The Outcome of Induction Only Versus Induction and Maintenance With A Low Dose Intravesical BCG Therapy For High-Grade NMIBC

Background: According to standard guidelines, high-risk NMIBC (Non-Muscle Invasive Bladder Cancer) is treated by TUR (Transurethral resection) followed by intravesical immunotherapy(BCG). Induction followed by maintenance is recommended for achieving maximum delay of tumor recurrence and progression. Objective: This study aimed to find the outcome of induction only vs induction and maintenance, considering recurrence and progression of the disease. Materials and Methods: This experimental study was conducted in BSMMU from June 2018 to December 2020 among the histologically proved high-risk NMIBC (Ta, T1, and/ Tis) patients. Patients were allocated in two groups. In one arm BCG induction only and another arm induction and maintenance were implemented. Patients were followed up upto 2 years period. Disease recurrence and progression along with different local and systemic adverse effects were recorded add analyzed. Results: Total 30 patients were allocated in 2 groups.14 patients in induction only arm and 16 in induction and maintenance arm. Upto 24 months follow upoverall disease recurrence was 23.3% and disease progression was found in 10 % of patients. 28.5% of the induction-only arm and 18.75% patients of induction and maintenance arm developed recurrence. Whereas 7.14% of the induction-only arm and 12.5% of other arm patients developed disease progression. Both were statically insignificant (p 0.198). Conclusion: For high-risk NMIBC inductiononly BCG therapy is not inferior to induction and maintenance therapy in terms of recurrence and progression, rather it has relatively fewer adverse effects.