The Management of T1G3 Bladder Cancer

Abstract

Introduction: The treatment of T1G3 bladder cancer is still a controversial issue. Nowadays, intravesical bacillus Calmette-Guérin (BCG) instillation is considered to be the treatment of choice for patients with high-grade superficial bladder tumour after transurethral resection of all visible tumour. The aim of this retrospective study was to determine the effects and results of this approach, recurrence and progression rates in patients with T1G3 superficial bladder tumours. Material and Methods: 43 patients (28 male, 15 female; mean age 65.5 years, range 21–82) with T1G3 TCC (transitional cell carcinoma) bladder tumour underwent transurethral resection and subsequent intravesical BCG according to Morales protocol, in the period 1993–1998 at our institution. The mean follow-up period was 52.5 (range 30–96) months. Results: After one or more initial courses of therapy, 33 patients were disease-free. Twelve patients (27.90%) had recurrent tumour after a median of 7 (range 3–46) months. After a second course of BCG treatment, 6 patients had no evidence of disease, 3 patients had progression and 3 had recurrence. Progression occurred in 7 (16.27%) patients after a median of 19 (range 3–43) months. Five patients underwent radical cystectomy and the remaining 2 underwent bladder-preserving therapies. Two patients died of TCC and 3 due to disease-unrelated conditions. Conclusion: Intravesical BCG instillation can be recommended as treatment modality for responders with T1G3 TCC bladder tumour. The benefit of the second course of intravesical BCG therapy has to be confirmed in further investigations.

The optimal management of T1G3 bladder cancer

“…Several authors consider BCG as the first‐line treatment for primary G3T1 bladder cancer. At 22–78 months of follow‐up, recurrence rates were 20–70% and progression rates 0–33% (Table 5) [13,48,50–71].…”

Bacillus Calmette-Guérin versus Gemcitabine for Intravesical Therapy in High-Risk Superficial Bladder Cancer: A Randomised Prospective Study

“…Despite its confirmed efficacy, 21-53% of patients experience relapses [13][14][15] , and 0-35% show disease progression [16] . Furthermore, BCG has a broad array of local and systemic side effects ranging from 5 to 15%.…”

Controversial issues and optimal management of stage T1G3 bladder cancer

“…Furthermore, in the first 5 years after BCG induction, 15-50% of patients will experience disease progression [59,63,[86][87][88][89][90][91]. The wide variation in the failure rates of BCG therapy are largely due to differences in defining failure of therapy, with nonresponders and relapsers grouped together in some series.…”