Treatment of Ta, T1 Bladder Tumors: Recent Results of the EORTC-GU Group

Superficial bladder cancer is one of the most frequently encountered tumors in urologic practice. The best management at present is a matter of controversy. Transurethral resection (TUR) remains the treatment of choice, but there is a considerable risk of recurrence of tumors thus treated (50%–70%), as well as a lower risk (10%–15%) of progression to muscle-invasive disease (Kurth et al. 1995). Adjuvant treatment has been advocated for 30 years in order to reduce the number of locally recurrent tumors, the incidence of metastatic disease, and the risk of progression to muscle-invasive disease. Numerous randomized trials have been reported in which the effectiveness of multiple intravesically instilled chemo-and immunotherapeutic agents has been investigated. These adjuvant therapies have been investigated for more than 20 years by the European Organization for Research and Treatment of Cancer (EORTC) Genito-Urinary (GU) Group (Bouffioux 1995). The conclusions drawn from these studies have been: 1. Primary, solitary, low-stage, low-grade tumors should be resected and should not be treated by adjuvant intravesical therapies. One instillation of a chemotherapeutic agent soon after TUR may favorably influence the recurrence rate. 2. TUR alone results in a higher recurrence rate than TUR followed by instillation therapy, whatever drug is used. 3. There are no hard data to demonstrate that a superior drug exists, although bacille Calmette-Guerin (BCG) might be superior for high-risk tumors. 4. It is not possible to conclude from individual trials whether intravesical chemotherapy is able to prevent the occurrence of muscle-invasive disease and metastases.