Intravesical Chemotherapy Versus Immunotherapy in Superficial Carcinoma of the Bladder

Intravesical chemotherapy or immunotherapy is the mainstay in the treatment of superficial transitional cell carcinoma (TCC) of the bladder after transurethral resection of bladder neck (TURBT). These methods, however, have some limitations in terms of therapeutic response and the rate of complications. This study was performed to evaluate the complication rates, response to treatment, and relapse of TCC after mixed chemotherapy with thiotepa and mitomycin C in comparison with immunotherapy with BCG. In this clinical trial, 140 patients who were admitted to Departments of Urology, Ghaem and Musabn-e- Jafar Hospitals, with superficial TCC, were divided into four groups of 35 patients. After TURBT, the patients in group one were treated with thiotepa. The patients in the second and third groups were treated by monotherapy with mitomycin C and BCG, respectively. The patients of the last group received mixed therapy with thiotepa plus mitomycin C. All patients were followed by physical examination, laboratory tests (CBC, UA), and cystoscopy every three months for the first two years, and then every six months until the end of the study. CBC was performed before and after eight weeks of every therapy. In this study, the maximum prevalence rate of TCC was in the 7th and 8th decades with a mean age of 66 years. Of the patients studied, 3.5% had stage TIs, 43.5% stage Ta, and 53% stage T1. Tumors were mostly (94%) seen in the lateral walls and the base of bladder. In the third group, who were treated with intravesical BCG, the recurrence rate of carcinoma was apparently lower and the remission time was longer. However, the highest incidence of acute cystitis was seen in BCG-therapy group; in the mixed-therapy group, it was the lowest. Hematologic and allergic side-effects were significantly lower with mixed therapy. Recurrence in BCG-therapy group was lower but its complications, especially acute cystitis, were common. Administration of mixed therapy has been successful in reducing the complications (both systemic and local). Nonetheless, the therapeutic response was similar to the monotherapy treatment.