Maintenance bacillus Calmette-Guérin therapy prolongs recurrence-free survival in non-muscle-invasive bladder cancer: AREAL-world experience

Objective: We studied the benefit of bacillus Calmette-Guérin (BCG) maintenance therapy to determine the ideal maintenance therapy schedule. Methods: We retrospectively reviewed non-muscle-invasive bladder cancer patients who underwent transurethral resection of bladder tumors and BCG instillation treatment at Chang-Gung Memorial Hospital, Linkou, Taiwan, from January 1997 to December 2009. All patients in the study had non-muscle-invasive urothelial carcinoma of the bladder or carcinoma in situ. We compared the recurrence-free rate of patients who received induction alone and with maintenance BCG therapy sessions. In addition, we analyzed the best number of maintenance therapy sessions that gave the lowest cancer recurrence. Results: This study included 427 patients with a mean age of 64 years. The median number of BCG treatments was 11, and the ratio of male to female was 3:1. Receiving an induction dose alone was a significant factor for tumor recurrence with a hazard ratio of 3.77. The recurrent risk rate of patient who received BCG therapy 13-15 times had lower recurrence rate than other groups. Conclusion: A maintenance dose gave patients a significant benefit over those who just received induction therapy. BCG maintenance therapy worked best if given 13-15 times in our study.