Intravesical Adriamycin Chemotherapy in Bladder Cancer

In an experimental study undertaken to elucidate the mechanism whereby Adriamycin (ADM) instilled into the bladder produces its side-effects, the time course of ADM concentration in blood, urine, and tissues of various organs, and also histopathological changes in the bladder mucosa were investigated in normal adult dogs that had undergone bilateral ureterostomy and then received intravesically instilled ADM. Clinically, ADM was used in the treatment of superficial bladder tumors in an attempt to facilitate the transurethral operative procedure. A total of 261 patients were included in this trial. ADM was instilled into the bladder at the following dosages: 1,000 micrograms/ml (30 mg ADM per 30 ml physiological saline), 1,600 micrograms/ml (50 mg ADM per 30 ml physiological saline), and 2,000 micrograms/ml (60 mg ADM per 30 ml physiological saline). The rate of effectiveness was 32%, 66%, and 60%, respectively. The incidence of side-effects was 29%, 20%, and 45%, respectively. The systemic uptake of the drug was small and the side-effects were pain an micturition, pollakiuria, and urgency. From the aspects of efficacy and toxicity, 1,600 micrograms/ml was found to be the optimal dosage.