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

Abstract

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.

Long-Term Experience with Hyperthermic Chemotherapy (HIVEC) Using Mitomycin-C in Patients with Non-Muscle Invasive Bladder Cancer in Spain

“…It seems of paramount importance to define that adjunct COMBAT BRS treatment with MMC with a duration longer than 4 months is an independent prognostic factor, not only to prevent tumor recurrence but also in terms of mortality; and this finding appears critical for the design of comparative trials in the future. The long-term experience with RF-induced hyperthermia also confirms that a long-term maintenance confers better results [ 27 ].…”

“…It is difficult to provide an indirect comparison of efficacy in the absence of control arms but the progression-free data we provide for HIVEC using BRS seem preferable to the results provided by the long-term experience with RF-induced hyperthermia combined with intravesical chemotherapy in the recent publication of Brummelhuis et al [ 27 ]. Similarly, the progression-free rate we report may also be equivalent to the results provided by long-term BCG maintenance [ 7 , 28 ].…”

“…The global tolerability of HIVEC-MMC seems to be much better than that of RF-induced hyperthermia in which a rate of 94.2% patients experience at least one AE [ 27 ]. Furthermore, the frequency of cutaneous contact allergic reactions observed with HIVEC MMC, including vesicular dermatitis of the hands and feet and/or dermatitis of the genitals, or even more widespread eruptions, is notably lower than the 15.4% rate recently reported for RF-induced hyperthermia [ 27 ].…”

Carbon ion radiotherapy for bladder cancer: A case report

“…Radical cystectomy is considered the treatment of choice for muscle-invasive bladder carcinoma[ 1 - 6 ]. Surgery may not be possible, however, for patients with locally advanced tumors or for those considered medically unfit[ 7 , 8 ]. External beam radiotherapy (EBRT) is a noninvasive and efficient treatment modality[ 9 - 11 ], although it is based on very limited literature consisting mainly of small retrospective series of patients not eligible for curative treatment[ 12 - 14 ].…”

Hyperthermia-Based Anti-Cancer Treatments

“…Ten original research and review papers have been included until now (status 9 March 2021). Again a range of relevant topics is covered, including technical design and innovations for improved hyperthermia treatment delivery [24][25][26][27][28], a novel small animal model for preclinical HIPEC research [29], as well as clinical application of mild hyperthermia, thermal ablation and HIPEC for bladder cancer, prostate cancer, hepatocellular carcinoma, and peritoneal surface malignancies [30][31][32][33].…”