Bacillus Calmette-Guérin treatment of 39 patients with superficial transitional cell carcinoma of the bladder.

The effect of intravesical Pasteur-F strain Bacillus Calmette-Guérin (BCG) on bladder carcinoma was studied in 39 patients. Multiple recurrent superficial transitional cell carcinoma was present in 36 cases, including 11 with concomitant carcinoma in situ (CIS), and primary CIS in three. The mean age of the 27 men and 12 women was 72 years. A 6-week induction course was given, beginning usually 4-6 weeks after transurethral tumor resection (TUR) or random biopsies, with periodic followup cystoscopies and cytologic analyses. A second 6-week course was given only to patients with incomplete response (positive urinary cytology or recurrent tumor). Three patients received maintenance intravesical BCG. If there was no response at the first cystoscopy after the induction course, no further BCG was given. Side effects were mostly local, moderate and transient, subsiding spontaneously or responding to symptomatic treatment. Severe systemic side effects occurred in three patients. Two with arthritis/arthralgia were managed as out-patients, while one with BCG pneumonitis/hepatitis required hospitalization, triple antituberculosis medication, cloxacillin and prednisolone. Complete response, defined as negative cystoscopy, cytology and histology, was obtained in 11 of 21 cases of papillary carcinoma without concomitant CIS. These patients were followed up for 8-47 months. Of the ten non-responders, two died and eight underwent further TUR. Of the 11 patients with concomitant CIS, six showed complete and five no response. Two of the latter died and three had further TUR. In all three cases of primary CIS there was complete response.