The Management of Non-Invasive Bladder Tumours with Doxorubicin Intravesical Instillation after Transurethral Resection

Abstract

Objectives: Evaluation of the intravesical instillation of doxorubicin for its effect on disease recurrence for patients with non-invasive bladder tumour. Methods: The trial was performed at Al Assad University Hospital in Lattakia, Syria and included patients with non–invasive bladder tumours who were managed with transurethral resection and induction and maintenance therapy with intravesical doxorubicin. They were followed up by cystoscopy every 3 months for 2 years and every 6 months thereafter with special emphasis on recurrence rates. Results: The trial included 85 patients with non–invasive bladder tumours: 23 with non-invasive papillary carcinoma (Stage Ta), 62 with tumour invading subepithelial connective tissue (Stage T1). Twelve patients had well differentiated tumours (Grade 1), 48 were moderately differentiated (Grade 2), 25 were poorly differentiated (Grade 3). The total recurrence rate was 23%. The rates of recurrence were 56% in Grade 3 and 0% in Grade 1. The recurrence rate was 41% in patients with large tumours versus 17% in those with small tumours; 44% in those with multiple tumours compared to 18% in those with solitary tumours; 30% of Stage Ta tumours recurred and 21% of Stage T1 tumours. Conclusion: In short term follow-up, our rate of recurrence was 23% compared to 54% in multicentre international studies without the intravesical adjuvant; thus adjuvant intravesical doxorubicin was shown to reduce the recurrence of superficial bladder cancer. Tumour grade, size and number were shown to be prognostic factors for recurrence.