Cystectomy outcomes in patients who have failed Radiofrequency-induced Thermo-chemotherapeutic Effect Mitomycin-C (RITE-MMC) treatment for high-risk non-muscle invasive bladder cancer (HRNMIBC)–Does it complicate surgery and adversely impact oncological outcome?

Sri, Denosshan; Lee, Hack Jae; El-Gemmal, Sarah; Backhouse, C. M.; Tay, Andrea; John, Babbin; Perry, Matthew; Ayres, B.; Issa, Rami

doi:10.1016/j.urolonc.2020.09.016

Cited by 5 publications

(4 citation statements)

References 10 publications

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“…Though BCG is recommended as the most effective first-line intravesical therapy in NMIBC, up to 40%-50% of patients will eventually recur after BCG, with the recommended radical cystectomy, which may, however, represent an overtreatment, especially for those patients with non-high-grade BCG failure (58). Furthermore, Sri et al (59) found that HIVEC with MMC steered clear of a technically more challenging cystectomy or a compromise on the oncological outcome compared to those patients undergoing cystectomy immediately post-BCG failure. For patients with BCG unresponsive disease, we suggest HIVEC as a feasible treatment.…”

Section: Discussionmentioning

confidence: 99%

Hyperthermia intravesical chemotherapy acts as a promising alternative to bacillus Calmette–Guérin instillation in non-muscle-invasive bladder cancer: a network meta-analysis

Zeng

Sun

et al. 2023

Front. Oncol.

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IntroductionWith the shortage of bacillus Calmette–Guérin (BCG) vaccine, it is important to find an alternative to BCG instillation, which is the most commonly used adjuvant treatment for non-muscle-invasive bladder cancer (NMIBC) patients after transurethral resection of bladder tumor treatment (TURBt) to delay tumor recurrence. Hyperthermia intravesical chemotherapy (HIVEC) with mitomycin C (MMC) is a potential treatment choice. We aim to compare HIVEC with BCG instillation for the preventive efficacy of bladder tumor recurrence and progression.MethodsA network meta-analysis (NMA) was taken with MMC instillation and TURBt as the attached comparators. Randomized controlled trials (RCTs) with NIMBC patients after TURBt were included. Articles with pure BCG unresponsive patients and combined therapies were excluded. The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO, CRD42023390363).ResultsIt was found that HIVEC had a non-significant 22% relative reduction in bladder tumor recurrence compared with BCG instillation [HIVEC vs. BCG: HR 0.78, 95% credible interval (CrI) 0.55–1.08] and a nonsignificant higher risk of bladder tumor progression (BCG vs. HIVEC: HR 0.77, 95% CrI 0.22–3.03).DiscussionHIVEC is a potential alternative to BCG, and it is expected to be the standard therapy for NMIBC patients after TURBt during the global shortage of BCG.Systematic Review RegistrationPROSPERO identifier, CRD42023390363

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Section: Discussionmentioning

confidence: 99%

Hyperthermia intravesical chemotherapy acts as a promising alternative to bacillus Calmette–Guérin instillation in non-muscle-invasive bladder cancer: a network meta-analysis

Zeng

Sun

et al. 2023

Front. Oncol.

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“…In our series 80 patients (29.2%) underwent radical cystectomy after a mean follow up of 55.5 months. A recent study published by Sri et al focused on operative challenges and oncological outcome in high risk, BCG refractory NMIBC patients undergoing radical cystectomy after RF-CHT, compared to a comparable group of patients who received radical cystectomy immediately after BCG failure [32]. After a mean follow up of 24 months, 36 out of 138 patients (26%) underwent radical cystectomy.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Experience with Radiofrequency-Induced Hyperthermia Combined with Intravesical Chemotherapy for Non-Muscle Invasive Bladder Cancer

Brummelhuis

Wimper

et al. 2021

Cancers

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Background: The recurrence rate of non-muscle invasive bladder cancer (NMIBC) is high, despite intravesical treatments. Importantly, patients are frequently unfit or unwilling to undergo a recommended radical cystectomy when standard intravesical treatments fail, due to the substantial risk of morbidity and mortality. For these patients, radiofrequency-induced hyperthermia combined with intravesical chemotherapy (RF-CHT) has shown promising results. We aim to determine treatment outcomes and assess the effect of (ablative) dose. Methods: 299 intensively pretreated patients treated with RF-CHT were included in safety analysis. Of these, 274 patients who fulfilled induction treatments were included in efficacy analysis. Six-month complete response (CR) and durable response were reported for (concomitant) carcinoma in situ (CIS) patients and recurrence-free survival (RFS) for papillary patients. Results: For CIS, six-month CR-rate was 56.0%; and durable response rates were 79.7%, 66.5%, and 40.3% at one-, two- and five-year, respectively. RFS rates for papillary patients were 77.9%, 57.5%, and 37.2%, respectively. Patients treated with ablative dose are less likely to develop recurrence (adjusted Hazard Ratio 0.54, p = 0.01), compared to adjuvant dose. Conclusions: RF-CHT is effective in NMIBC patients in whom standard intravesical treatments have failed and should be considered in patients who are unwilling or unfit to undergo radical cystectomy. Patients with CIS or residual papillary tumor at baseline benefit from ablative dose.

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“…Radiofrequency-induced thermo-chemotherapeutic effect (RITE) has been developed to improve intravesical chemotherapy, especially for BCG-unresponsive NMIBC [ 104 , 105 ]. The minitype antenna in the catheter with radiofrequency at 915 MHz is directed at the bladder wall.…”

Section: Physical Methods To Get Drugs Across Bladder Penetrating mentioning

confidence: 99%

Strategies to Get Drugs across Bladder Penetrating Barriers for Improving Bladder Cancer Therapy

et al. 2021

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Bladder cancer is a significant public health concern and social burden due to its high recurrence risk. Intravesical drug instillation is the primary therapy for bladder cancer to prevent recurrence. However, the intravesical drug therapeutic effect is limited by bladder penetrating barriers. The inadequate intravesical treatment might cause the low drug concentration in lesions, resulting in a high recurrence/progression rate of bladder cancer. Many strategies to get drugs across bladder penetrating barriers have been developed to improve intravesical treatment, including physical and chemical methods. This review summarizes the classical and updated literature and presents insights into great therapeutic potential strategies to overcome bladder penetrating barriers for improving the intravesical treatment of bladder cancer.

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Cystectomy outcomes in patients who have failed Radiofrequency-induced Thermo-chemotherapeutic Effect Mitomycin-C (RITE-MMC) treatment for high-risk non-muscle invasive bladder cancer (HRNMIBC)–Does it complicate surgery and adversely impact oncological outcome?

Cited by 5 publications

References 10 publications

Hyperthermia intravesical chemotherapy acts as a promising alternative to bacillus Calmette–Guérin instillation in non-muscle-invasive bladder cancer: a network meta-analysis

Hyperthermia intravesical chemotherapy acts as a promising alternative to bacillus Calmette–Guérin instillation in non-muscle-invasive bladder cancer: a network meta-analysis

Long-Term Experience with Radiofrequency-Induced Hyperthermia Combined with Intravesical Chemotherapy for Non-Muscle Invasive Bladder Cancer

Strategies to Get Drugs across Bladder Penetrating Barriers for Improving Bladder Cancer Therapy

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