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Results of Intravesical Chemo-Hyperthermia in High-risk Non-muscle Invasive Bladder Cancer

  • Ekin, Rahmi Gokhan (Department of Urology, Tepecik Teaching and Research Hospital) ;
  • Akarken, Ilker (Urology Clinic, Kemalpasa State Hospital) ;
  • Cakmak, Ozgur (Department of Urology, Tepecik Teaching and Research Hospital) ;
  • Tarhan, Huseyin (Department of Urology, Tepecik Teaching and Research Hospital) ;
  • Celik, Orcun (Department of Urology, Tepecik Teaching and Research Hospital) ;
  • Ilbey, Yusuf Ozlem (Department of Urology, Tepecik Teaching and Research Hospital) ;
  • Divrik, Rauf Taner (Department of Urology, Sifa University, Faculty of Medicine) ;
  • Zorlu, Ferruh (Department of Urology, Tepecik Teaching and Research Hospital)
  • Published : 2015.04.29

Abstract

Purpose: To examine the effectiveness of mitomycin-C and chemo-hyperthermia in combination for patients with high-risk non-muscle-invasive bladder cancer. Materials and Methods: Between November 2011-September 2013, 43 patients with high-risk non-muscle-invasive bladder cancer undergoing adjuvant chemo-hyperthermia in two centers were evaluated retrospectively. Treatment consisted of 6 weekly sessions, followed by 6 sessions. Recurrence and progression rate, recurrence-free interval and side effects were examined. Analyzed factors included age, gender, smoking status, AB0 blood group, body mass index, T stage and grade, concominant CIS assets. The associations between predictors and recurrence were assessed using multivariate Cox proportional hazard analyses. Results: A total of 40 patients completed induction therapy. Thirteen (32.5%) were diagnosed with tumor recurrence. Median follow-up was 30 months (range 9-39). Median recurrence-free survival was 23 months (range 6-36). The Kaplan-Meier-estimated recurrence-free rates for the entire group at 12 and 24 months were 82% and 61%. There was no statistically significant difference between patient subgroups. Cox hazard analyses showed that an A blood type (OR=6.23, p=0.031) was an independent predictor of recurrence-free. Adverse effects were seen in 53% of patients and these were frequently grades 1 and 2. Conclusions: Intravesical therapy with combination of mitomycin-C and chemohyperthermia seems to be appropriate in high-risk patients with non-muscle-invasive bladder cancer who cannot tolerate or have contraindications for standard BCG therapy.

Keywords

Chemohyperthermia;recurrence;mitomycin C;thermochemotherapy;non muscle-invasive bladder cancer

References

  1. Babjuk M, Burger M, Zigeuner R, et al (2013). EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder:update 2013. Eur Urol, 64, 639-53. https://doi.org/10.1016/j.eururo.2013.06.003
  2. Basiri A, Shakhssalim N, Jalaly NY, et al (2014). Difference in the incidences of the most prevalent urologic cancers from 2003 to 2009 in Iran. Asian Pac J Cancer Prev, 15, 1459-63. https://doi.org/10.7314/APJCP.2014.15.3.1459
  3. Burger M, Catto JWF, Dalbagni G, et al (2013). Epidemiology and risk factors of urothelial bladder cancer. Eur Urol, 63, 234-41. https://doi.org/10.1016/j.eururo.2012.07.033
  4. Cheng CW, Chan SFP, Chan LW, et al (2004). 15-year experience on intravesical therapy of T1G3 urinary bladder cancer: a conservative approach. Jpn J Clin Oncol, 34, 202-5. https://doi.org/10.1093/jjco/hyh030
  5. Colombo R, Lev A, Da Pozzo LF, et al (1995). A new approach using local combined microwave hyperthermia and chemotherapy in superficial transitional bladder carcinoma treatment. J Urol, 153, 959-63. https://doi.org/10.1016/S0022-5347(01)67613-4
  6. Colombo R, Salonia A, Leib Z, et al (2011). Long-term outcomes of a randomized controlled trial comparing thermochemotherapy with mitomycin-C alone as adjuvant treatment for non-muscle-invasive bladder cancer (NMIBC). BJU Int, 107, 912-8. https://doi.org/10.1111/j.1464-410X.2010.09654.x
  7. Divrik RT, Sahin AF, Yildirim U, et al (2010). Impact of routine second transurethral resection on the long-term outcome of patients with newly diagnosed pT1 urothelial carcinoma with respect to recurrence, progression rate, and diseasespecific survival: a prospective randomised clinical trial. Eur Urol, 58, 185-90. https://doi.org/10.1016/j.eururo.2010.03.007
  8. Eser S, Zorlu F, Divtik RT, et al (2009). Incidence and epidemiological features of cancers of the genitourinary tract in Izmir between 1993-2002. Asian Pacific J Cancer Prev, 10, 491-6.
  9. Grivas N, Hastazeris K, Kafarakis V, et al (2014). Efficacy of postoperative bladder irrigation with water for injection in reducing recurrence rates of non muscle invasive bladder cancer. Asian Pac J Cancer Prev, 15, 2263-6. https://doi.org/10.7314/APJCP.2014.15.5.2263
  10. Hildebrandt B, Wust P, Ahlers O, et al (2002). The cellular and molecular basis of hyperthermia. Crit Rev Oncol Hematol, 43, 33-56. https://doi.org/10.1016/S1040-8428(01)00179-2
  11. Institute NC, (2010). Common terminology criteria for adverse events (CTCAE ) Version 4.0. , 2009.
  12. Lammers RJM, Witjes JA, Inman B a, et al (2011). The role of a combined regimen with intravesical chemotherapy and hyperthermia in the management of non-muscle-invasive bladder cancer: a systematic review. Eur Urol, 60, 81-93. https://doi.org/10.1016/j.eururo.2011.04.023
  13. Moskovitz B, Halachmi S, Moskovitz M, et al (2012). 10-year single-center experience of combined intravesical chemohyperthermia for nonmuscle invasive bladder cancer. Future Oncol, 8, 1041-9. https://doi.org/10.2217/fon.12.90
  14. Okamura T, Akita H, Ando R, et al (2010). Intravesical bacillus Calmette-Guerin (BCG) instillation for primary and recurring T1G3 bladder cancers. Asian Pac J Cancer Prev, 11, 1107-10.
  15. Okamura T, Ando R, Akita H, et al (2012). Are there time-periodrelated differences in the prophylactic effects of bacille calmette-guerin intravesical instillation therapy in Japan? Asian Pacific J Cancer Prev, 13, 4357-61. https://doi.org/10.7314/APJCP.2012.13.9.4357
  16. Richards KA, Smith ND, and Steinberg GD, (2014). The importance of transurethral resection of bladder tumor in the management of nonmuscle invasive bladder cancer: a systematic review of novel technologies. J Urol.
  17. Sangar VK, Ragavan N, Matanhelia SS, et al (2005). The economic consequences of prostate and bladder cancer in the UK. BJU Int, 95, 59-63.
  18. Volpe A, Racioppi M, Bongiovanni L, et al (2012). Thermochemotherapy for non-muscle-invasive bladder cancer: is there a chance to avoid early cystectomy? Urol Int, 89, 311-8. https://doi.org/10.1159/000341912
  19. Wang H-F, Wang J (2012). Research progress in potential urinary markers for the early detection, diagnosis and follow-up of human bladder cancer. Asian Pac J Cancer Prev, 13, 1723-6. https://doi.org/10.7314/APJCP.2012.13.5.1723

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