ADJUVANT INTRAVESICAL THERAPY AND PROGNOSIS IN SUPERFICIAL TRANSITIONAL CELL CARCINOMAS OF THE URINARY BLADDER

THE AIM of the investigation was to analyze longterm results of adjuvant intravesical immunotherapy with BCG vaccine «Imuron» in subtotal dosage 100 mg and chemotherapy with thiophosphamide in the regimen of a single early postoperative injection in the dose 20 mg in patients with superficial transitional cell carcinomas of the urinary bladder who had transurenal resection (TUR) and to estimate the contribution of adjuvant therapy to prognosis of the disease. PATIENTS AND METHODS. The materials of the primary examination and fiveyear dispensary followup of 173 patients on whom TUR had been performed for superficial transitional cell carcinoma of the urinary bladder were studied retrospectively. In a month after TUR 42 patients received a course of instillation of BCG vaccine «Imuron» by 100 mg once a week during 6 weeks, 18 patients were given a single intravesical instillation of 20 mg of thiotepa immediately after TUR. The signs associated with recurrences and progression of carcinoma and with the survival of the patients at the postoperative period were analyzed. RESULTS. A course of immunotherapy with BCG vaccine after TUR resulted in three times less incidence of recurrent carcinoma (p0.1). The multiple regression analysis has shown (R2 =0.15; p=0.016) that the leading factors allowing prognosis of the patient’s survival independent of other indices are the depth of invasion and degree of differentiation of the primary tumor. CONCLUSION. The intravesical course therapy with BCG vaccine «Imuron» in dosage 100 mg once a week during 6 weeks and early postoperative single intravesical instillation of 20 mg thiotepa were shown to be effective means to decrease the incidence of postoperative recurrences of superficial transitional cell carcinomas of the urinary bladder. The depth of invasion and degree of differentiation of the primary tumor are the leading factors in prognozing the clinical course of the disease.

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