Intravesical Doxorubicin for Prophylaxis in the Management of Recurrent Superficial Bladder Carcinoma — An Update

Abstract

The natural history of transitional cell carcinoma of the bladder that is superficial and limited to the mucosa or lamina propria is extremely variable. The 5-year survival rates range between 65 and 85 per cent. However, 5 0 to 70 per cent of the patients will have recurrent lesions of a similar or different stage or grade (1). In a detailed natural history study by the National Bladder Cancer Collaborative Group A, 30 per cent of the patients with stage T1 lesions (cancer limited to the lamina propria) had muscle invasion during a 3-year interval (2). Although the likelihood of muscle invasion was less than with stage Ta lesions (papillary noninvasive carcinoma), patients with poorly differentiated lesions eventually may have muscular invasion. Variables such as histopathologic findings, pathologic grade, anatomic location multiplicity of lesions, cytogenetic abnormalities of the exfoliated urothelial cells, presence of ABO surface antigens and the concomitant presence of cellular atypia or carcinoma in situ in surrounding areas are of prognostic importance when designing therapeutic strategies. The fact that traditional endoscopic resection and fulguration of these superficial lesions still are accompanied by a substantial number of recurrences underscores the need for additional therapy to decrease the number of recurrences, increase the duration between recurrences, decrease the likelihood of subsequent muscle, lymphatic and ultimately disseminated spread, and, hopefully,eradicate the disease.