Long-term efficacy of maintenance bacillus Calmette-Guérin versus maintenance mitomycin C instillation therapy in frequently recurrent TaT1 tumours without carcinoma in situ: a subgroup analysis of the prospective, randomised FinnBladder I study with a 20-year follow-up

Abstract

Editorial CommentThe authors describe the cumulative incidence of acute urinary side effects and delayed urinary complications of prostate brachytherapy. The cumulative incidence of urethral stricture was similar to what has been previously reported -just under 5% (1). A review of the grade 2-4 complications reveals them all to be problems that are very difficult to manage. Urethral strictures in radiated tissue rarely have a durable response to optical urethrotomy. Urinary incontinence after brachytherapy is much more troublesome to treat than after radical prostatectomy. Moderate to severe dysuria has no good solution. When examining Figure-2 in the article -a graph of the cumulative incidence of late urinary complications -one sees a trend common to most radiation series. That trend is that complications continue to accrue at a steady rate through the end of the follow-up period. To measure the true risk of these complications the follow-up needs to be carried out much further. Urethral complications of radiation therapy are not rare and continue to be a vexing problem to manage. Background: The long-term prospective data on bacillus Calmette-Guérin (BCG) and mitomycin C (MMC) instillation therapy are limited. Objective: To compare the long-term benefit of BCG and MMC maintenance therapy in patients with recurrent bladder carcinoma. Design, Setting, and Participants: Eighty-nine patients with frequently recurrent TaT1 disease without carcinoma in situ (CIS) were eligible. Originally, the patients were enrolled in the prospective FinnBladder I study between 1984 and 1987 and randomised to receive BCG or MMC. Both regimens involved five weekly instillations, followed by monthly instillations for 2 yr. Because of alkalinising the urine and adjusting the dose to bladder capacity, the average concentration of MMC was low: 30-40 mg in 150-200 ml of phosphate buffer. Overall median follow-up time was 8.5 yr, whereas the median follow-up time of the patients who were still alive was 19.4 yr. Measurements: Primary end points were time to first recurrence and overall mortality. Secondary end points were progression and disease-specific mortality. Results and Limitations: Thirty-six of 45 patients (80.0%) in the MMC group experienced recurrence in contrast to 26 of 44 patients (59.1%) in the BCG group. This finding was reflected in significantly lower cumulative