Hyperthermia for non-muscle invasive bladder cancer

ABSTRACT

Recurrent non muscle invasive bladder cancer (NMIBC) represents a therapeutic challenge, especially in the case of Bacillus Calmette Guerin (BCG)-failures. Chemohyperthermia (CHT) has been tested as adjuvant therapy in selected categories of patients with promising results. The aim of this systematic review is to explore the current role of CHT and its future perspectives. The review process was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. After the selection process, 30 articles were used in this review. Treatment with CHT is safe and quite well tolerated. CHT seems to be effective in low and intermediate risk bladder cancer. Moreover CHT could be offered to selected categories of high risk patients and BCG failures NMIBC. Further trials are needed in order to better identify the categories of patients which could benefit from this therapy and to standardise the right schedule of treatment.

KEY WORDS:

• bladder cancer
• review
• hyperthermia
• thermochemotherapy
• device assisted

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Key issues

• Intravesical CHT represents a feasible and safe treatment option for selected cases of NMIBC.

• The results of recent studies in terms of ability of CHT to prevent recurrence and progression are promising. The superiority of CHT against MMC alone has been demonstrated in selected categories of patients, namely those with BCG-refractory NMIBC.

• To date, intravesical CHT represents an effective treatment for selected patients with BCG refractory NMIBC, or those with recurrent NMIBC not suitable or not willing to undergo radical cystectomy.

• No definitive conclusions can be drawn about the efficacy of CHT in comparison with BCG, nor about its possible role as first-line therapy. Randomized controlled trials comparing CHT versus BCG as first-line therapy in intermediate and high-risk NMIBC are needed.

• Further studies are needed in order to better identify the categories of patients which could get most benefit from this treatment and to standardize the modality of administration and the optimal schedule.