The management of the patient with recurrent local of disseminated bladder cancer presents a difficult problem. In the majority of these patients an operation or radiation therapy is of no value. Because none of the single agent chemotherapy seems to be capable of achieving an objective response rate greater than 50 percent and because complete responses are rare, combination chemotherapy trials have been developed. In l977 Sternberg et al reports 83 percent response rate (CR: 8%, PR: 75%) with CISCA combination chemotherapy (cis-platinum, cyclophosphamide, adriamycin) in advanced urinary tract carcinoma. Other similar studies have shown various results ranging from 43 to 82 percent response rate in advanced bladder cancer. Herein, we report 3 cases of CISCA combination chemotherapy in far advanced bladder cancer, which had measurable metastatic lesions enough to evaluate the objective response of chemotherapy.
Cyclophosphamide ; Drug Therapy ; Drug Therapy, Combination* ; Humans ; Urinary Bladder Neoplasms* ; Urinary Bladder* ; Urinary Tract

Patients with advanced carcinoma of the bladder that relapses or persists after conventional therapy have a poor prognosis. The management of the patient with recurrent local or disseminated bladder cancer presents a difficult clinical problem. In l985, Sternberg et al reported 7l% significant tumor regression and 50% complete clinical remission with M-VAC(Methotrexate, Vinblastin, Adriamycin and Cisplatin) combination chemotherapy for treatment of advanced bladder carcinoma Herein, we report 4 cases of M-VAC combination chemotherapy in far advanced bladder carcinoma with had measurable metastatic lesions enough to evaluate the objective response of chemotherapy.
Doxorubicin ; Drug Therapy ; Drug Therapy, Combination* ; Humans ; Prognosis ; Recurrence ; Urinary Bladder Neoplasms* ; Urinary Bladder*

5-Fluorouracil was used for the treated of 4 cases of carcinoma of the bladder along with electrocoagulation, X-ray radiation, Cobalt teletherapy and estrogen and its effectiveness was evaluated Further experience with this druy is necessary for detailed evaluation, though the cases reported herein seems to have responded to this chemotherapy to some extent.
Cobalt ; Drug Therapy ; Electrocoagulation ; Estrogens ; Fluorouracil* ; Urinary Bladder Neoplasms ; Urinary Bladder*

We tried to treat 16 patients with superficial transitional cell carcinoma of the bladder with prophylactic and therapeutic intravesical chemotherapy. The 2 drugs used were adriamycin and thio-tepa and checked for efficacy by repeated cystoscopy with at least 3 months` interval. The clinical data and results of both groups are presented and the importance of intravesical treatment with minimal toxicity is discussed with a brief review of the literatures.
Carcinoma, Transitional Cell ; Cystoscopy ; Doxorubicin ; Drug Therapy* ; Humans ; Thiotepa ; Urinary Bladder Neoplasms* ; Urinary Bladder*

Superficial bladder tumors are usually treated by TUR. However, recurrence of the tumor after complete resection occurs in about 50-70%, of the patients with a significant percentage of these recurrences showing a higher degree of malignancy. In 10% of the cases, the tumor progresses to invasive carcinoma. Most of these recurrent tumors will occur within 6-12 months. The multifocal nature of these tumors and the frequent recurrences after TUR indicate a need for adjuvant chemotherapy to reduce or delay the incidence of recurrence tumors. We studied to evaluate prophylactic effects of topical chemotherapy in 116 cases with superficial bladder tumors admitted to the Department of Urology, Keimyung University School of Medicine during the period from Jenuary, 1971 through July, 1985. All patients were followed up for more than 6 months. Study group consists of 83 cases (Thio-tepa: 39, Adriamycin; 44) treated with topical chemotherapy following TUR during the period from January, 1978 through July, 1985. Control group consists of 33 cases treated by TUR only during the period from January 1971 through December, 1977. Following results were obtained: 1. No. of patients with recurrence; In study group, 36Pr In control group. 67% 2. Average interval of recurrence: In study group, 38 months. In control group, 30 months 3. Recurrence rate; In study group, 2.58 In control group, 3.16 4. Complication: local side effects; In TUR + Thio-tepa, 20.5% In TUR + Adriamycin, 15.9%.
Chemotherapy, Adjuvant ; Doxorubicin ; Drug Therapy* ; Humans ; Incidence ; Recurrence ; Thiotepa ; Urinary Bladder Neoplasms* ; Urinary Bladder* ; Urology

