Preliminary European Results of Local Microwave Hyperthermia and Chemotherapy Treatment in Intermediate or High Risk Superficial Transitional Cell Carcinoma of the Bladder

Heijden, Antoine G. van der; Kiemeney, Lambertus A.; Gofrit, Ofer N.; Nativ, Ofer; Sidi, Avner; Leib, Z.; Colombo, Renzo; Naspro, Richard; Pavone, Mary Ellen; Baniel, Jack; Hasner, F.; Witjes, J. Alfred

doi:10.1016/j.eururo.2004.01.019

Cited by 150 publications

(77 citation statements)

References 24 publications

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“…20 In 41 patients failing BCG treatment, the 1-and 2-year recurrence rates were 23% and 41%, which are at least as good as the results achieved with BCG and IFN-a. Still, longer follow-up and more results will have to indicate the value of thermochemotherapy in patients in whom BCG fails.…”

Section: Toxicitymentioning

confidence: 64%

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Gemcitabine versus bacille Calmette‐Guérin after initial bacille Calmette‐Guérin failure in non‐muscle‐invasive bladder cancer

Lorenzo

Perdonà

Damiano

et al. 2010

Cancer

154

103

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BACKGROUND:The efficacy of intravesical gemcitabine was evaluated compared with repeated administration of bacille Calmette-Guérin (BCG) after BCG failure in high-risk, non-muscle-invasive bladder cancer (BC). METHODS: In this multicenter, prospective, randomized, phase 2 trial, eligible patients were those with high-risk non-muscle-invasive BC, failing 1 course of BCG therapy. All patients were randomly allocated to Group A, receiving intravesical gemcitabine (at a dose of 2000 mg/50 mL) twice weekly for 6 consecutive weeks and then weekly for 3 consecutive weeks at 3, 6, and 12 months, or Group B, receiving intravesical BCG (Connaught strain, 81 mg/50 mL) over a 6-week induction course and each week for 3 weeks at 3, 6, and 12 months. Outcome measures were recurrence rate, time to first recurrence, and progression rate. Treatment-related complications were also evaluated. RESULTS: Eighty participants were enrolled, 40 for each group 52.5% in Group A developed disease recurrence versus 87.5% of those in Group B (P ¼ .002). There was no statistically significant difference in mean time to the first recurrence (Group A, 3.9 months; Group B, 3.1 months; P ¼ .09). Kaplan-Meier analysis of 2-year recurrence-free survival showed significant differences between Group A and B (19% and 3%, respectively, P < .008). Seven of 21 (33%) patients in Group A and 13 of 35 (37.5%) patients in Group B had disease progression and underwent radical cystectomy (P ¼ .12). Both intravesical administrations were generally well tolerated. CONCLUSIONS: Gemcitabine might represent a second-line treatment option after BCG failure in high-risk non-muscle-invasive BC patients. Cancer 2010;116:1893-900.

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Section: Toxicitymentioning

confidence: 64%

“…The clinical and pathological characteristics of the 2 groups are shown in Table 1. Median follow-up was 15.2 months (range, [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] in Group A and 15.8 months (range, 7-21) in Group B.…”

Section: Resultsmentioning

confidence: 99%

Gemcitabine versus bacille Calmette‐Guérin after initial bacille Calmette‐Guérin failure in non‐muscle‐invasive bladder cancer

Lorenzo

Perdonà

Damiano

et al. 2010

Cancer

154

103

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“…La administración electromotriz multiplica entre 4 y 7 veces su transporte a través de las membranas biológicas en comparación con el transporte pasivo y consigue aumentar significativamente la eficacia de la quimioterapia intravesical 78,79 . La hipertermia local aplicada mediante un dispositivo intrauretral emisor de microondas también mejora la penetración de las drogas y su eficacia clínica 80,81 . En tumores de alto grado y CIS, la hipertermia ha mostrado eficacia no sólo en la profilaxis de recurrencias y la progresión sino también en la terapia ablativa 82 y en el tratamiento de segunda línea tras fracasos de BCG 80 .…”

Section: Aplicación Prácticaunclassified

Mecanismos del ciclo celular y la apoptosis implicados en las resistencias a los fármacos de uso intravesical en el cáncer superficial de vejiga

