title: Recirculant hyperthermic IntraVEsical chemotherapy (HIVEC) in intermediate-high-risk non-muscle-invasive bladder cancer.
abstract: Purpose To examine the effectiveness of hyperthermic intravesical chemotherapy (HIVEC™) with mitomycin-C (MMC) for patients with intermediate-high-risk non-muscle invasive bladder cancer (NMIBC). Materials and methods From November 2010 to April 2015, 40 patients with intermediate-high-risk NMIBC received HIVEC™ treatment with a Combat BRS system. Of these patients, 24 received neoadjuvant HIVEC™ treatment (eight weekly instillations) before a transurethral resection of the bladder (TURBT) and 16 received adjuvant HIVEC™ treatment post-TURBT (four instillations weekly + six monthly). The pathological response of each tumour was evaluated after the neoadjuvant treatment. Recurrence rates and adverse effects were evaluated in both groups. Results A total of 40 patients completed the induction therapy: 24 patients received the Neoadjuvant HIVEC™ treatment. Of these patients, 15 (62.5%) showed a complete response. Eight patients (33.3%) showed a partial response, and one patient (4.1%) showed no response at all. The 4-year cumulative incidence of recurrence was 20.8%. The adjuvant HIVEC™ treatment was given to 16 patients. The 2-year cumulative incidence of recurrence was 12.5% for this group. The incidence and severity of side effects were slightly lower in the adjuvant group than in the neoadjuvant group. However, the difference was not statistically significant (p < 0.3). Most of the side effects were low grade and had virtually no effect on the treatment plan, and 97% of patients completed all of the HIVEC™ instillations scheduled. Conclusions The recirculation of hyperthermic MMC using Combat's HIVEC™ treatment is safe and effective and is capable of achieving good success rates in both neoadjuvant and adjuvant settings. This treatment seems to be appropriate for NMIBC intermediate-high-risk patients who cannot tolerate or have contraindications for standard BCG therapy or in cases in which there are supply issues or shortages of BCG.
authors.affiliation: a Department of Urology , Comarcal Hospital , Monforte , Spain ;
authors.forename: Alejandro
authors.initials: A
authors.lastname: Sousa
authors.affiliation: b Day Hospital, Comarcal Hospital of Monforte , Monforte , Spain ;
authors.forename: Idelfonso
authors.initials: I
authors.lastname: Piñeiro
authors.affiliation: b Day Hospital, Comarcal Hospital of Monforte , Monforte , Spain ;
authors.forename: Silvia
authors.initials: S
authors.lastname: Rodríguez
authors.affiliation: c Pharmacy, Comarcal Hospital , Monforte , Spain ;
authors.forename: Vicente
authors.initials: V
authors.lastname: Aparici
authors.affiliation: c Pharmacy, Comarcal Hospital , Monforte , Spain ;
authors.forename: Victor
authors.initials: V
authors.lastname: Monserrat
authors.affiliation: c Pharmacy, Comarcal Hospital , Monforte , Spain ;
authors.forename: Pilar
authors.initials: P
authors.lastname: Neira
authors.affiliation: d Department of Pathology , Comarcal Hospital , Monforte , Spain ;
authors.forename: Enrique
authors.initials: E
authors.lastname: Carro
authors.affiliation: d Department of Pathology , Comarcal Hospital , Monforte , Spain ;
authors.forename: Cármen
authors.initials: C
authors.lastname: Murias
authors.affiliation: e Department of Urology , Comarcal Hospital , Monforte , Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Uribarri
mesh_terms: D000283:Administration, Intravesical; D000368:Aged; D000369:Aged, 80 and over; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D020360:Neoadjuvant Therapy; D012306:Risk; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000628:therapy*
chemical_list: D000903:Antibiotics, Antineoplastic; D016685:Mitomycin
keywords: Bladder cancer; chemohyperthermia; recirculant