MANAGEMENT OF BCG-REFRACTORY SUPERFICIAL BLADDER CANCER

Introduction: Seventy percent of bladder tumors are confined to the mucosa and lamina propria when diagnosed and are called superficial bladder tumors. Whereas 70-80% of these do not extend beyond the mucosa, 20-30% involves lamina propria. Even though defined superficial, these tumors have heterogeneous biologic behavior and can be highly malignant. In those who do not receive further treatment after transurethral resection, recurrence rates are %50-70 and progression rates range between 25-50%. Intravesical Bacille-Calmette Guerin treatment is the main treatment after TUR. However, 30-40% of patients do not respond to BCG treatment and %30-40 of those who respond, recur within five years. In medium to high risk patients with recurrence after intravesical chemotherapy, BCG treatment can be tried. However, when BCG as a first line of treatment fails, the situation is more complicated. In these patients, cystectomy should be considered primarily. New treatment modalities have shown some promising results. The addition of interferon to BCG has proven effective, with response rates near 50%. Intravesical gemcitabine and photodynamic therapy are new therapies that need to be evaluated further with randomized studies.