Original Articles: Bladder Cancer: Intravesical Adjuvant Chemotherapy for Superficial Transitional Cell Bladder Carcinoma: Results of 2 European Organization for Research and Treatment of Cancer Randomized Trials With Mitomycin C and Doxorubicin Comparing Early Versus Delayed Instillations and Short-Term Versus Long-Term Treatment

The Schedule and Duration of Intravesical Chemotherapy in Patients with Non–Muscle-Invasive Bladder Cancer: A Systematic Review of the Published Results of Randomized Clinical Trials

“…Although some evidence suggests that 1 yr may be better than 5-6 mo of treatment when one immediate instillation has not been given [13], results among the different studies were inconsistent (Table 6). There was no suggestion that 1 or 2 yr of treatment is more effective than 6 wk or that 3 yr is more effective than 5 mo; however, the number of patients studied is insufficient to draw definitive conclusions.…”

“…Comparing nine instillations of MMC or Adria-mycin given during 6 mo to 15 instillations given during 12 mo, there was no difference in the percentage of patients with recurrence [13]; however, no results were presented taking 6 mo as time zero. In another study, no difference was found when comparing six instillations of epirubicin during 1 mo to 17 instillations in 12 mo [14].…”

“…Six months of chemotherapy-Two trials assessed the benefit of an immediate instillation when chemotherapy was given during 6 mo (Table 4). In the first trial in which patients were randomized to start immediately or start 1-2 wk after TUR (9 instillations of MMC or Adriamycin during 6 mo), fewer patients receiving immediate chemotherapy had recurrence, 43.8% versus 55.8% (p = 0.03) [13]. However, in the second trial in which patients received 4 weekly instillations of epirubicin followed by 5 monthly instillations (9 instillations in 6 mo) preceded or not by one "immediate" instillation within 48 h, no significant difference was found [18].…”

“…In the first two studies, the percentage with recurrence in the two treatment groups was similar [12,13]. In the third study, more patients had recurrences on the delayed treatment (p = 0.04); however, patients on delayed treatment tended to have a worse prognosis [19].…”

“…One year of chemotherapy-Three trials using various drugs compared short-term instillations of 5-6 mo to instillations during 1 yr [13,18,21]. In one study, fewer patients had recurrence with 12 mo of MMC or Adriamycin (15 instillations) as compared to 6 mo of treatment (9 instillations), 41.2% versus 55.8% (p = 0.01) [13]. However, in another study comparing 11 instillations of epirubicin during 12 mo to 9 instillations during 6 mo, no difference was found [18].…”