Combined Chemohyperthermia: 10-Year Single Center Experience in 160 Patients with Nonmuscle Invasive Bladder Cancer

Arends, T.J.H.; Heijden, Antoine G. van der; Witjes, J. Alfred

doi:10.1016/j.juro.2014.03.101

Cited by 58 publications

(49 citation statements)

References 17 publications

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“…6 Even though new treatments have been reported, more results and larger studies are needed. 6,12,[14][15][16] Colombo and colleagues found that C-HT is more effective than MMC alone. 17 The 10-year disease-free survival rate for C-HT and MMC alone were 53% and 15%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Intravesical bacillus Calmette-Guérin versus chemohyperthermia for high-risk non-muscle-invasive bladder cancer

Ekin¹,

Akarken

Zorlu³

et al. 2015

CUAJ

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Introduction: Patients with high-risk non-muscle invasive bladder cancer (NMIBC) need adjuvant intravesical treatment after surgery. Although bacillus Calmette-Guérin (BCG) is highly effective, new adjuvant treatments to decrease recurrences and toxicity have been studies. We performed a retrospective propensity score-matched study to compare the efficacy of BCG and chemohyperthermia (C-HT). Methods: We included 1937 patients diagnosed with bladder cancer between January 2004 and January 2014. The primary efficacy endpoint was recurrence-free interval. Patients treated with C-HT were matched with patients treated with BCG using propensity score-matched analysis. Cox-regression models were used to estimate the association between intravesical treatments and the presence of recurrence and progression. Results: Of the 710 patients treated with intravesical treatments, 40 and 142 were eligible for inclusion in C-HT and BCG groups, respectively. Following case matching, there were no differences in patient or tumour characteristics between treatment groups. The 2-year recurrence-free interval in C-HT and BCG groups were 76.2% and 93.9%, respectively (p = 0.020). C-HT treatment (hazard ratio [HR] 5.42; 95% confidence interval [CI] 1.11-26.43; p = 0.036) and high-grade tumour (HR 4.60; 95% CI 1.01-20.88; p = 0.048) are associated with an elevated odds of tumour recurrence. In multivariate Cox-regression analysis, there was no significant difference between C-HT and BCG in the odds of recurrence (p = 0.054). There were no differences in progression between C-HT and BCG. Conclusion: C-HT is not as effective treatment as BCG in high-risk NMIBC patients who are BCG-naive. Although, there were no significant difference in the odds of recurrence, recurrence-free interval is significantly improved by the administration of BCG.

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Section: Discussionmentioning

confidence: 99%

Intravesical bacillus Calmette-Guérin versus chemohyperthermia for high-risk non-muscle-invasive bladder cancer

Ekin¹,

Akarken

Zorlu³

et al. 2015

CUAJ

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“…RF-potentiation is not restricted to MMC alone, but also to other anti-neoplastic agents such as epirubicin [71]. As mentioned earlier [66], the statistically significant superiority of RITE over BCG could possibly lead to a paradigm shift in the treatment of NMIBC, as no treatment was found comparable to the BCG gold standard for 40 years.…”

Section: Rf Applications In the Futurementioning

confidence: 96%

“…This technique also minimizes the inter-patient variability and increases patients' tolerability, and has been used throughout the years with RITE [54][55][56][66][67][68][69][70][71].…”

Section: Pharmacokinetics In Rite and "Dose Splitting"mentioning

confidence: 99%

Intravesical Chemotherapy and Chemohyperthermia in Non-Muscle-Invasive Bladder Cancer; An Overview on Drug Administration Technologies and Pharmacokinetics

Campodonico

Stasi

Lev³

et al. 2017

CDM

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Background: Tumor recurrence is the most expected clinical event after the resection of non-muscle invasive bladder cancer, depending on histological findings of the initial lesion. In patients with low and intermediate risk of disease, the intravesical instillation of chemotherapy agents is recommended as a standard treatment to reduce recurrences. Methods:A comprehensive review covering various aspects of different treatments with intravesical drugs is presented.Results: Drugs may be instilled into the bladder starting with a single, 'early' postoperative administration or, after tumor resection with adjuvant intent or, before tumor resection under a neo-adjuvant regimen. Both latter protocols would consist of weekly treatments followed by monthly maintenance treatments. Different methods of administering drugs intravesically have been proposed to enhance the depth of drug penetration and its absorption into the bladder wall thus increasing the rate of drug-DNA reaction. These device-assisted therapies therefore have set a goal to potentiate the drug's effect and efficaciousness. The Radiofrequency-Induced Thermochemotherapeutic Effect (RITE) and the Electromotive-Drug Administration (EMDA) are the two most relevant modalities used to increase the activity of intravesical chemotherapy. Despite the widely adopted international guidelines' recommendations, and recent clinical trials of device-assisted chemotherapy instillations showing markedly enhanced recurrence-free survival compared even to the standard of care, clinicians and pharmacologists are not familiar with the in-depth physical aspects, pharmacokinetics and systemic absorption of chemotherapeutic drugs following their intravesical administration. Conclusion:Knowledge of drug diffusion mechanisms into the tissue and cellular cytoplasm following bladder instillation is a key to understand the safety profile and clinical activity of chemotherapy.

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“…Progression to muscle-invasive bladder cancer occurred in three patients, all treated within the ablative protocol. Arends et al evaluated the efficacy of CHT in 160 patients with NMIBC, refractory to intravesical treatment (MMC, epirubicin, BCG) [29]. Patients were treated with either a prophylactic or an ablative protocol.…”

Section: Post Previous Intravesical Treatmentmentioning

confidence: 99%

“…Posterior wall thermal reaction, a phenomenon typically seen on cystoscopy after microwave-induced CHT, is caused by the location of the RF antenna. It appears as a medallion-shaped discoloured scar-like patch, which in general resolves spontaneously and is not associated with symptoms [9][10][11]21,[23][24][25][26][27][28][29][30].…”

Section: Synergomentioning

confidence: 99%

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

Liem

Crezee

Rosette

et al. 2016

International Journal of Hyperthermia

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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

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Combined Chemohyperthermia: 10-Year Single Center Experience in 160 Patients with Nonmuscle Invasive Bladder Cancer

Cited by 58 publications

References 17 publications

Intravesical bacillus Calmette-Guérin versus chemohyperthermia for high-risk non-muscle-invasive bladder cancer

Intravesical bacillus Calmette-Guérin versus chemohyperthermia for high-risk non-muscle-invasive bladder cancer

Intravesical Chemotherapy and Chemohyperthermia in Non-Muscle-Invasive Bladder Cancer; An Overview on Drug Administration Technologies and Pharmacokinetics

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

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