Of the 11 advanced bladder cancer patients who received M-VAC (Methotrexate, Vinblastine, Doxorubicin and Cisplatin) combination chemotherapy, complete and partial remission were observed in 63.6%. Of the 17 advanced bladder cancer patients who received MAC (Methotrexate, Doxorubicin and Cisplatin) combination chemotherapy, complete and partial remissions were observed in 17%. Complete remission was achieved in 18.2% of the patients clinically, pathologically in M-VAC group and 5.9% in MAC group. Partial remission was occurred in 46.5% of the patients in M-VAC group and 41.2% in MAC group. All metastatic sites including the bone and liver, lung were well responded in M-VAC group, but poorly responded in MAC group. Toxicity was significant but tolerable.
Doxorubicin ; Drug Therapy, Combination* ; Humans ; Liver ; Lung ; Urinary Bladder Neoplasms* ; Urinary Bladder* ; Vinblastine

Recurrence in patients with superficial bladder tumor is a serious problem. In one series, the recurrence rate was 73%, and invasive cancer developed in 10% of patients with recurrences. To eliminate or reduce the rate of recurrence, topical chemotherapy has been tried and showed adjunct effects. We studied to evaluate prophylactic effects of topical chemotherapy in 51 patients with superficial bladder tumor admitted to the Department of Urology, Kyung Hee University Hospital during the period from April, 1979 to April, 1984. Patients were divided into 2 groups. Group A comprised 19 patients (Adriamycin; 8, Thio-TEPA; 11) treated with topical chemotherapy following initial TUR and 27 patients treated by TUR only. Group B comprised 5 patients treated with topical chemotherapy (Adriamycin) after repeated TUR and 7 patients among 27 patients who had repeated TUR for recurrence. Patients treated by TUR only were defined as control group. Recurrence rate was analyzed in each group. Following results were obtained. 1. In group A, recurrence rate was 2.54 in patients with chemotherapy comparing to 3.35 in control patients. Average interval of recurrence was 39.3 months in chemotherapy patients and 29.8 months in control patients. 2. In group B, recurrence rate was higher in chemotherapy patients than in control patients with rate of 6.6 and 5.3, respectively. But recurrence rate was diminished to 6.6 after chemotherapy comparing to pre-chemotherapy period (10.3). 3. There was no difference in recurrence rate relating to multiplicity of tumor as a whole.
Drug Therapy* ; Humans ; Recurrence ; Thiotepa ; Urinary Bladder Neoplasms* ; Urinary Bladder* ; Urology

Transurethral resection is the mainstay of curative treatment for superficial bladder cancer. Unfortunately, tumors recur in 40~70% of patients. Recently, we tried intravesical Mitomycin C chemotherapy after TUR to eliminate or decrease the frequency of recrrence. In this study, 22 patients with superficial bladder carcinoma received Mitomycin C intravesically at weekly intervals for eight weeks in dose of 40mg/40ml, starting about 48 hours after TUR. The results were compared to a group consists of 39 patients with superficial bladder cancer who received no further therapy after TUR. In the follow-up of 6 and 12 months, tumor recurrence was l3.6(3pts) and 18.2(4pts) percent respectively, in the Mitomycin C group, and 38.5(15pts, and 43.6(17 pts) per cent, respectively, in the control group. The frequency of recurrence in the Mitomycin C group was significantly less than that in the control group in the follow-up of both 6(P< 0.05) and 12 months(P< 0.05). Side effects of intravesical Mitomycin C therapy were negligibly minimal. Therefore, Mitomycin C intravesical chemotherapy after TUR is effective prophylactic treatment in reducing bladder tumor recurrence.
Drug Therapy ; Follow-Up Studies ; Humans ; Mitomycin* ; Recurrence* ; Urinary Bladder Neoplasms ; Urinary Bladder*

