Wu Jiangtao | Postoperative perfusion chemotherapy for bladder cancer12015-08-18 Wu Jiangtao Department of Urology, Xuanwu Hospital Jia Chunsong, Department of Urology, Xuanwu Hospital, Capital Medical University 1. Need for postoperative perfusion chemotherapy for bladder cancer Bladder cancer is the most common urological tumor, of which 70%-80% is superficial bladder cancer. Transurethral resection of bladder tumor (TUR-BT), is the treatment of choice for superficial bladder cancer. 10%-67% of patients will recur within 12 months after TUR-BT and 24%-84% within 5 years after surgery, and 10%-30% of recurrences are accompanied by increased malignancy or progression to the invasive type. There are two peak periods of recurrence after TUR-BT for non-muscle invasive bladder cancer, 3-6 months and 1.5 years postoperatively. The reasons for recurrence include: persistent exposure of bladder mucosal epithelium to carcinogenic substances; biology of bladder tumors with multicentric growth; and residual tumor due to incomplete surgical excision of the lesion. The first peak of postoperative recurrence is associated with intraoperative tumor cell dissemination. Postoperative perfusion therapy can greatly reduce the recurrence caused by tumor dissemination. Therefore, it is clinically important to enhance postoperative intravesical drug infusion to reduce and delay tumor recurrence and prevent tumor infiltration to improve patient survival and quality of life.2. There are two main types of drugs commonly used for postoperative bladder cancer infusion: 1) immune enhancers: such as BCG, interleukin II, interferon, etc. Action: mobilize autologous leukocyte aggregation to produce factors that kill cancer cells. BCG, which has been used for a long time for bladder tumor perfusion therapy, is currently used as the first choice of treatment for high-risk patients in all national treatment guidelines. Currently, BCG vaccine has just been released in China, and the access and cost of the drug have limited its widespread use. BCG is a more effective treatment than ordinary chemotherapy drugs, but it is not suitable for low- and intermediate-risk patients, because BCG treatment has a lot of side effects, which can cause strong urinary frequency and urgency and even high fever, and the efficacy is not better than general bladder chemotherapy drugs for low- and intermediate-risk patients, but for high-risk patients, the efficacy of BCG is still recognized worldwide. The infusion regimen of BCG is usually started two weeks after surgery, and the first phase is once a week for six consecutive weeks for the induction period; after that, the maintenance period is followed by a round of treatment every three months, and the treatment is once a week for three consecutive weeks of infusion, and such a round is repeated every three months for two to three years. 2) Chemotherapeutic drugs: such as epirubicin, pirarubicin, mitomycin, gemcitabine, etc. Action: Block the synthesis of cellular DNA so that cancer cells cannot proliferate and die.