Failure of bacillus calmette guerin (bcg) therapy for the treatment of bladder cancer: al-azhar experience

Abstract

Objective: To determine the failure rate of intravesical Bacillus Calmette Guerin (BCG) instillation following complete transurethral resection of superficial transitional cell carcinoma (TCC) of the urinary bladder at the Urology Department, Al-Azhar University, Cairo, Egypt. Patients and Methods: A prospective analysis of 160 patients with superficial TCC of the urinary bladder treated by transurethral resection of the bladder tumor (TURT) and adjuvant intravesical BCG instillation was performed at the Urology Department, Al-Azhar University, Cairo, between 2002 and 2008. The mean follow-up was 37 ± 4 (range 3 to 64) months. Results: After the initiation of BCG treatment 12 patients (7.5%) were lost to follow-up, 6 (3.8%) stopped BCG due to side-effects and were subsequently treated with intravesical chemotherapy, while another 5 (3.1%) died during BCG therapy due to tumor-unrelated causes. The overall survival rate at 3 years was 90.4%. At a mean follow-up period of 37 ± 4 months, 70.4% of the patients showed no tumor recurrence and 82% no tumor progression. BCG failure was significantly observed in cases with stage T1, or grade-3 tumors or in cases associated with carcinoma in situ. Conclusion: TURT with adjuvant intravesical BCG therapy is considered the first treatment option in high and intermediate risk patients with superficial TCC. Failure of BCG treatment is mainly observed in stage T1 or grade-3 tumors. Different treatment modalities can be used after a second tumor recurrence or progression according to the tumor aggressiveness and the patient’s preference.

Keywords : Superficial bladder cancer, Bacillus Calmette Guerin (BCG), tumor recurrence, progression