our experience with reduced-dose intravesical BCG treatment in cases of in situ bladder cancer
DOI: 10.22591/magyurol.2024.4.pappm.184
Authors:
Papp Máté dr.1, Szabó Kíra2, Szántó Árpád dr.1, Damásdi Miklós dr.1
1Pécsi Tudományegyetem, Klinikai Központ, Urológiai Klinika, Pécs (igazgató: Szántó Árpád dr.)
2Pécsi Tudományegyetem, Általános Orvostudományi Kar, Pécs (dékán: Nyitrai Miklós dr.)
Summary
Introduction: In situ carcinoma is a special histological type of non-muscle-invasive bladder tumours with a high grade and extremely aggressive behaviour, which progresses in 54% of cases in the absence of appropriate therapy. The therapeutic options are induction and then maintenance BCG treatment, as well as radical cystectomy.
Patients and methods: Authors reviewed 616 patient’s history who underwent transurethral resection between January 2017 and December 2021 at PTE KK Urology Clinic. Patients data with in situ carcinoma histology pattern (CIS) were analysed. 49 people without synchronic muscle-invasive tumour component were included in the study material, their data were evaluated using the IBM SPSS Statistics program.
Results: In one group of patients BCG relapse prophylaxis, followed by maintenance treatment, and radical cystectomy in the other group was performed. Radical cystectomy reduced the risk of disease progression by approximately four times compared to the group of people who only received BCG therapy (P= 0.063). In the case of patients receiving 80 mg of BCG per treatment, no early relapse occurred, while in the case of patients treated with a reduced dose (40 mg), the relapse rate was 37.8% (14/37). The BCG maintenance treatment doubled the average recurrence-free survival time.
Conclusions: With the of appropriate BCG instillation treatment the rate of early relapse can be reduced. Supplementation of induction therapy with maintenance BCG is justified for all patients in this patient group. In terms of oncological endpoints, more favourable results were confirmed after radical cystectomy than in the case of BCG therapy.