A total of 85 cases treated by intravesical administration of adriamycin (ADM) at Okayama University and other cooperating institutions were examined. Instillation of 50 mg adriamycin dissolved in 30 ml physiological saline was performed in two courses of 3 consecutive days, with a 4-day interval between the courses. The response rate was 70.6%. Following instillation therapy transurethral resection (TUR) was carried out in 69 cases (80%), segmental cystectomy in 7, and total cystectomy in 3. The follow-up period averaged 42 months, during which the recurrence rate was 57%; recurrence occurred within 18 months in 80% of these cases. Since the recurrence per patient-month x 100 was 3.348, the precise effect of intravesical chemotherapy in the prevention of recurrence was unclear. There were 9 cases of advanced disease (11% of the total, 18% of cases with recurrence). One patient with CIS (flat invasive tumor) seemingly achieved CR, but died 43 months after treatment due to metastatic disease. While this method is not always indicated in cases of CIS (flat invasive tumor), in cases in which it is indicated a drug causing only limited stimulation of the bladder mucosa should be used and long-term follow-up is essential.