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Bladder Cancer. 2018 Oct 29;4(4):365-376. doi: 10.3233/BLC-180187.

Intravesical Radiofrequency-Induced Chemohyperthermia for Carcinoma in Situ of the Urinary Bladder: A Retrospective Multicentre Study.

Author information

1
Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands.
2
Ente Ospedaliero Ospedali Galliera, Genova, Italy.
3
University Clinics Giessen and Marburg GmbH, Location Giessen, Justus-Liebig University Giessen, Germany.
4
Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
5
Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.
6
Bnai-Zion Hospital, Haifa, Israel.
7
Darent Valley Hospital, Dartford, UK.
8
St. George's Hospital, London, UK.

Abstract

Objective:

To examine the effect of intravesical radiofrequency-induced chemohyperthermia (RF-CHT) in carcinoma in-situ (CIS) patients overall and split according to previously received therapy.

Methods:

CIS patients that underwent an induction and maintenance phase of≥6 RF-CHT instillations, and had either pathology or cystoscopy plus cytology available at 6 months of follow-up were retrospectively included. Complete response (CR), recurrences, cystectomy-free rate, overall survival (OS), and adverse events were evaluated. Analysis was performed for overall, bacillus Calmette-Guérin (BCG)-unresponsive, other BCG-treated, and treatment naïve patients.

Results:

Patients (n = 150) had a mean of 17.5, 9.2, or 0 previous BCG instillations in the BCG-unresponsive (n = 50), other BCG-treated (n = 46, missing n = 4), and treatment naïve groups (n = 47, missing n = 3), respectively. After 6 months, a CR of 46.0%, 71.7%, and 83.0% was found (p < 0.001). Subsequent 2-year recurrence rates were 17.4%, 27.3%, and 12.8%, respectively. The overall cystectomy-free rate and OS at mean follow-up (35.8 months) were 78.5% and 78.0%, respectively. These were 71.4% vs. 84.1% vs. 86.7% (cystectomy-free rate, p = 0.006) and 76.0% vs. 69.6% vs. 87.2% (OS, p = 0.06) for BCG-unresponsive vs. other BCG-treated vs. treatment naïve patients. Progression to muscle-invasive disease was seen in 13.3% of patients. Patients stopped induction or maintenance RF-CHT instillations due to adverse events in respectively 13.4% and 17.8%.

Conclusions:

Intravesical RF-CHT showed good results in both treatment naïve and BCG-treated CIS patients, avoiding the need for cystectomy in 78.5% of cases for at least 3 years with a modest risk of progression. Thus, RF-CHT proves an alternative to cystectomy in selected high-risk patients.

KEYWORDS:

Hyperthermia; bacillus Calmette-Guérin; carcinoma in situ; intravesical therapy; radiofrequency; urinary bladder neoplasms

Conflict of interest statement

B Ayres has received non-financial support from Medical Enterprises Ltd. and speaker fees from Kyowa Kirin and Olympus. R Issa reports grants from Medical Enterprises Ltd., outside the submitted work. JA Witjes and G Lüdecke are advisors for Medical Enterprises Ltd. and JA Witjes additionally for Spectrum, Taris, and BioCanCell; without any financial disclosure or conflict of interest on this manuscript. FJP van Valenberg, A Kajtazovic, G Canepa, J Kilb, KKH Aben, O Nativ, and S Madaan have no financial disclosures or conflicts of interest to report.

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