Researchers from Israel have reported that thermo-chemotherapy with mitomycin C in patients with recurrent superficial bladder cancer after treatment with Bacillus Calmette-Guerin (BCG) results in an 85% one-year disease-free survival (DFS) rate. The details of this study appeared in the October 2009 issue of the Journal of Urology.[1]
Standard initial treatment for all patients with Stage I bladder cancer is a transurethral resection (TUR) with electrical (cautery) or laser thermal destruction of all visualized cancer. Most patients receive adjuvant therapy with BCG or chemotherapy such as mitomycin C. BCG is the most common form of adjuvant treatment, but almost half of all patients with superficial bladder cancer will ultimately have progression to invasive bladder cancer. A recent study has shown that weekly BCG or mitomycin C treatments for six weeks are associated with a 25% three-year recurrence rate. However, three-year monthly mitomycin C treatment decreases the three-year recurrence rate to 10%.
Patients failing BCG who still have superficial bladder cancer without muscle invasion are treated with instillation of chemotherapy, usually mitomycin C or other chemotherapy. The current study involved 111 patients with recurrent papillary non-muscle-invasive bladder cancer. All had been previously treated with BCG. They received weekly bladder instillations of mitomycin C for six weeks followed by six maintenance treatments at four- to six-week intervals. Heating of the bladder wall to 42C and flushing of the bladder was accomplished with the Synergo® machine.[2] The estimated one-year DFS rate was 85%, and the two-year DFS rate was 56%. Patients who received the maintenance therapy had a 61% DFS rate at two years compared with 39% for those with no maintenance. The progression rate to muscle invasion was 3%, which is lower than would have been predicted from the literature.
Comments: These authors suggest that the thermo-chemotherapy approach may be superior to conventional instillation of mitomycin C with a low rate of progression to muscle invasion.
Reference:
[1] Nativ O, Witjes JA, Hendricksen K, et al. Combined thermo-chemotherapy for recurrent bladder cancer after Bacillus Calmette-Guerin. Journal of Urology. 2009;182:1313-1317.
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