LOCAL MICROWAVE HYPERTHERMIA AND INTRAVESICAL CHEMOTHERAPY AS BLADDERSPARING TREATMENT FOR SELECT MULTIFOCAL AND UNRESECTABLE SUPERFICIAL BLADDER-TUMORS

Purpose: The role of a combined regimen of local hyperthermia and topi cal chemotherapy in patients with multifocal and recurrent superficial bladder tumors not curable by transurethral resection was evaluated i n a neodjuvant organ sparing clinical study. Materials and Methods: A total of 19 patients with multifocal, superficial grades 1 to 3 bladde r tumors that recurred after intravesical chemoprophylaxis or immunopr ophylaxis underwent local combined administration of microwave induced hyperthermia and intravesical chemotherapy as a debulking approach. D ue to extensive superficial involvement of the bladder walls complete transurethral resection of all tumors seemed technically unfeasible in all cases and radical cystectomy was considered the treatment of choi ce. Endovesical hyperthermia at 42.5 to 46C was delivered using the SB -TS 101 system, based on a microwave transurethral applicator that ir radiates the bladder filled with a circulating solution of mitomycin C . Patients underwent 8 weekly 1-hour sessions on an outpatient basis w ithout anesthesia. When possible, after treatment patients underwent t ransurethral resection of residual tumors and all suspicious areas. Re sults: After treatment transurethral resection appeared to be feasible and curative in 16 patients (84%). Histological study revealed comple te and partial responses in 9 (47%) and 7 (37%) cases, respectively. D ue to extensive residual tumors radical cystectomy was performed in 3 patients (16%). At a median 33-month followup 8 superficial transition al tumor recurrences were documented and easily eradicated by transure thral resection or laser therapy in patients in whom the bladder had b een saved. Conclusions: Microwave induced hyperthermia combined with i ntravesical mitomycin C seems to be a feasible, safe and elective appr oach for conservative treatment of multifocal and recurrent superficia l bladder tumors when other treatment strategies have failed.