Intravesical mitomycin C combined with hyperthermia for patients with T1G3 transitional cell carcinoma of the bladder

Sarel Halachmi, Boaz Moskovitz, Massimo Maffezzini, Giario Conti, Fabrizio Verweij, Daniel Kedar, Sandro D. Sandri, Ofer Nativ, Renzo Colombo

Research output: Contribution to journalArticle

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Abstract

Objectives: Non-muscle invasive bladder cancer (NMIBC) classified as T1G3 represents one of the most challenging issues in urologic oncology. Although it is still considered a lesion amenable for conservative management, the risk for recurrence and progression remains high. The aim of this study was to define both recurrence and progression rate in patients with T1G3 UCC treated by complete transurethral resection (TURT) and adjuvant thermochemotherapy approach. Materials and methods: We retrospectively evaluated the clinical data of patients with T1G3 NMIBC who underwent TURT followed by thermochemotherapy (TCT) treatment. Data recorded included age, gender, previous resections, previous intravesical treatment, time to tumor recurrence, and progression. TCT was given once weekly for 6 consecutive weeks, followed by 6 maintenance sessions at 4 to 6 weeks intervals. During each treatment session, 40 mg of mitomycin C (MMC) was instilled into the bladder in combination with bladder wall hyperthermia of 42 ± 2°C for 60 minutes. Follow-up cystoscopy and urinary cytology were performed every 3 months for the first 2 years and than biannually. Results: A total of 56 T1G3 patients were treated with adjuvant TCT treatment at 7 urologic centers. Mean age was 68 years (range 35-91), 10 were females and 46 were males. Twenty-six patients failed on at least 1 previous intravesical treatment. Five patients who dropped out due to adverse events before reaching the first outcome evaluation cystoscopy were referred to another intravesical therapy, and were therefore excluded from the current analysis. A total 51 patients were available for analysis. Median follow-up time of tumor-free patients was 18 months (average 20, range 2-49 months). Seventeen patients (33.3%) had tumor recurrence and 4 of them progressed to muscle invasive disease. The median time to recurrence was 9 months (average 11, range 2-31 months). The Kaplan-Meier estimated recurrence rate for this group is: 42.9% at 2 years, 51.0% at 4 years. Conclusions: TCT can be an effective adjuvant treatment option after TURT to prevent recurrence in patients with T1G3 NMIBC. Progression rate after this treatment was low (7.9%). TCT treatment was documented to be effective also in those who failed previous intravesical BCG. Treatment was confirmed to be safe and well tolerated.

Original languageEnglish
Pages (from-to)259-264
Number of pages6
JournalUrologic Oncology: Seminars and Original Investigations
Volume29
Issue number3
DOIs
Publication statusPublished - May 2011

Fingerprint

Transitional Cell Carcinoma
Mitomycin
Urinary Bladder
Fever
Recurrence
Urinary Bladder Neoplasms
Therapeutics
Cystoscopy
Neoplasms
Mycobacterium bovis
Cell Biology
Maintenance
Muscles

Keywords

  • Noninvasive bladder cancer
  • Progression
  • Recurrence
  • Safety
  • T1 high grade
  • Thermochemotherapy

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

Intravesical mitomycin C combined with hyperthermia for patients with T1G3 transitional cell carcinoma of the bladder. / Halachmi, Sarel; Moskovitz, Boaz; Maffezzini, Massimo; Conti, Giario; Verweij, Fabrizio; Kedar, Daniel; Sandri, Sandro D.; Nativ, Ofer; Colombo, Renzo.

In: Urologic Oncology: Seminars and Original Investigations, Vol. 29, No. 3, 05.2011, p. 259-264.

Research output: Contribution to journalArticle

Halachmi, Sarel ; Moskovitz, Boaz ; Maffezzini, Massimo ; Conti, Giario ; Verweij, Fabrizio ; Kedar, Daniel ; Sandri, Sandro D. ; Nativ, Ofer ; Colombo, Renzo. / Intravesical mitomycin C combined with hyperthermia for patients with T1G3 transitional cell carcinoma of the bladder. In: Urologic Oncology: Seminars and Original Investigations. 2011 ; Vol. 29, No. 3. pp. 259-264.
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abstract = "Objectives: Non-muscle invasive bladder cancer (NMIBC) classified as T1G3 represents one of the most challenging issues in urologic oncology. Although it is still considered a lesion amenable for conservative management, the risk for recurrence and progression remains high. The aim of this study was to define both recurrence and progression rate in patients with T1G3 UCC treated by complete transurethral resection (TURT) and adjuvant thermochemotherapy approach. Materials and methods: We retrospectively evaluated the clinical data of patients with T1G3 NMIBC who underwent TURT followed by thermochemotherapy (TCT) treatment. Data recorded included age, gender, previous resections, previous intravesical treatment, time to tumor recurrence, and progression. TCT was given once weekly for 6 consecutive weeks, followed by 6 maintenance sessions at 4 to 6 weeks intervals. During each treatment session, 40 mg of mitomycin C (MMC) was instilled into the bladder in combination with bladder wall hyperthermia of 42 ± 2°C for 60 minutes. Follow-up cystoscopy and urinary cytology were performed every 3 months for the first 2 years and than biannually. Results: A total of 56 T1G3 patients were treated with adjuvant TCT treatment at 7 urologic centers. Mean age was 68 years (range 35-91), 10 were females and 46 were males. Twenty-six patients failed on at least 1 previous intravesical treatment. Five patients who dropped out due to adverse events before reaching the first outcome evaluation cystoscopy were referred to another intravesical therapy, and were therefore excluded from the current analysis. A total 51 patients were available for analysis. Median follow-up time of tumor-free patients was 18 months (average 20, range 2-49 months). Seventeen patients (33.3{\%}) had tumor recurrence and 4 of them progressed to muscle invasive disease. The median time to recurrence was 9 months (average 11, range 2-31 months). The Kaplan-Meier estimated recurrence rate for this group is: 42.9{\%} at 2 years, 51.0{\%} at 4 years. Conclusions: TCT can be an effective adjuvant treatment option after TURT to prevent recurrence in patients with T1G3 NMIBC. Progression rate after this treatment was low (7.9{\%}). TCT treatment was documented to be effective also in those who failed previous intravesical BCG. Treatment was confirmed to be safe and well tolerated.",
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AU - Maffezzini, Massimo

AU - Conti, Giario

AU - Verweij, Fabrizio

AU - Kedar, Daniel

AU - Sandri, Sandro D.

AU - Nativ, Ofer

AU - Colombo, Renzo

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