Hosoda K

Carcinoma in situ of the urinary bladder. Effect of associated neoplastic lesions on clinical course and treatment

Clinical courses of 67 patients with carcinoma in situ (CIS) of the urinary bladder bladder during 14 years from 1971 to 1984 were investigated according to the clinical type of CIS and treatment methods. CIS was classified into four types: (1) the primary group included 18 patients who had neither prior nor simultaneous tumors of the urinary tract; (2) the secondary group included 10 patients who had CIS diagnosed subsequent to the treatment of superficial papillary bladder tumor; (3) the concurrent group included 14 patients who had CIS concomitantly with superficial papillary bladder tumor; and (4) the nonpapillary T1 group included 25 patients who presented with CIS with concomitant nonpapillary T1 tumor. As a rule, the initial treatment was conservative (transurethral resection [TUR] or intravesical chemotherapy) for the primary, secondary, and concurrent CIS groups, whereas treatment was radical (total cystectomy or irradiation) for the nonpapillary T1 group. Five‐year survival rates of the primary, secondary, concurrent, and nonpapillary T1 groups were 41%, 100%, 49%, and 68%, respectively. Secondary CIS revealed a rather good prognosis, probably due to the early detection of CIS and early application of intravesical chemotherapy when compared to other groups. Except for patients with nonpapillary T1 tumors, the 5‐year rate of malignant progression (invasion or metastasis) and multiple recurrences leading to delayed cystectomy was 81% in 16 patients treated by TUR, whereas it was 39% in 21 patients treated by instillation therapy. It appears likely that intravesical chemotherapy was preferrable to other conservative therapies as an initial treatment of CIS. Radical therapy, however, may be the choice for CIS with nonpapillary T1 tumors, ab initio. Cancer 59:164–173, 1987.

Intravesical Combination Chemotherapy with Mitomycin C and Doxorubicin for Carcinoma in Situ of the Bladder

We treated 30 patients with carcinoma in situ of the bladder via intravesical combination chemotherapy. As an induction therapy 20 mg. mitomycin C on day 1 and 40 mg. doxorubicin on day 2 were instilled into the bladder once a week for 5 consecutive weeks. Patients who achieved complete response were assigned a maintenance instillation of mitomycin C alone every 2 to 4 weeks for 1 year. A total of 19 patients achieved complete response following an initial course of induction therapy and 2 partial responders to initial therapy also achieved complete response after repeated induction therapy, resulting in a 70 per cent over-all complete response rate. Toxicity was considerable with moderate to severe bladder irritation occurring in 20 patients but it was tolerable in the majority. Of 21 complete responses 13 remained free of disease for 6 to 43 months (average of 23 months), 5 had recurrent carcinoma in situ and 1 had invasive urethral cancer. In contrast, of 9 nonresponders 2 and 1 had invasive cancer of the bladder and ureter, respectively.

Sequential instillation therapy with mitomycin C and adriamycin for superficial bladder tumors.

SummaryFrom October 1983 to September 1985, 84 patients with superficial bladder tumor (Ta, Tl, Tis) were treated with sequential instillation of mitomycin C (MMC) and adriamycin (ADM). Doses of 20 mg MMC on day 1 and 40 mg ADM on day 2 were instilled into the bladder and retained for at least 2 h; this was repeated once a week for 5 consecutive weeks. Patients who achieved complete response (CR), were randomized and underwent prophylactic treatment taking the form of either intermittent instillation of MMC or daily oral administration of 5-fluorouracil. Of 79 evaluable patients, 72 (91%) had received prior treatment for superficial bladder tumors, 69 (87%) had high-grade tumors, and 18 (23%) had non-papillary Tis. The overall response rate was 68%, made up of CR in 43 patients (54%) and partial response (PR) in 11 (14%). Patients with either five or more tumors or tumors larger than 1 cm showed a significantly lower response rate than those with fewer than five tumors and tumors smaller than 1 cm, respectively. There was no correlation between tumor growth pattern, tumor grade and response rate, though non-papillary Tis appeared to respond better than papillary tumors. A history of prior instillation therapy or of toxicity to this treatment had no significant influence on the response rate. Although no systemic toxicity was observed, 62 patients (74%) experienced cystitis and the treatment had to be discontinued within 4 weeks in 13 of 33 cases with severe symptoms. The preliminary conclusion of prophylactic treatment was that intermittent instillation of MMC was superior to 5-FU medication in reducing the recurrence rate for at least 2 years after the treatment.