Neoadjuvant Combined Microwave Induced Local Hyperthermia and Topical Chemotherapy Versus Chemotherapy Alone for Superficial Bladder Cancer

Colombo, R.; Pozzo, L. Da; Lev, A.; Freschi, Massimo; Gallus, Giuseppe; Rigatti, Patrìzio

doi:10.1097/00005392-199604000-00022

Cited by 27 publications

(49 citation statements)

References 20 publications

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“…The patient is free of recurrence or metastases 4 years after therapy. combined with hyperthermia in superficial bladder cancer (89). Both groups received 40 mg mitomycin C in 50 cc distilled water instilled in the bladder (changed after 30 min).…”

Section: Miscellaneous Phase I/ii Studiesmentioning

confidence: 99%

Status of Clinical Hyperthermia

Dahl

Dalene²,

Bc³

et al. 1999

Acta Oncologica

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Section: Miscellaneous Phase I/ii Studiesmentioning

confidence: 99%

Status of Clinical Hyperthermia

Dahl

Dalene²,

Bc³

et al. 1999

Acta Oncologica

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“…1,2 However, patients undergoing standard treatment suffer from a high rate of recurrence. [2][3][4] Compared to chemotherapy alone, both progression and recurrence of bladder carcinoma were better controlled by using a combination of heat and chemotherapy. 2,4 The rationale behind this could be the increased rate of drug uptake due to increased permeability of the tumor cell membrane with heating.…”

Section: Introductionmentioning

confidence: 99%

“…[2][3][4] Compared to chemotherapy alone, both progression and recurrence of bladder carcinoma were better controlled by using a combination of heat and chemotherapy. 2,4 The rationale behind this could be the increased rate of drug uptake due to increased permeability of the tumor cell membrane with heating. 5 Therapeutic heating of the anticancer agent can be accomplished by intracavitary irrigation with warmed saline (43-45 C) 6 or by delivering a properly focused power deposition pattern using ultrasound 7 or electromagnetic (EM) waves, which penetrates heat further into and around the bladder wall than heated saline irrigation.…”

Section: Introductionmentioning

confidence: 99%

Utility of treatment planning for thermochemotherapy treatment of nonmuscle invasive bladder carcinoma

et al. 2012

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Purpose: A recently completed Phase I clinical trial combined concurrent Mitomycin-C chemotherapy with deep regional heating using BSD-2000 Sigma-Ellipse applicator (BSD Corporation, Salt Lake City, UT, U.S.A.) for the treatment of nonmuscle invasive bladder cancer. This work presents a new treatment planning approach, and demonstrates potential impact of this approach on improvement of treatment quality. Methods: This study retrospectively analyzes a subset of five patients on the trial. For each treatment, expert operators selected "clinical-optimal" settings based on simple model calculation on the BSD-2000 control console. Computed tomography (CT) scans acquired prior to treatment were segmented to create finite element patient models for retrospective simulations with SigmaHyperPlan (Dr. Sennewald Medizintechnik GmbH, Munchen, Germany). Since Sigma-HyperPlan does not account for the convective nature of heat transfer within a fluid filled bladder, an effective thermal conductivity for bladder was introduced. This effective thermal conductivity value was determined by comparing simulation results with clinical measurements of bladder and rectum temperatures. Regions of predicted high temperature in normal tissues were compared with patient complaints during treatment. Treatment results using "computed-optimal" settings from the planning system were compared with clinical results using clinical-optimal settings to evaluate potential of treatment improvement by reducing hot spot volume. Results: For all five patients, retrospective treatment planning indicated improved matches between simulated and measured bladder temperatures with increasing effective thermal conductivity. The differences were mostly within 1.3 C when using an effective thermal conductivity value above 10 W/K/m. Changes in effective bladder thermal conductivity affected surrounding normal tissues within a distance of $1.5 cm from the bladder wall. Rectal temperature differences between simulation and measurement were large due to sensitivity to the sampling locations in rectum. The predicted bladder T90 correlated well with single-point bladder temperature measurement. Hot spot locations predicted by the simulation agreed qualitatively with patient complaints during treatment. Furthermore, comparison between the temperature distributions with clinical and computedoptimal settings demonstrated that the computed-optimal settings resulted in substantially reduced hot spot volumes. Conclusions: Determination of an effective thermal conductivity value for fluid filled bladder was essential for matching simulation and treatment temperatures. Prospectively planning patients using the effective thermal conductivity determined in this work can potentially improve treatment efficacy (compared to manual operator adjustments) by potentially lower discomfort from reduced hot spots in normal tissue.

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“…6 All patients underwent TUR one week following therapy, and a pathologic complete response was observed in 66% versus 22% of patients, respectively (P , 0.01). 132 This study was followed by a prospective, multicenter, randomized trial in which 42 patients with intermediate-and high-risk NMIBC received MMC in combination with local microwave-induced hyperthermia and 41 patients received MMC alone following TUR. 9 With a minimum follow-up of 24 months, recurrence rates were significantly reduced in the combination therapy arm compared with the MMC alone arm (17.1% versus 57.5%, P = 0.002) respectively.…”

Section: Optimizing Efficacy Of Current Agentsmentioning

confidence: 99%

Emerging intravesical therapies for management of nonmuscle invasive bladder cancer

Smaldone¹,

Tomaszewski²

2010

OAJU

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Transitional cell carcinoma (TCC) is the second most common urologic malignancy, and 70% of patients present with superficial or nonmuscle invasive bladder cancer (NMIBC). Intravesical bacillus Calmette-Guerin (BCG) is the most effective agent for preventing disease recurrence, and the only therapy able to inhibit disease progression. However, recurrence rates as high as 30% and significant local and systemic toxicity have led to increased interest in alternative intravesical therapies. In patients refractory or intolerant to BCG, BCG-interferon α2b, gemcitabine, and anthracyclines (doxorubicin, epirubicin, valrubicin) have demonstrated durable clinical responses. Phase I trials investigating alternative cytotoxic agents, such as apaziquone, taxanes (docetaxel, paclitaxel), and suramin are reporting promising data. Novel immunomodulating agents have demonstrated promise as efficacious alternatives in patients refractory to BCG. Optimization of existing chemotherapeutic regimens using hyperthermia, photodynamic therapy, magnetically-targeted carriers, and liposomes remains an area of active investigation. Despite enthusiasm for new intravesical agents, radical cystectomy remains the treatment of choice for patients with NMIBC who have failed intravesical therapy and selected patients with naïve T1 tumors and aggressive features. This report provides a comprehensive review of contemporary intravesical therapy for NMIBC and refractory NMIBC, with an emphasis on emerging agents and novel treatment modalities.

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Neoadjuvant Combined Microwave Induced Local Hyperthermia and Topical Chemotherapy Versus Chemotherapy Alone for Superficial Bladder Cancer

Abstract: According to these preliminary data, microwave induced hyperthermia combined with local intravesical chemotherapy seems to be a feasible, safe and promising approach for neoadjuvant and minimally invasive treatment of superficial bladder cancer.

Cited by 27 publications

References 20 publications

Status of Clinical Hyperthermia

Status of Clinical Hyperthermia

Utility of treatment planning for thermochemotherapy treatment of nonmuscle invasive bladder carcinoma

Emerging intravesical therapies for management of nonmuscle invasive bladder cancer

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