Gasión

Moreno

Donoso

et al. 2005

Actas Urológicas Españolas

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han demostrado la utilidad de la quimioterapia intravesical en la profilaxis de las recidivas del tumor vesical superficial después de la resección transuretral. Pero la eficacia de esta práctica puede verse limitada por la existencia de resistencias a agentes individuales o de multirresistencias a varios fármacos. Además de los mecanismos de resistencia clásicos o "unicelulares" determinados genéticamente, como la expresión de la glicoproteína P-170 (gen mdr-1), la sobreexpresión del gen Bcl-2 o la actividad de la glutation S-transferasa, existen otros mecanismos de resistencia "multicelular" que han podido ser demostrados en cultivos de agregados celulares tridimensionales, y no en las mismas células cultivadas en monocapa o en suspensión de células individuales. La adhesión célula-célula y célula-estroma condiciona por un lado una limitada penetración de las drogas y, por otro, unos gradientes de oxígeno y proliferación en los tejidos que crean distintas susceptibilidades al efecto citotóxico. El conocimiento de las resistencias y sus mecanismos es de gran importancia, puesto que se trata de uno de los puntos donde se puede actuar para optimizar la eficacia de la quimioterapia intravesical. Muchos investigadores han dedicado sus esfuerzos a la búsqueda de medios contra las resistencias mediante la aplicación de métodos para mejorar la penetración de los fármacos, la búsqueda de agentes reversores o la identificación de las resistencias con tests in vitro de quimiosensibilidad.Palabras clave: Quimioterapia intravesical. Quimiorresistencia. Tumor vesical superficial. ABSTRACT CELL CYCLE AND APOPTOSIS MECHANISMS IMPLICATED IN INTRAVESICAL CHEMOTHERAPY RESISTANCESIN SUPERFICIAL BLADDER CANCER It is well documented the effectiveness of intravesical chemotherapy following transurethral resection to prevent recurrences of superficial bladder cancer. But it is also known that efficacy may be limited by tumour cell resistance to one or several of the drugs available for instillation. In addition to the genetically determined unicellular mechanisms classically described in the literature such as glycoprotein P-170 expression (mdr-1), overexpression of Bcl-2 or glutation S-transferase activity, it has been recently shown that multicellular mechanisms may also be involved in drug resistance. Multicellular resistance can only be demonstrated in three-dimensional cultures and fails to be shown in monolayers or cell suspensions. This is explained by the fact that cell-to-cell and cell-to-stroma adhesion limits drug penetration and by the variable susceptibility to cytotoxicity determined by oxygen and tissue proliferation gradients. A better understanding of the molecular mechanisms involved in drug resistance is necessary to increase intravesical chemotherapy effectiveness. Current research includes improving drug penetration, searching resistance reversing agents and developing in vitro chemosensitivity tests to identify drug resistance.

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“…Following TURB, patients received adjuvant therapy with MMC and hyperthermia using Synergo V R [23]. The treatment schedule consisted of six to eight sessions once a week followed by four to six sessions once a month.…”

Section: Intermediate-high-risk Nmibcmentioning

confidence: 99%

“…Posterior wall thermal reaction, a phenomenon typically seen on cystoscopy after microwave-induced CHT, is caused by the location of the RF antenna. It appears as a medallion-shaped discoloured scar-like patch, which in general resolves spontaneously and is not associated with symptoms [9][10][11]21,[23][24][25][26][27][28][29][30].…”

Section: Synergomentioning

confidence: 99%

Chemohyperthermia in non-muscle-invasive bladder cancer: An overview of the literature and recommendations

Liem

Crezee

Rosette

et al. 2016

International Journal of Hyperthermia

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Non-muscle-invasive bladder cancer (NMIBC) is characterised by a high risk of recurrence for the present standard treatment of transurethral resection of the bladder (TURB) followed by intravesical instillation of Mitomycin-C (MMC) or bacillus Calmette-Gu erin (BCG). To decrease this high recurrence rate, alternative treatments are studied. Intravesical MMC combined with hyperthermia could be an interesting alternative active treatment for intermediate-and high-risk NMIBC, and has been investigated in the past years. Hyperthermia, raising tumour temperatures to 40-44 C, can be achieved with several hyperthermia systems, based on three different techniques: 1) intravesical microwave induced heating, 2) conductive heating, and 3) loco-regional, using external radiofrequency antennas. In this review an overview is given of the available hyperthermia systems and the reported outcomes. Future directions are discussed. Optimal implementation of a combined regimen of MMC and hyperthermia requires further clinical trials to identify patients who will benefit most from this treatment, to optimise treatment schedules and to compare the efficacy of different hyperthermia devices. ARTICLE HISTORY

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Preliminary European Results of Local Microwave Hyperthermia and Chemotherapy Treatment in Intermediate or High Risk Superficial Transitional Cell Carcinoma of the Bladder

Cited by 150 publications

References 24 publications

Gemcitabine versus bacille Calmette‐Guérin after initial bacille Calmette‐Guérin failure in non‐muscle‐invasive bladder cancer

Gemcitabine versus bacille Calmette‐Guérin after initial bacille Calmette‐Guérin failure in non‐muscle‐invasive bladder cancer

Mecanismos del ciclo celular y la apoptosis implicados en las resistencias a los fármacos de uso intravesical en el cáncer superficial de vejiga

Chemohyperthermia in non-muscle-invasive bladder cancer: An overview of the literature and recommendations

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