The Treatment of Non–Muscle-Invasive Bladder Cancer with Intravesical Chemotherapy and Immunotherapy

ObjectivesTo determine the efficacy, best indications, and regimens of intravesical adjuvant instillations in case of non–muscle-invasive bladder tumours.MethodsThe authors analyse the most significant articles of the literature to draw recommendations.ResultsThe three main factors that appear to determine a patient's ultimate prognosis are tumour size at presentation, the grade, and the prior recurrence rate per year. Bacillus Calmette-Guérin (BCG) has a beneficial effect in preventing progression, especially in patients with pT1G3 disease and carcinoma in situ. It seems to be important to improve the results achieved so that at least maintenance, whatever it is, may occur. The effectiveness of mitomycin C with relation to progression may, in fact, be diluted because of its lack of effective usage. The recommendation seems to indicate one single early mitomycin C postoperative instillation in patients with superficial low- and intermediate-risk tumours.ConclusionsMitomycin C and BCG are effective agents in both preventing recurrence and progression. It is customary to use mitomycin C in the perceived less aggressive lesions and BCG for patients at higher risk.