ABSTRACT
History The instillation of a chemotherapeutic drug immediately after transurethral resection (TUR) is an old idea that was tested in the 1970s,1,2 when thiotepa was used. Later, adriamycin and epodyl were also evaluated.3,4 These first nonrandomized clinical trials suggested a reduction in the rate of tumor recurrence when a perioperative instillation was given. After these preliminary results, the need for properly conducted, large scale, randomized controlled studies became evident. The first important study of this kind came from the British Medical Research Council. Four hundred and seventeen patients with newly diagnosed superficial bladder tumors were treated with a complete TUR and then randomized into one of three groups.5 Groups 1 and 2 received an instillation of 30 mg thiotepa at the time of TUR; thereafter patients in group 2 also received instillations of thiotepa every 3 months for a year, and group 3 was a control group that received no instillations at all. Neither the first publication of the MRC in 1985,5 nor the second publication of the results in 19946 with a longer follow-up was able to show any differences in the recurrence rate in the three groups. However, subsequent randomized studies7-14 have shown impressive improvements in the recurrence-free rate.
