Intravesical mitomycin C combined with hyperthermia for patients with T1G3 transitional cell carcinoma of the bladder

Halachmi, Sarel; Moskovitz, Boaz; Maffezzini, Massimo; Conti, Giario; Verweij, Fabrizio; Kedar, Daniel; Sandri, S; Nativ, Ofer; Colombo, Renzo

doi:10.1016/j.urolonc.2009.02.012

Cited by 45 publications

(28 citation statements)

References 22 publications

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“…Similarly, Halachmi et al [79] did not observe any difference in the rate of recurrence at 4 years among those who had failed BCG and those without (46 vs 44%, respectively, p = 0.54).…”

Section: Tumoral Progression After Cht and Bladder Preservation Ratesmentioning

confidence: 79%

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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“…Similarly, Halachmi et al [79] did not observe any difference in the rate of recurrence at 4 years among those who had failed BCG and those without (46 vs 44%, respectively, p = 0.54).…”

Section: Tumoral Progression After Cht and Bladder Preservation Ratesmentioning

confidence: 79%

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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“…Clinical trials in sarcoma, melanoma, tumours of the head and neck, lung, oesophagus, breast, peritoneal organs, and genitourinary tract have all confirmed a synergistic effect of hyperthermia with chemotherapy [1]. Early studies in bladder cancer demonstrated that HM had an ablative effect on incompletely resected tumours [7,19], and later studies confirmed its use in prophylaxis for high-risk NMIBC, both before and after BCG [6,8,18,20,21,22,23,24,25,26]. Of 75 patients with primary or recurrent NMIBC who were randomized to MMC alone versus HM, 53% were tumour-free after 10 years and 86% had preserved their native bladders [8].…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors for Time to Progression after Hyperthermic Mitomycin C Treatment for High-Risk Non-Muscle Invasive Urothelial Carcinoma of the Bladder: An Observational Cohort Study of 97 Patients

et al. 2015

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Introduction: Hyperthermic mitomycin (HM) is a novel treatment modality for selected patients with high-risk non-muscle invasive bladder cancer (NMIBC). We sought to determine predictors of response to this therapy. Patients and Methods: A longitudinal, cohort study of 97 patients with high-risk NMIBC treated with ≥4 HM instillations on a prophylactic schedule was conducted. The primary outcome was time-to-progression survival; secondary outcomes were overall survival, cancer-specific survival, and adverse events. Descriptive statistics, Kaplan-Meier survival analyses, Cox proportional hazards modelling, and univariate and multivariable regression were performed. Results: The presence of initial complete response (CR; no evidence of disease at first check video-cystoscopy and urine cytology) post-HM treatment was an independent predictor of good response to HM. Female patients and those without carcinoma in situ (CIS) also appeared to respond better to the intervention. The overall bladder preservation rate at a median of 27 months was 81.4%; 17/97 (17.5%) patients died during the course of the study. Conclusions: High-risk NMIBC patients can be safely treated with HM and have good oncological outcome. However, those without an initial CR have a poor prognosis and should be counselled towards adopting other treatment methodologies such as cystectomy. Female gender and lack of CIS may be good prognostic indicators for response to HM.

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“…[6][7][8]10,11,[14][15][16][17][18] In particular, greater temperature differences in the bladder wall because the spatial power distribution of an intracavitary microwave antenna is not evenly distributed over the surface of the bladder wall, and a single antenna offers no option to modify the power distribution. Achieving a good thermal dose over the entire bladder wall can thus easily result in overheating of parts of the bladder wall, resulting in pain and toxicity.…”

Section: Discussionmentioning

confidence: 99%

Novel multi-sensor probe for monitoring bladder temperature during loco-regional chemo-hyperthermia for non-muscle invasive bladder cancer: technical feasibility study

Feijoo¹,

Geijsen²,

Vörding³

et al. 2013

Journal of Endourology

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Background and Purpose: The effectiveness of locoregional hyperthermia combined with intravesical instillation of mitomycin C to reduce the risk of recurrence and progression of intermediate-and high-risk nonmuscleinvasive bladder cancer is currently investigated in clinical trials. Clinically effective locoregional hyperthermia delivery necessitates adequate thermal dosimetry; thus, optimal thermometry methods are needed to monitor accurately the temperature distribution throughout the bladder wall. The aim of the study was to evaluate the technical feasibility of a novel intravesical device (multi-sensor probe) developed to monitor the local bladder wall temperatures during loco-regional C-HT. Materials and Methods: A multisensor thermocouple probe was designed for deployment in the human bladder, using special sensors to cover the bladder wall in different directions. The deployment of the thermocouples against the bladder wall was evaluated with visual, endoscopic, and CT imaging in bladder phantoms, porcine models, and human bladders obtained from obduction for bladder volumes and different deployment sizes of the probe. Finally, porcine bladders were embedded in a phantom and subjected to locoregional heating to compare probe temperatures with additional thermometry inside and outside the bladder wall. Results: The 7.5 cm thermocouple probe yielded optimal bladder wall contact, adapting to different bladder volumes. Temperature monitoring was shown to be accurate and representative for the actual bladder wall temperature. Conclusions: Use of this novel multisensor probe could yield a more accurate monitoring of the bladder wall temperature during locoregional chemohyperthermia.

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Intravesical mitomycin C combined with hyperthermia for patients with T1G3 transitional cell carcinoma of the bladder

Cited by 45 publications

References 22 publications

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

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

Predictive Factors for Time to Progression after Hyperthermic Mitomycin C Treatment for High-Risk Non-Muscle Invasive Urothelial Carcinoma of the Bladder: An Observational Cohort Study of 97 Patients

Novel multi-sensor probe for monitoring bladder temperature during loco-regional chemo-hyperthermia for non-muscle invasive bladder cancer: technical feasibility study

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