The Role of Thiotepa Instillations in Bladder Cancer

An encouraging form of chemotherapy in bladder carcinoma has been the use of thiotepa, topically instilled by urethral catheter directly into the bladder for the treatment of multiple, well-differentiated, superficial, papillary bladder tumors.²¹The urinary bladder lends itself well to the use of topical therapy, and a high local concentration of the drug can be obtained with minimal general toxicity. In the past, such agents as podophyllum extract, phenol, and glycerin were used with a measure of success. It is well-recognized that bladder tumors are multifocal in origin, frequently recur, and readily "seed." Studies by Melicow²²have shown microscopic evidence of numerous "subcistoscopic" tumors interspersed between the cystoscopically recognized tumors. This accounts in part for the great tendency of lesions to recur and demonstrates the futility of relying alone on endoscopic resection or fulguration of visible tumors to control the neoplasm. The use of a cytotoxic agent instilled