Intravesical Bacillus Calmette-Guérin (BCG) Immunotherapy for Patients with Non-Muscle Invasive Bladder Tumors

Introduction: Intravesical instillations with bacillus Calmette-Guerin (BSG) is currently considered the most effective intravesical therapy for non-muscle invasive bladder tumors. The aim of this study is to present our experience with intravesical BCG immunotherapy instillations in patients with non-muscle invasive bladder tumors.
Material and method: Between September 30, 2005 and March 31, 2012 we performed intravesical instillation with BCG in 183 patients with non-muscle invasive bladder tumors, initiated at 6 weeks after transurethral resection of the tumor. The induction of BCG instillations was administrated according to the empirical 6-weekly induction schedule. Maintenance therapy was scheduled to 3 and 6 months following the instillation with BCG and at every 6 months afterwards for 3 years.
Results: Five patients did not finish the induction therapy protocol and were excluded from the study. The median clinical follow-up was 37 months. Endoscopic examination showed no reccurence in 126 patients. For 52 patients with bladder tumor reccurence, we performed tranurethral resection of the bladder. Histopathological examination demonstrated no progression in 30 cases. For this group of patients we continued the BCG tratment. The other 22 patients with progression of the tumor were excluded from the BCG treatment and received oncological or surgical treatment. The main complications were represented by tuberculization of the bladder, hematuria and fever, BCG treatment was stopped for these patients.
Conclusions: Our results show a low rate of tumor recurrence in patients with non-invasive tumors treated with BCG instillation. Complication rate is low, but the treatment required discontinuation in several patients.