Intravesical chemotherapy. Treatment selection, techniques, and results.

A variety of chemotherapeutic agents are available for the patient with rapidly recurring superficial bladder cancer. Management should have two therapeutic goals--ablation of existing tumors and prevention of tumor recurrence. Stage, grade, and multicentricity are all important factors in the decision for therapeutic intervention. Intravesical instillation of chemotherapeutic agents can reduce the rate of recurrence of superficial tumors but has not yet been proved to lower the incidence of later muscle-invasive tumors. Different dosage schedules and methods require further study. Empiric dose schedules may not provide optimal therapeutic effects. The question of timing of instillation of agents after definitive resection needs clarification as well. Questions that remain can be answered only through appropriately designed studies encompassing large numbers of patients with treatments assigned in a randomized fashion.