[Bacillus Calmette Guerin as adjuvant treatment for superficial bladder tumors using two different therapeutic schemes].

OBJECTIVES

To demonstrate the importance of BCG as adjuvant treatment for superficial bladder tumors. To suggest the best dosage and treatment scheme for patients with this severe disease. To emphasize treatment-associated toxicity in our study with endovesical BCG. To evaluate relapse and progression rates of superficial bladder tumors. To describe histological grade and tumor location in our sample. To offer an economic and social benefit to both patient and our Country, improving the quality of life of our patients.

METHODS

We performed a descriptive research in a series of cases, both retrospectively and prospectively, and a review of published advances in BCG adjuvant treatment for superficial bladder tumors. Between 1996 and 2000, 90 ambulatory patients were selected at the "Hospital Docente Clinico Quirurgico 10 de Octubre" to receive endovesical treatment with BCG in two different programs of treatment, 6 and 12 months long respectively, using statistical methods such as the homogeneicity test, chi-square test and the test for independence in selected tables and graphics. 45 controls were randomly selected from a group of patients to whom BCG was not administered between 1992 and 1996; their clinical records were retrospectively analyzed selecting the same variables of the 90 cases sample, being their results presented in tables and graphics.

RESULTS

We evaluate and review a technology applied to patients with superficial bladder tumors. They were treated with Bacillus Calmette Guerin (BCG) after endoscopic resection (TUR) of bladder tumors and we observe that long-term treatment over 12 months is better than short-term over 6 months, improving quality of live with longer survivals. Using low doses of 50 mg/ml of a nationally produced BCG, economic savings were obtained for both patient and Country with fast patient's return to work, achieving the introduction and maintenance of the treatment in Cuba with relevant results during the "special period". Comparisons between both treatment groups and control group showed greater benefits with the first two.

CONCLUSIONS

In patients with superficial bladder tumors stage I, the use of low dose (50 mg/ml) Bacillus Calmette Guerin is an effective treatment with minimal side effects (cystitis). Most tumors were located in the bladder trigone; histological grade 1 was predominant. Long-term treatment for 12 months was more effective than the short-term one, offering a social and economic benefit to patient and to our Country, by delaying or preventing tumor recurrences and progression, so that we recommend this modality of treatment should be part of the therapeutic armamentarium of the urologist in his fight against this severe health problem.