Abstract：
OBJECTIVE: Many patients receiving intravesical BCG treatment for non-muscle-invasive bladder cancer experience high recurrence rates despite initial adequate response. In this study, the effectiveness of intravesical chemohyperthermia (CHT) with mitomycin C (MMC) was evaluated in patients who developed relapse after intravesical BCG treatment or could not tolerate the treatment and could not undergo radical cystectomy for any reason.
METHODS: 59 patients who underwent complete bladder tumour resection, who had a T1 high-grade tumour and no variant histology was observed in the pathology, and who had previously received intravesical BCG treatment were included in the study. Adjuvant treatment with intravesical CHT-MMC was applied. As a treatment protocol, induction was applied once a week for 6 weeks, followed by maintenance treatment 6 times at 4-week intervals. Each treatment session, it involved bladder wall hyperthermia with a temperature of up to 42 ℃ ± 2 and intravesical administration of 20 mg/50 ml MMC solution twice at 30-min intervals.
RESULTS: Recurrence-free survival after warm mitomycin was 58.7 and 48%, respectively, at 24 months and 44 months, and progression-free survival was 72.6 and 66.2%, respectively. In the subgroup analysis performed according to the number of tumours at diagnosis (single, 2-5, more than 5), recurrence-free survival rates were 81.8%, 48.2% and 11%, respectively, during the median follow-up period of 44 months.
CONCLUSIONS: Intravesical CHT-MMC can be considered as an alternative treatment in selected well-informed patients with non-muscle-invasive papillary urothelial carcinoma who are unresponsive to BCG or intolerant to BCG. Prospectively designed studies with larger number of patients are needed.
METHODS: 59 patients who underwent complete bladder tumour resection, who had a T1 high-grade tumour and no variant histology was observed in the pathology, and who had previously received intravesical BCG treatment were included in the study. Adjuvant treatment with intravesical CHT-MMC was applied. As a treatment protocol, induction was applied once a week for 6 weeks, followed by maintenance treatment 6 times at 4-week intervals. Each treatment session, it involved bladder wall hyperthermia with a temperature of up to 42 ℃ ± 2 and intravesical administration of 20 mg/50 ml MMC solution twice at 30-min intervals.
RESULTS: Recurrence-free survival after warm mitomycin was 58.7 and 48%, respectively, at 24 months and 44 months, and progression-free survival was 72.6 and 66.2%, respectively. In the subgroup analysis performed according to the number of tumours at diagnosis (single, 2-5, more than 5), recurrence-free survival rates were 81.8%, 48.2% and 11%, respectively, during the median follow-up period of 44 months.
CONCLUSIONS: Intravesical CHT-MMC can be considered as an alternative treatment in selected well-informed patients with non-muscle-invasive papillary urothelial carcinoma who are unresponsive to BCG or intolerant to BCG. Prospectively designed studies with larger number of patients are needed.
摘要：
目的：许多接受膀胱内BCG治疗的非肌层浸润性膀胱癌患者尽管最初有足够的反应，但复发率高。在这项研究中,对膀胱内化疗(CHT)联合丝裂霉素C(MMC)治疗后复发或不能耐受治疗且因任何原因不能接受根治性膀胱切除术的患者进行了评价.
方法：59例接受完全膀胱肿瘤切除术的患者，谁有T1高级别肿瘤，在病理学中没有观察到变异的组织学，和以前接受过膀胱内BCG治疗的患者被纳入研究.应用膀胱内CHT-MMC辅助治疗。作为一种治疗方案，诱导每周一次，持续6周，随后以4周的间隔进行6次维持治疗。每次治疗,它涉及温度高达42℃±2的膀胱壁热疗，并以30分钟的间隔两次膀胱内给药20mg/50mlMMC溶液。
结果：热丝裂霉素后的无复发生存率分别为58.7％和48％，分别,在24个月和44个月，无进展生存率为72.6％和66.2％，分别。在根据诊断时肿瘤数量进行的亚组分析中（单个，2-5，超过5），无复发生存率为81.8%,48.2%和11%，分别,中位随访期44个月.
结论：膀胱内CHT-MMC可被视为对BCG无反应或对BCG不耐受的非肌肉浸润性乳头状尿路上皮癌患者的替代治疗。需要对更多患者进行前瞻性设计的研究。
方法：59例接受完全膀胱肿瘤切除术的患者，谁有T1高级别肿瘤，在病理学中没有观察到变异的组织学，和以前接受过膀胱内BCG治疗的患者被纳入研究.应用膀胱内CHT-MMC辅助治疗。作为一种治疗方案，诱导每周一次，持续6周，随后以4周的间隔进行6次维持治疗。每次治疗,它涉及温度高达42℃±2的膀胱壁热疗，并以30分钟的间隔两次膀胱内给药20mg/50mlMMC溶液。
结果：热丝裂霉素后的无复发生存率分别为58.7％和48％，分别,在24个月和44个月，无进展生存率为72.6％和66.2％，分别。在根据诊断时肿瘤数量进行的亚组分析中（单个，2-5，超过5），无复发生存率为81.8%,48.2%和11%，分别,中位随访期44个月.
结论：膀胱内CHT-MMC可被视为对BCG无反应或对BCG不耐受的非肌肉浸润性乳头状尿路上皮癌患者的替代治疗。需要对更多患者进行前瞻性设计的研究。
