Chemohyperthermia in non-muscle-invasive bladder cancer: An overview of the literature and recommendations

Abstract

Non-muscle-invasive bladder cancer (NMIBC) is characterised by a high risk of recurrence for the present standard treatment of transurethral resection of the bladder (TURB) followed by intravesical instillation of Mitomycin-C (MMC) or bacillus Calmette-Gu erin (BCG). To decrease this high recurrence rate, alternative treatments are studied. Intravesical MMC combined with hyperthermia could be an interesting alternative active treatment for intermediate-and high-risk NMIBC, and has been investigated in the past years. Hyperthermia, raising tumour temperatures to 40-44 C, can be achieved with several hyperthermia systems, based on three different techniques: 1) intravesical microwave induced heating, 2) conductive heating, and 3) loco-regional, using external radiofrequency antennas. In this review an overview is given of the available hyperthermia systems and the reported outcomes. Future directions are discussed. Optimal implementation of a combined regimen of MMC and hyperthermia requires further clinical trials to identify patients who will benefit most from this treatment, to optimise treatment schedules and to compare the efficacy of different hyperthermia devices. ARTICLE HISTORY

Intravesical Radiofrequency-Induced Chemohyperthermia for Carcinoma in Situ of the Urinary Bladder: A Retrospective Multicentre Study

“…Alternative bladder-sparing therapies to replace BCG immunotherapy are being investigated [ 16 ]. An effective option is to combine intravesical chemotherapy with mild hyperthermia of the bladder mucosa [ 17, 18 ]. A recent randomized clinical trial evaluated the efficacy of intravesical radiofrequency-induced chemohyperthermia (RF-CHT) vs. BCG immunotherapy in intermediate-high risk NMIBC patients, showing a 2-year recurrence free survival (RFS) rate of 81.8% and 64.8%, respectively, and a progression rate of <2% in both groups [ 19 ].…”

Intravesical radiofrequency induced hyperthermia enhances mitomycin C accumulation in tumour tissue

“…A promising and effective alternative treatment appears to be intravesical radiofrequency-induced chemohyperthermia (RF-CHT), typically combining MMC with hyperthermia of the bladder wall [9,10]. It compares favourably to standard MMC instillations, with recurrence rates of 28% vs. 68% [9][10][11]. In a meta-analysis based on four studies, the overall risk ratio of RF-CHT was 0.41, indicating 59% less recurrences after RF-CHT when compared to cold MMC alone [9].…”

Device-assisted intravesical therapy for non-muscle invasive bladder cancer

“…Other hyperthermia systems are based on conductive (COMBAT BRS ® , Combat Medical, Wheathampstead, UK, and Unithermia ® , Elmedical, Hod-Hasharon, Israel) or loco-regional heating (BSD-2000 ® , BSD Medical, Salt Lake City, UT, and AMC 70 MHz, Academic Medical Centre, Amsterdam, the Netherlands) of intravesical chemotherapy (24). Little is known about the results of these techniques, and this should be communicated with the NMIBC patients for whom this kind of CHT is used.…”