LAUSR

Abstract Background and objective Intravesical Bacillus Calmette-Guerin (BCG) is essential for preventing recurrence and progression of Non-muscle invasive bladder cancer (NMIBC). The aim of our study was to compare the efficacy and toxicity of the Connaught and Tice strains, as well as the importance of the maintenance schedule. Material and methods We retrospectively reviewed 110 patients with NMIBC who underwent adjuvant endovesical treatment. The patients were distributed into 3 groups, based on whether the treatment was with the Connaught strain, the Tice strain or both sequentially. We calculated the recurrence-free survival rate in each group and compared the patients who completed the maintenance treatments against those who did not. To identify the predictors of recurrence, we performed a multivariate analysis. We also assessed the toxicity by analyzing the onset of BCGitis, urinary urgency, fever, urinary tract infection and treatment withdrawal due to adverse effects. Results We found no differences in the efficacy parameters. The patients in the Connaught group completed the maintenance to a lesser extent (38.4 vs. 72% for the Tice group and 76.3% for both strains group; p  = 0.010). The patients who completed the maintenance had better recurrence-free survival at 60 months (88.5 vs. 74.2%; p  = 0.036), regardless of the strain used. The following risk factors of recurrence were identified by multivariate analysis: size larger than 3 cm, more than 3 implants and not completing the manteinance. Patients under therapy with Connaught strain had a higher rate of BCGitis, with no differences in the other events studied. Conclusion Completing the maintenance phase is essential, regardless of the strain employed. The Connaught strain has a greater risk of BCGitis, and a sequential regimen could be useful in certain scenarios.