[Intravesical Bacillus Calmette Guerin treatment of bladder tumors and carcinoma in situ].

Intravesical Bacillus Calmette-Guérin (BCG) has been used in the treatment of transitional neoplasia of the bladder since 1976. The indications for BCG-treatment are: 1. Carcinoma in situ (CIS), 2. Prophylaxis and 3. Treatment of tumor(s). This paper reviews the treatment schedules, results, side effects, mode of actions and the efforts at improvement of the treatment. In conclusion, the results in CIS are satisfactory, especially in primary CIS. In prophylaxis, efficacy has been demonstrated in small randomized trials against recurrence of tumor, rate of progression and survival. Unfortunately, the characteristics of the tumor(s) treated by BCG are heterogenous (stage, concomitant CIS) and the numbers of patients are small, making it difficult to determine whether there is an effect in all patients or only a subgroup. Tumor treatment with intravesical BCG is only indicated in patients not fit to undergo transurethral resection. Treatment of CIS with BCG is well established, but the exact indications for prophylaxis and tumor treatment are not known. The optimal treatment schedule has probably not been established, and further studies are necessary in an effort to improve the efficacy.