Combination radiotherapy of urinary bladder carcinoma with chemohyperthermia

Abstract

The combination therapy of urinary bladder cancer with radiation and hyperthermia with bleomycin was investigated. Immediately following daily external irradiation (40 Gy/4 weeks), patients were irrigated with a solution of warmed saline (intravesical temperature, 42-43 degrees C) containing 30 micrograms/ml bleomycin. Of a total of 56 patients, complete responses were observed in 25, and partial responses in 21. Among T2-T3 cases, an 84% response rate was noted in combination therapy, whereas a 56% response rate was observed after radiation alone (50-70 Gy). The side-effects of the combination therapy were limited to reversible bladder irritation, and bladder capacity could be maintained within normal limits. These results suggest that combination therapy represents an effective conservative therapy for the management of bladder cancer.

Integrating Hyperthermia into Modern Radiation Oncology: What Evidence Is Necessary?

“…HT was delivered by intravesical infusion of warmed saline solution containing bleomycin. The RTHT group had a higher response rates (RTHT: 84%, RT: 56%, p  < 0.001) with decreased toxicity rates (less bladder capacity reduction) (99). In a different approach, 49 patients with nodal-negative disease of all T stages were treated with a hypofractionated RT scheme (24 Gy, 4 Gy/fraction) with or without HT.…”

Is hyperthermia combined with radiotherapy adequate in elderly patients with muscle-invasive bladder cancers? Thermo-radiobiological implications from an audit of initial results

“…The RT dose was 40 Gy delivered at 4 Gy/fraction, twice weekly with Adriamycin, 5-fluorouracil and cisplatin chemotherapy. Matsui et al [19] reported a triple modality treatment in all stages of bladder cancers using RT (40 Gy/4 weeks) and daily hyperthermic irrigation of the bladder with bleomycin following RT. Of the 56 patients, 25 achieved CR.…”

“…It has been shown to be effective for non-muscle-invasive bladder cancers when applied intravesically with instillation of CT agents, such as, mitomycin C [14,15]. In MIBC, HT has been used with radiotherapy (RT) alone either as a preoperative or definitive treatment [16,17], or with CTRT, both resulting in positive outcomes [18][19][20]. Thermal radiosensitisation has been primarily attributed to reoxygenation, selective killing of radioresistant hypoxic tumour cells, and inhibition of repair of radiation-induced DNA damage [13].…”

Hyperthermia and radiotherapy in bladder cancer

“…Several Japanese institutions have published their experiences with thermoradiotherapy in bladder cancer from the late 1970s through the early 1990s. Matsui et al described a Yokohama City University series in 1991 [55]. Fifty-six patients were included in this report.…”