Intravesical Chemohyperthermia for NMIBC: Rationale and Results of This Developing Treatment

Abstract

Bladder cancer is the fourth most common cancer in men, and the lifetime risk of getting bladder cancer is 2.4%. Approximately 75% of newly diagnosed cases of bladder cancer are non-muscle-invasive bladder cancer (NMIBC), and half of them will show recurrence and/or progression after transurethral resection. Therefore, after transurethral resection, in high-risk patients, intravesical therapy is mandatory. However, bacillus CalmetteGuérin (BCG) is associated with important side effects such as systemic tuberculosis and bladder retraction. Chemohyperthermia (CHT) has shown a 60% lower recurrence rate than standard mitomycin C (MMC). However, its effectiveness in high-risk patients, especially CIS and BCG refractory patients, is even more important. CHT will probably be an option for patients unsuitable for radical cystectomy or those on whom BCG can't be used. Two main technologies are currently available for intravesical CHT: microwaves and recirculating heated fluids. Both of them have pros and cons that should be known and evaluated by a urologist. In this chapter, we will speak about rationale, technical options, clinical results, ongoing studies, and future perspective for this interesting treatment option for intermediate and high-risk patients with NMIBC.Keywords: NMIBC, MMC, BCG, chemohyperthermia, radio frequency, recirculant systems, adjuvant, neoadjuvant BackgroundIn 2002, the world-adjusted incidence rate of bladder cancer was 33 new cases/100,000 inhabitants/year. That makes it the fourth tumor with the highest incidence in men, after lung, prostate, and colorectal cancers [1].© 2017 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Each body tumor has unique characteristics in terms of its presentation, histological types, surgical approaches, and sensitivity to different types of treatment (surgery, chemotherapy,Approximately, 95% of bladder neoplasms are urothelial carcinomas, and 75% of them will be diagnosed as non-muscle-invasive tumors. However, they have a high tendency to recur, and one-third of them will reappear during the first 5 years after transurethral resection. Incidence of recurrence and progression is directly related to the tumoral grade and stage, being higher in carcinoma in situ and T1G3 tumors.Most recidives have similar grade and stage to the original tumor. However, a significant number of bladder cancers progress to invasive tumors whose prognosis and treatment are completely different. Therefore, intravesical postoperative therapy is mandatory, especially in those with medium and high-risk tumors.The urethra allows ease of access from the outside, which generally allows a resection of the tumor and the application of chemo-and/or immunotherapy locally with minimal systemic toxicity.Intravesical chemotherapy, with single postoperat...

<p>Humanistic and Economic Burden of Non-Muscle Invasive Bladder Cancer: Results of Two Systematic Literature Reviews</p>

“… 121 , 123 , 124 It involves the intravesical application of heated chemotherapy to the bladder through use of microwaves to heat the local bladder environment or through circulation of heated fluids (hyperthermic intravesical chemotherapy [HIVEC]). 121 , 122 , 125 , 126 In a meta-analysis of 12 studies, intravesical chemothermotherapy was associated with a significantly decreased risk of disease recurrence compared with normal-temperature chemotherapy after 2 years, with no difference in the rate of AEs. 125 However, AEs of hematuria, bladder spasms, and pain have been reported with chemothermotherapy.…”