Intravesical Doxorubicin for Prophylaxis in the Management of Recurrent Superficial Bladder Carcinoma

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Abstract
Intermittent intravesical doxorubicin chemotherapy was given to 27 patients with multiple recurrent superficial transitional cell carcinoma of the bladder, including 12 who had become refractory to intravesical thiotepa. The starting dose was 60 mg. doxorubicin diluted in 40-50 ml normal saline solution and doses were increased to 90 mg. The duration of instillation was 60 min. Treatments were administered every 3 wk for a total of 8 doses, then every 6 wk for 2 doses and then every 12 wk for 2 doses. Therapy then ended for patients who were rendered free of disease. Cystoscopy and urinary cytology studies were performed every 3 mo. throughout the study. Of the patients 30% had intermittent episodes of dysuria, 26% had urinary frequency, 41% had hematuria and 15% had bladder spasms. None of these toxicities required discontinuation of the drug. Analysis of plasma samples for doxorubicin and metabolites revealed no systemic absorption and there was no myelosuppression. Of the 27 patients 15 (56%) have maintained complete eradication of bladder cancer without any evidence of residual carcinoma detected endoscopically or with urinary cytology. Recurrent disease developed in 9 patients (33%) while on therapy, including 3 with muscle invasion. Cystoscopy has remained grossly negative in 3 patients who have had positive class 5 cytology studies. The median duration of followup in all patients was 12 mo. with a range of 6-24 mo. Intravesical doxorubicin is tolerated well and is effective in the management of multiple recurrent superficial transitional cell carcinoma of the bladder.