Intravesical Bacillus Calmette-Guerin (BCG) had been shown to be effective therapy and prophylaxis against recurrent tumor in patients with superficial bladder cancer, including carcinoma in situ. A study was performed to determine the prophylactic efficacy of intravesical Tice-Chicago strain BCG instillation in 47 patients with high risk superficial bladder cancers (stage Ta or T1). Group I consisted of 17 patients with a history of at least 1 tumor recurrence before BCG therapy. Most had received various forms of intravesical chemotherapy as prophylaxis following previous TUR of the bladder tumor. The tumor recurrence rate of patients was compared with the rate during the 2 years prior to BCG therapy as a personal historical control. The simple recurrence rate of group I was 41.2% before and 5.9% after intravesical BCG therapy. According to the person-years method. the number of recurrent tumors per patient-months was 0.0149 before and 0.0021 after BCG therapy(p>0.05). Group R consisted of 30 consecutive new patients. The tumor recurrence rate after BCG therapy was compared with that of historical controls in our hospital. There were lI6 other patients who had previously been treated by transurethral resection and most had also received intravesical chemotherapy. The simple recurrence rate was 20% in BCG patients and 44.8% in the historical controls. According to the person-years method, the number of recurrences per patient-months in this group was 0.0081 and 0.0576 in the historical group. The results show that intravesical BCG instillation is effective and safe as a prophylaxis against the recurrence of the superficial bladder tumors. The granulomatous response in the bladder and PPD responsiveness have their statistical correlation with status free of tumor.
Bacillus ; Carcinoma in Situ ; Drug Therapy ; Humans ; Mycobacterium bovis* ; Recurrence ; Urinary Bladder Neoplasms* ; Urinary Bladder*

PURPOSE: Forty percent of the newly diagnosed bladder cancer patients are over the age of 70 years, but it is said that over 75% of them are excluded from active programs of management. This study was to evaluate the usefulness of M-VAC(methotrexate, vinblastine, adriamycin and cisplatin) chemotherapy for invasive bladder cancer patients over the age of 70 years compared with that of patients under the age of 70 years. MATERIALS AND METHODS: Sixty patients with invasive bladder cancer were treated with M-VAC chemotherapy. We divided the patients into group 1- 20 patients over the age of 70 years and group 2- 40 patients under the age of 70 years. We compared cycle length, toxicity and clinical response of M-VAC chemotherapy in group 1 with those of group 2. RESULTS: The Karnofsky performance score was 85.5% in group 1 and 96.3% in group 2. The cycle length needed for 2 cycle of M-VAC chemotherapy was 67.2(range, 56-92) days in Group 1 and 61.5(range, 56-78) days in Group 2(p>0.05). Hematologic toxicities had not significant difference between two groups. Vomiting and stomatitis occurred more common in group 1. In 3 patients of group 1, the serum creatinine level rose to more than 3 mg/dl. The clinical response was 50% in Group 1 and 67% in Group 2(p>0.05). CONCLUSIONS: The bladder cancer patients over the age of 70 years had much more toxicity, longer cycle length and lower response rate, but these differences had not statistical significance. These results suggest that M-VAC chemotherapy in patients over the age of 70 years will achieves the therapeutic effects when the patients have a good physical condition and toxicities to chemotheraphy are monitored closely.
Aged* ; Creatinine ; Doxorubicin ; Drug Therapy* ; Humans ; Stomatitis ; Urinary Bladder Neoplasms* ; Urinary Bladder* ; Vinblastine ; Vomiting