Intravesical therapy of superficial bladder cancer has been in routine use since the introduction of thiotepa in 1961. An empirical approach has been used to optimize this kind of treatment – clinical data are, unfortunately, often lacking. Marker lesion studies indicate that BCG is more effective than cytostatic drugs. For the prophylaxis of recurring disease, the recurrence rate is lower with chemotherapy than in controls, but no effect on the risk of progression has been verified. None of the chemotherapy drugs used has proved superior to the others. Randomized trials have recently been performed with mitomycin C vs. BCG. Comparison of the different trials is difficult due to the use of different methodologies. The majority of the studies found BCG to be more effective in lowering the number of recurrences, but progression rates were not significantly different. Trials with combinations of BCG-mitomycin C or epirubicin-interferon have yielded promising results.

1.
Herring HT: The treatment of vesical papilloma by injections. Br Med J 1903;ii:1398.
2.
Jones HC, Swinney J: Thiotepa in the treatment of tumours of the bladder. Lancet 1961;ii:615–620.
3.
Schmidbauer CP, Porpaczy P, Georgopoulos A, Rameis H: Absorption of doxorubicin hydrochloride and mitomycin C after instillation into non-infected and infected bladders of dogs. J Urol 1984;131:818–821.
4.
Dalton JT, Wientjes MG, Badalament RA, Drago JR, Au JL: Pharmacokinetics of intravesical mitomycin C in superficial bladder cancer patients. Cancer Res 1991;51:5144–5152.
5.
Badalament RA, Farah RN: Treatment of superficial bladder cancer with intravesical chemotherapy. Semin Surg Oncol 1997;13:335–341.
6.
Wientjes MG, Badalament RA, Au JL: Use of pharmacologic data and computer simulations to design an efficacy trial of intravesical mitomycin C therapy for superficial bladder cancer. Cancer Chemother Pharmacol 1993;32:255–262.
7.
Bono AV, Hall RR, Denis L, Lovisolo JA, Sylvester R: Chemoresection in Ta-T1 bladder cancer. Members of the EORTC Genito-Urinary Group. Eur Urol 1996;29:385–390.
8.
Pawinski A, Sylvester R, Kurth KH, Bouffioux C, van der Meijden A, Parmar MK, Bijnens L: A combined analysis of European Organization for Research and Treatment of Cancer, and Medical Research Council randomized clinical trials for the prophylactic treatment of stage Ta-T1 bladder cancer. European Organization for Research and Treatment of Cancer Genitourinary Tract Cancer Cooperative Group and the Medical Research Council Working Party on Superficial Bladder Cancer. J Urol 1996;156:1934–1941.
9.
Malmström PU, Wijkstrom H, Lundholm C, Busch C, Wester K and Norlen BJ: Five-year follow-up of a randomized prospective study comparing intravesical instillations of mitomycin-C and Bacillus Calmette-Guérin in patients with superficial bladder carcinoma. J Urol. 1999 ;161:1124–1127.
10.
Vegt PD, Witjes JA, Witjes WPJ, Doesburg WH, Debruyne FMJ, van de Mejden APM: A randomized study of intravesical Mitomycin C, Bacillus Calmette-Guérin Tice and Bacillus Calmette-Guérin RIVM treatment in pTa-pT1 papillary carcinoma and carcinoma in situ of the bladder. J Urol 1995;153:929–933.
11.
Krege S, Giani G, Meyer R, Otto T, Rubben H: A randomized multicenter trial of adjuvant therapy in superficial bladder cancer: Transurethral resection only versus transurethral resection plus mitomycin C versus transurethral resection plus bacillus Calmette-Guérin. Participating Clinics [see comments]. J Urol 1996;156:962–966.
12.
Lamm DL, Blumenstein B, Crawford ED, Crissman JD, Lowe BA, Smith JA, Sarosdy MF, Schellhammer PF, Sagalowsky AI, Messing EM, Loehrer P, Grossman HB: Randomized intergroup comparison of Bacillus Calmette-Guérin immunotherapy and mitomycin C chemotherapy in superficial transitional cell carcinoma of the bladder. Urol Oncol 1995;1:119–126.
13.
Rintala E, Jauhianien K, Alfthan O, Hansson E, Juusela H, Kanerva K, Korhonen H, Permi J, Sotarauta M, Vaalasti T: Intravesical chemotherapy (MMC) versus immunotherapy (BCG) in superficial bladder cancer. Eur Urol 1991;20:19–25.
14.
Witjes JA, van der Meijden AP, Sylvester LC, Debruyne FM, van Aubel A, Witjes WP: Long-term follow-up of an EORTC randomized prospective trial comparing intravesical bacillus Calmette-Guerin-RIVM and mitomycin C in superficial bladder cancer. EORTC GU Group and the Dutch South East Cooperative Urological Group. European Organisation for Research and Treatment of Cancer Genito-Urinary Tract Cancer Collaborative Group. Urology 1998;52:403–410.
15.
Wijkström H, Kaasinen E, Malmström PU, Hellsten S, Duchek M, Wahlkvist R, Rintala E: Intravesical instillations with alternating mitomycin C and BCG or BCG alone in carcinoma in situ of the urinary bladder. A Nordic study (abstract 155). Eur Urol 1999;39:155.
16.
Raitanen MP, Lukkarinen O: A controlled study of intravesical epirubicin with or without alpha 2b-interferon as prophylaxis for recurrent superficial transitional cell carcinoma of the bladder. Finnish Multicentre Study Group. Br J Urol 1995;76:697–701.
17.
Nygren P, Csóka K, Larsson R, Busch C, Wester K, Malmström PU: Activity of standard and investigational cytotoxic drugs in primary cultures of tumor cells from patients with kidney and urinary bladder carcinomas. (Manuscript submitted)
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