[Therapy of superficial bladder carcinoma].

Topical therapy is administered after transurethral resection (TUR) for superficial cancer to reduce the frequency of recurrence, to avoid local tumor progression and to increase the survival rate. However, the results of prospective randomized studies on topical chemotherapy show that successful reduction of tumor recurrence is limited to a small group of patients. Topical immunotherapy with BCG seems to be more efficient, but prospective multicenter studies have not confirmed the superiority of BCG treatment. At present neither chemotherapy nor immunotherapy can influence progression or survival rate. It therefore seems advisable to continue to enroll patients with superficial bladder tumors in prospective studies to obtain more information on treatment schedules and their side-effects and therapeutic activity. The following information may be helpful in deciding on individual treatment schedules for patients with superficial bladder cancer: (1) Carcinoma in situ is the only therapeutic indication for topical therapy, and BCG may be more potent than chemotherapy. (2) Patients with pTaG1 tumor should be excluded from topical therapy. (3) Topical therapy may not be indicated at all for pT1G3 tumors. The rate of local progression and distant metastasis is high and cannot be influenced by this form of adjuvant treatment. (4) At present no drug of first choice is known. (5) Early application of intravesical chemotherapy immediately after TUR has no advantage over delayed treatment. (6) Long-term chemoprophylaxis is equivalent to short-term prophylaxis (6-24 months) in effect. (7) Immunotherapy with BCG can be limited to a period of 6 months.