표재성 방광암에서 반복 BCG 방광내 주입요법의 치료효과와 적응중 선택

Abstract

Although initial and additional course of intravesical bacillus Calmette-Guerin (BCG) immunotherapy have proved effective in the treatment and prophylaxis of superficial bladder cancers, including carcinoma in situ, a significant minority of patients will fail such therapy and criteria for selection of patients who may benefit from an additional course of BCG have not yet been established. In an attempt to identify patients who are likely to respond, we analyzed our experience in patients with superficial bladder cancer treated with a subsequent course of BCG. Of 86 patients who received an initial once a week for 6-week and once a month for 3-month of intravesical BCG for superficial transitional cell carcinoma of the bladder 18(21 per cent) were treated with another course. First course of BCG was successful in 50 (66 per cent) of 76 patients treated for prophylaxis and 4 (40 per cent) of 10 treated for carcinoma in situ. The response rate for the total patients population treated with first course was 62.8 per cent (54 of 86). Of 32 patients who failed the initial treatment course 18 were given an additional BCG therapy, subsequent progression of disease occurred in 2 patients( 11 per cent). Of the l6 patients (89 per cent) without progression 10 (56 percent) had a complete response and 6 (33 per cent) had new tumors. and they were rendered free of disease after transurethral resection. The median interval between course 1 and 2 of intravesical BCG was 12 months (range, 4-40 months) and the median followup after course 2 was 22 months (range, 4-69 months). The median duration of response to course 1 of BCG was shorter for patients with disease progression or recurrence after course 2 than for those with no progression or recurrence (8 and 15 months) . The results suggest that initial and subsequent course of intravesical BCG are effective in the treatment and prophylaxis of superficial bladder cancer, including carcinoma in situ, and a subsequent treatment with BCG is most likely to be useful in patients who have a sustained response to the initial treatment. Key word : Superficial bladder cancer, BCG.