Combined Therapy Helpful in High-Grade Superficial Bladder Cancer

Laurie Barclay, MD

March 29, 2004

March 29, 2004 — Combining local hyperthermia with intravesical chemotherapy is effective for prophylactic and ablative therapy of high-grade superficial bladder cancer, according to the results of a study published in the March issue of Urology.

"Combining thermal energy and chemotherapy offers several theoretical anticancer advantages over chemotherapy alone," write Ofer N. Gofrit, from Hadassah University Hospital in Jerusalem, Israel, and colleagues. "Applying thermal energy to the bladder provides another theoretical advantage — the pathologic blood vessels nourishing the tumor lack the ability to vasodilate in response to heat the way normal blood vessels do."

Of 52 patients who received combined chemo-thermotherapy for high-grade (G3) superficial bladder cancer, 11 patients had stage Ta tumors and 40 had stage T1 tumors, three of which had concomitant or isolated carcinoma in situ.

All patients received combined intravesical chemotherapy with mitomycin-C and local radiofrequency hyperthermia of the bladder wall. The patients were treated with either a prophylactic protocol (40 mg mitomycin-C) after complete transurethral resection of all tumors, or with an ablative protocol (80 mg mitomycin-C) when videocystoscopy revealed visible tumor or when bladder biopsies were positive for carcinoma in situ.

At a median follow-up of 15.2 months (mean, 23 months; range, 6-90 months), there was no stage progression to T2 or disease-related deaths in the entire group, and the bladder preservation rate was 86.5% overall.

Of 24 patients who received the prophylactic protocol, 15 patients (62.5%) were recurrence-free after a mean follow-up of 35.3 months. The bladder preservation rate was 95.8%.

Of 28 patients who received the ablative protocol, 21 patients (75%) had complete ablation of the tumor. After a mean follow-up of 20 months, 80.9% of these patients were recurrence-free, and the bladder preservation rate was 78.6%.

"Combined local bladder hyperthermia and intravesical chemotherapy has a beneficial prophylactic effect in patients with G3 superficial bladder cancer," the authors write. "Ablation of high-grade bladder tumors is feasible, achieving a complete response in about three quarters of the patients."

Two of the authors are paid consultants to Medical Enterprises, the manufacturer of the Synergo cryotherapy device.

Urology. 2004;63:466-471

Reviewed by Charlotte E. Grayson, MD

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