title: Combined thermo-chemotherapy for recurrent bladder cancer after bacillus Calmette-Guerin.
abstract: OBJECTIVE
  Despite an initial adequate response many patients with nonmuscle invasive urothelial cell carcinoma of the bladder eventually have recurrence after intravesical bacillus Calmette-Guerin treatments. We evaluated the efficacy of combined bladder wall hyperthermia and intravesical mitomycin C instillation (thermo-chemotherapy) in cases of recurrence after bacillus Calmette-Guerin.
  
  
  METHODS
  A total of 111 patients with recurrent papillary nonmuscle invasive urothelial cell carcinoma of the bladder after previous bacillus Calmette-Guerin treatment underwent complete bladder tumor resection and were referred for prophylactic adjuvant treatment with thermo-chemotherapy. Treatment was received on an outpatient basis weekly for 6 weeks, followed by 6 maintenance sessions at 4 to 6-week intervals. Each treatment included 2, 30-minute cycles of 20 mg mitomycin C and bladder wall hyperthermia to 42C +/- 2C. Cystoscopy and urine cytology were performed after the completion of induction treatment and every 3 months thereafter.
  
  
  RESULTS
  The Kaplan-Meier estimated disease-free survival rate was 85% and 56% after 1 and 2 years, respectively. No maintenance treatment was associated with decreased efficacy, that is the recurrence rate was 61% at 2 years vs 39% in those with maintenance treatments (p = 0.01). The progression rate was 3%.
  
  
  CONCLUSIONS
  Thermo-chemotherapy may be effective for papillary nonmuscle invasive urothelial cell carcinoma of the bladder that recurs after BCG treatment without increasing the risk of tumor progression. Maintenance therapy is important and improves the outcome.
authors.affiliation: Urology Department, Bnai-Zion Medical Center, Haifa, Israel. ofer.nativ@b-zion.org.il
authors.forename: Ofer
authors.initials: O
authors.lastname: Nativ
authors.forename: J Alfred
authors.initials: JA
authors.lastname: Witjes
authors.forename: Kees
authors.initials: K
authors.lastname: Hendricksen
authors.forename: Michael
authors.initials: M
authors.lastname: Cohen
authors.forename: Daniel
authors.initials: D
authors.lastname: Kedar
authors.forename: Ami
authors.initials: A
authors.lastname: Sidi
authors.forename: Renzo
authors.initials: R
authors.lastname: Colombo
authors.forename: Ilan
authors.initials: I
authors.lastname: Leibovitch
mesh_terms: D000276:Adjuvants, Immunologic / Q000627:therapeutic use; D000283:Administration, Intravesical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage*; D001500:BCG Vaccine / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000628:therapy*
chemical_list: D000276:Adjuvants, Immunologic; D000903:Antibiotics, Antineoplastic; D001500:BCG Vaccine; D016685:Mitomycin