低劑量卡介苗膀胱灌注療法在尿毒或腎移植膀胱癌復發病人之療效及安全性評估
郭威廷 余家政 吳東霖
高雄榮總 外科部 泌尿科
THE SAFETY AND EFFICACY OF LOW DOSE BCG INTRAVESICAL INSTILLATION FOR THE TREATMENT OF UREMIC OR KIDNEY TRANSPLANT PATIENTS WITH RECURRENT UROTHELIAL CARCINOMA OF THE BLADDER
Wei-Ting Kuo, Chia-Cheng Yu, Tony T. Wu
Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C.
Purpose: Theoretically, immunosuppression is a relative contraindication for intravesical BCG trerapy because of the risk of severe morbidity and sepsis. We present our experience with intravesical BCG therapy in uremia/renal transplant patients with recurrent urothelial carcinoma of
Bladder.
Materials and Methods: A total of 34 patients with recurrent superficial bladder cancer (pTa or pT1) were enrolled. Ten patients are uremic and the other 14 were renal transplantation patient. Intravesical instillation with low dose(1/2 or 1/3 of 81mg) of BCG was administered weekly for 6 weeks, postoperatively. Boost dose was given at 3 months interval and then every 6 months until 2 years postoperatively. Cystoscopic examination was performed every 3 months for the first year
and semiannually for 2 years and then annually.
Results: Low dose BCG intravesical instillation was completed in 30 patients. Tumor recurrence was recognized in 2 patients during followup, who restarted second BCG induction therapy without recurrence. BCG therapy was withdrawn in 4 patients due to BCG-related local toxicity. No major complication or systemic dissemination of TB bacili was noted. Transient dysuria and hematuria are the most common adverse events
Conclusions: Uremia/renal transplantation patients were traditionally considered as immuno-compromised and high risk for tumor recurrence. Low dose BCG intravesical instillation in such patients seems to be a safe prophylaxis with similar efficacy on tumor control