PURPOSE: The effect of repeated 6 week courses of intravesical BCG therapy after early failure of the first induction course is well known, but few studies have evaluated the effect of repeat BCG therapy for transitional cell carcinoma (TCC) achieving a complete response (CR) with initial BCG therapy. We evaluated the results of additional BCG therapy for TCC recurring after a CR to the initial treatment course of BCG.
MATERIALS AND METHODS: All of 129 patients treated with BCO with minimum follow-up of 2 years were reviewed to identify complete responders who subsequently recurred and received additional BCG therapy. The duration of initial response and the incidence and duration of a secondary CR were recorded.
RESULTS: Of 129 patients treated with BCG, 82 patients had a CR to the initial treatment of BCG. Sixteen of the 82 patients who had a CR to the initial treatment of BCG and had recurred were subsequently retreated with BCG. Ten of 16 patients receiving a second course of BCG achieved a second CR. Of 6 patients who had a second recurrence after second course of BCG, 2 received third course of BCG and 4 intravesical mitomycin-C therapy. One of 2 patients receiving a third course of BCG had a third CR and 1 proceeded to cystectomy for disease progression. Two of 4 patients receiving intravesical mitomycin-C therapy had a CR and 2 had a third recurrence. One of 2 patients who had a third recurrence received intravesical mitomycin-C therapy and 1 third course of BCG, then they achieved CR after therapy.
CONCLUSIONS: A repeat course of BCG is a reasonable option of therapy for transitional cell carcinoma that has recurred after a CR to a prior course of BCG. But careful monitoring by cytology, cystoscopy and biopsy is mandatory to continue disease free status after additional BCG.
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