76-year-old man with a history of non-muscle invasive bladder cancer (5-cm mass) diagnosed 2015. Due to the size of the mass, he underwent concurrent chemo-radiation with cisplatin and 64.8 Gy, completed 2016. He has since had cystoscopies that have found atypia in cells, but most recently had a carcinoma in situ lesion (Tis). Urology is planning on administering intravesicular BCG as the patient does not want to undergo cystectomy. Is there any contraindication to BCG administration with a history of bladder radiation? In addition, is there thought in regard to efficacy of BCG in bladder tissue that has been radiated?
I am not aware of a contraindication to BCG administration in patients with such a remote history of bladder radiation. Recent/concurrent bladder radiation would be a contraindication, but this patient completed RT 7 years ago. Because chemoRT/RT is not a standard treatment for non-muscle invasive bladder cancer, there is little data to address your specific question about efficacy of BCG in previously irradiated bladder tissue. There are some small retrospective series looking at prior prostate RT (presumably bladder received some radiation dosage), and there did not seem to be a significant effect. Again, limited data with the caveat that these were very small series and retrospective in nature: https://pubmed.ncbi.nlm.nih.gov/35798647/; https://pubmed.ncbi.nlm.nih.gov/21868262/.
