Urologie pro praxi 1/2016

Current role of instillation chemotherapy and immunotherapy in treating non-invasive bladder cancer (Ta, T1, Tis)

Non–muscle-invasive bladder cancer (NMIBC) represents a group of diseases characterized by papillary tumours confined to the mucosa (in the case of Ta tumours), invading the lamina muscularis propria (in the case of T1 tumours), and flat (mostly highgrade) tumorous lesions of the mucosa (in the case of Tis tumours and/or CIS). Molecular biology techniques along with clinical experience have shown a high malignant potential in T1 and CIS, requiring aggressive treatment that is currently represented by the combination of transurethral endoresection (TURBT) and intravesical instillation chemotherapy or immunotherapy. In accordance with the recent EAU guidelines, the present article deals in detail with the individual regimens of instillation therapy, adverse effects, and their treatment. Also emphasized is the seriousness of the CIS diagnosis and the urgent need to eradicate the condition, whether it be by using instillation BCG immunotherapy or performing radical cystectomy. Finally, the paper presents the results of some recent studies dealing with current trends in treating NMIBC.

Keywords: non–muscle-invasive bladder cancer (NMIBC), carcinoma in situ (CIS), intravesical instillation chemotherapy and immunotherapy, BCG vaccine, mitomycin C (MMC), epirubicin, doxorubicin, transurethral resection of bladder tumour (TURBT), radical cystectomy (RACE), chemohyperthermia.