Abstract
From October 1983 to September 1985, 79 patients with either recurrent superficial papillary tumors (61) or carcinoma in situ (18) of the bladder underwent sequential instillation therapy with mitomycin-C and adriamycin (MA therapy).
Patients who achieved CR received randomly assigned prophylactic treatment of either MMC instillation or oral medication of 5-fluorouracil for at least 1 year. The following results were obtained.
1. Forty-three patients (54%) achieved CR and 11(14%) achieved PR, resulting in a 68% overall response.
2. Tumors smaller than 1cm in size and less than 5 in number showed significantly better responses to MA therapy than those otherwise (p<0.05). Though not significant, patients with CIS, no previous instillation and manifesting severe toxicity (bladder irritation) to MA therapy appeared more responsive than those with papillary tumors, previous instillation and manifesting mild or no toxicity.
3. Of 43 CR-patients, 15 underwent prophylactic treatment with MMC instillation and had a favorable 2-year non-recurrence rate (73%) compared to 18 patients receiving 5FU medication (30%). Though not significant, patients with CIS, G3 histologic anaplasia, and no previous instillation appeared to have a high 2-year non-recurrence rate when compared with those with papillary tumors, G2 tumors and a history of previous therapy.
4. Although the rate of malignant progression among these patients was not so high as predicted, further follow-up study would be necessary to assess the effectiveness of MA therapy for prophylaxis of malignant progression.
