Bacillus Calmette-Guérain (BCG) is the most potent intravesical agent but other intravesical agents are necessary for patients who have failed BCG or who are intolerant to the side effects of BCG. Many chemotherapeutic agents such as thiotepa, mitomycin C, doxorubicin, epirubicin and Gemcitabine are available. Intravesical chemotherapy reduces risk of recurrence, but does not appear to delay progression to muscle invasive cancer. Therefore, it is best indicated in moderate risk patients. Differences of efficacy in risk of recurrence and progression are not significant between agents. Side effects are usually mild and self-limited, but extravasation of chemotherapeutic agent can lead to severe inflammation and necrosis. Novel methods of drug administration such as local microwave-induced hyperthermia and electromotive drug administration are introduced to improve suboptimal effect of intravesical chemotherapy. Some studies showed promising results of these methods with lower recurrence and lower progression rates compared to intravesical chemotherapy alone.
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