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Intravesical Instillation Therapy

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Management of Urothelial Carcinoma

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Abstract

Transurethral resection of a bladder tumor (TURBT) is the gold-standard treatment for non-muscle-invasive bladder cancer (NMIBC); however, the recurrence rate is as high as 80%. Immediate post-TURBT intravesical chemotherapy (PIC) is focused on control of local recurrence of NMIBC. Current evidence in a large meta-analysis has shown that immediate PIC reduces the recurrence rate, especially in low-risk patients, but the quality of the evidence was low. The optimal dosage, number, and timing of treatments are still controversial. Both the American Urological Association (AUA) and the European Association of Urology (EAU) guidelines support immediate postoperative intravesical chemotherapy in NMIBC. The EAU has recommended immediate PIC in low- to intermediate-risk patients. The AUA has recommended PIC only in small-volume low-grade Ta-stage urothelial carcinoma tumors of the bladder (Chang et al., J Urol 196:1021–1029, 2016). Contraindications to PIC include deep muscle resection, bladder perforation, and prior allergy to the chemotherapy agent (Kulkarni et al., Eur Urol 57:60–70, 2010).

In patients with high-risk NMIBC, intravesical instillation (of bacillus Calmette–Guérin (BCG) immunotherapy or chemotherapeutic agents) and radical cystectomy are treatment options. Intravesical BCG has been shown to reduce tumor progression and recurrence. If high-grade NMIBC patients want bladder preservation, intravesical instillation of BCG is a good treatment option. However, because it uses a live strain of Mycobacterium bovis, caution is needed regarding possible side effects. BCG-unresponsive NMIBC and BCG shortages are other issues that can arise. Intravesical BCG instillation is associated with better oncological outcomes than intravesical chemotherapy, which is thus sometimes considered as an alternative treatment when patients cannot tolerate BCG or are unresponsive to it. Novel methods for administering mitomycin C (MMC), such as electromotive drug administration (EMDA) and chemohyperthermia (C-HT), provide promising results equivalent to those of BCG immunotherapy.

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Authors and Affiliations

  1. Department of Urology, Seoul National University Hospital, Seoul, South Korea

    Jungyo Suh

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  1. Jungyo Suh
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  1. Department of Urology, Seoul National University Hospital, Seoul, Korea (Republic of)

    Ja Hyeon Ku

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Suh, J. (2019). Intravesical Instillation Therapy. In: Ku, J. (eds) Management of Urothelial Carcinoma. Springer, Singapore. https://doi.org/10.1007/978-981-10-5502-7_8

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  • DOI: https://doi.org/10.1007/978-981-10-5502-7_8

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