Intravesical instillation of mitomycin C in 242 patients with superficial bladder cancer at high risk of recurrence: Long-term results

Purpose: The aim of the present study was to evaluate the long-term efficacy of intravesical mitomycin C (MMC) instillation after transurethral resection (TUR) in 242 consecutive patients with superficial bladder cancer at high risk of recurrence. Mat, and Meth.: A total of 242 patients with multiple primary or recurrent Ta-Tl bladder cancer (except Cis and T1 G3 tumor) were treated with weekly instillations of 40 mg. MMC for 8 weeks after TUR for bladder cancer. Tumor-free patients followed a maintenance course with monthly instillations for 3 months. Results: Mean follow-up of disease-free patients has been 49.5 (range 23 to 112) months. The incidence of first recurrence has been 59.5 % (144/242 patients) with a median time to first recurrence of 29 months; 95 patients (39.3%) remained disease-free; 3 had disease progression as a first event (1,2%). The risk of disease recurrence was significantly greater for multifocal tumors (p= 0.0002). Overall, patients have been followed for a mean time of 57 (range 10-114) months. During this period the recurrence rate has been 4.9. Another eleven patients had disease progression and progression rate has been 5.8% (14/242), with a mean time to progression of 34 months. Presently 209 patients are alive, 6 died of bladder cancer, 16 died of causes unrelated to the disease specific mortality 2.5% and non-disease specific mortality 6.6%. Conclusions: Our data suggest that intravesical adjuvant MMC in patients at high risk of recurrence is effective in short-term recurrences. Though it does not seem to give a benefit in the incidence of long-term recurrences a possible effectiveness has been detected in disease progression.