949 Radiofrequence induced hyperthermia chemotherapy (RIHTC) in high-risk non-muscle invasive bladder cancer (NMIBC): Multiinstitutional, international outcome analysis of 271 treated patients with a follow-up time of more than 2 years

Lüdecke, Gerson; Schafer, Liudmila N.; Nativ, Ofer; Witzsch, U.; Hanitzsch, Herbert; Hasner, F.; Issa, Rami; Witjes, Fred; Weidner, W.

doi:10.1016/s1569-9056(15)60937-x

Cited by 6 publications

(12 citation statements)

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“…After 3 years of follow-up, there were only two tumour recurrences (15%); these were treated by a TURBT and an additional adjuvant standard MMC intravesical treatment. The largest study relating to neoadjuvant treatment was presented at the European Congress of Urology (Madrid 2015) by L€ udecke et al [15]. The study group consisted of 271 patients treated with eight weekly doses of neoadjuvant hyperthermic MMC (40 mg þ 40 mg).…”

Section: Neoadjuvant Treatmentmentioning

confidence: 99%

Recirculant hyperthermic IntraVEsical chemotherapy (HIVEC) in intermediate–high-risk non-muscle-invasive bladder cancer

Sousa

Piñeiro

Rodríguez

et al. 2016

International Journal of Hyperthermia

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Purpose To examine the effectiveness of hyperthermic intravesical chemotherapy (HIVEC™) with mitomycin-C (MMC) for patients with intermediate-high-risk non-muscle invasive bladder cancer (NMIBC). Materials and methods From November 2010 to April 2015, 40 patients with intermediate-high-risk NMIBC received HIVEC™ treatment with a Combat BRS system. Of these patients, 24 received neoadjuvant HIVEC™ treatment (eight weekly instillations) before a transurethral resection of the bladder (TURBT) and 16 received adjuvant HIVEC™ treatment post-TURBT (four instillations weekly + six monthly). The pathological response of each tumour was evaluated after the neoadjuvant treatment. Recurrence rates and adverse effects were evaluated in both groups. Results A total of 40 patients completed the induction therapy: 24 patients received the Neoadjuvant HIVEC™ treatment. Of these patients, 15 (62.5%) showed a complete response. Eight patients (33.3%) showed a partial response, and one patient (4.1%) showed no response at all. The 4-year cumulative incidence of recurrence was 20.8%. The adjuvant HIVEC™ treatment was given to 16 patients. The 2-year cumulative incidence of recurrence was 12.5% for this group. The incidence and severity of side effects were slightly lower in the adjuvant group than in the neoadjuvant group. However, the difference was not statistically significant (p < 0.3). Most of the side effects were low grade and had virtually no effect on the treatment plan, and 97% of patients completed all of the HIVEC™ instillations scheduled. Conclusions The recirculation of hyperthermic MMC using Combat's HIVEC™ treatment is safe and effective and is capable of achieving good success rates in both neoadjuvant and adjuvant settings. This treatment seems to be appropriate for NMIBC intermediate-high-risk patients who cannot tolerate or have contraindications for standard BCG therapy or in cases in which there are supply issues or shortages of BCG.

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Section: Neoadjuvant Treatmentmentioning

confidence: 99%

Recirculant hyperthermic IntraVEsical chemotherapy (HIVEC) in intermediate–high-risk non-muscle-invasive bladder cancer

Sousa

Piñeiro

Rodríguez

et al. 2016

International Journal of Hyperthermia

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“…Nonetheless, this does provide an impression of its general efficacy. Regarding recurrence, for example, rates vary from 16-89%, see also Table 1 in this paper as well as Table 1 from the systematic review of Lammers et al [11,[25][26][27][28][29][30][31][32][33]. Two outliers are seen in this range, both representing studies with patients not suitable and/or unwilling for cystectomy [29,34].…”

Section: Chemo-hyperthermia Alonementioning

confidence: 85%

“…Progression is reported less often than recurrence, since it requires a longer follow-up of NMIBC. Nonetheless, some figures are published: overall 0-36% show progression, and when only studies with a follow-up of 42 years are considered, the same figures apply [11,[25][26][27][28][29][30][31][32][33]. Most of these studies define progression as occurrence of MIBC.…”

Section: Chemo-hyperthermia Alonementioning

confidence: 99%

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Intravesical radiofrequency-induced hyperthermia combined with chemotherapy for non-muscle-invasive bladder cancer

Valenberg

Colombo

Witjes

2016

International Journal of Hyperthermia

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Although many treatment modalities and schedules for non-muscle-invasive bladder cancer (NMIBC) exist, all yet prove to have limitations. Therefore the search for new forms of therapy continues. One of these forms consists of combining intravesical chemotherapy, typically mitomycin C (MMC), with hyperthermia achieved by a microwave-applicator. We aimed to review the current status of intravesical radiofrequency (RF) induced chemohyperthermia (CHT) for NMIBC with regard to efficacy, adverse-events (AEs) and its future perspective. A search for RF-induced CHT in MEDLINE, Embase, Cochrane and ClinicalTrials.gov databases was performed. Relevant conference abstracts were searched for manually. If applicable, experts on the area were consulted. Papers were selected based on abstract and title. A table of newly published clinical trials since 2011 was constructed. No meta-analysis could be performed based on these new papers. Efficacy proved to be better for RF-induced CHT compared to both MMC alone and bacillus Calmette-Guérin (BCG) instillations, with the latter being based on just one abstract of a randomised controlled trial. The AE rate in CHT is higher compared to MMC instillation, but is similar compared to BCG, albeit different in the type of AE. In almost all studies no severe AEs are reported. Although heterogeneity in methodology exists, RF-induced CHT seems promising. However, alternative methods of applying hyperthermia are starting to present their first results, imposing as effective options too. Intravesical RF-induced CHT may become an alternative for BCG instillation, and possibly for cystectomy, although further level 1 evidence is required for both reliable and reproducible data on efficacy and adverse events.

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“…The most comprehensive and recent neoadjuvant study was published by Lüdecke et al [85]; the study group consisted of 271 patients treated with 8 weekly doses of neoadjuvant CHT with MMC (40 + 40 mg). After TUR-B they observed that 76.1% had CR and another 7.6%…”

Section: Neoadjuvant Cht Treatment (Before Tur-b)mentioning

confidence: 99%

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

Alejandro¹,

Javier²,

Daniel³

et al. 2017

Bladder Cancer - Management of NMI and Muscle-Invasive Cancer

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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...

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949 Radiofrequence induced hyperthermia chemotherapy (RIHTC) in high-risk non-muscle invasive bladder cancer (NMIBC): Multiinstitutional, international outcome analysis of 271 treated patients with a follow-up time of more than 2 years

Cited by 6 publications

References 0 publications

Recirculant hyperthermic IntraVEsical chemotherapy (HIVEC) in intermediate–high-risk non-muscle-invasive bladder cancer

Recirculant hyperthermic IntraVEsical chemotherapy (HIVEC) in intermediate–high-risk non-muscle-invasive bladder cancer

Intravesical radiofrequency-induced hyperthermia combined with chemotherapy for non-muscle-invasive bladder cancer

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

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