Colombo Renzo, Moschini Marco
Dipartimento di Urologia, Urological Research Unit, Università San Raffaele, Milano - Italy.
Urologia. 2013 Apr-Jun;80(2):112-9. doi: 10.5301/RU.2013.11296. Epub 2013 Jul 1.
To give an updated review concerning the role of combined regimen (CT) based on microwave-induced hyperthermia (MwHT, CT-MwHT) with intravesical chemotherapy (ICT) as a treatment for non-muscle invasive bladder cancer (NMIBC).
The review process followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. An electronic search of the Medline, Embase, Cochrane Library, CancerLit, and ClinicalTrials.gov databases was undertaken. Relevant conference abstracts and urology journals were also included. The primary end-point was the time to recurrence. Secondary end-points included time to progression, bladder preservation rate, and adverse event (AE) rate.
A total of 24 studies met inclusion criteria and underwent data extraction. When feasible, data were combined using random-effects meta-analytic techniques. Recurrence was seen 59% less after CT-MwHT than after MMC alone, however, due to the short follow-up, no definitive conclusions can be drawn about the impact on the time to recurrence and progression. The overall bladder preservation rate after CT-MwHT was 87.6%. This rate appeared higher than after MMC alone, but valid comparison studies could not be drawn due to the absence of randomized trials in neo-adjuvant settings. AEs were higher with CT-MwHT than with MMC alone, but this difference was not statistically significant.
Published data suggest that recurrence rates for chemo-hyperthermia are substantially reduced compared with chemotherapy alone in adjuvant settings. Patients with refractory disease fare worse than those being treated with chemo-hyperthermia for their first tumor. Progression rates to muscle-invasive disease are markedly lower after combination treatment than after chemotherapy alone, with very high rates of bladder preservation. Tolerability is good, with few dropouts in the clinical trials. The results support CT-MwHT in the future as a standard procedure for high-risk recurrent patients, for subjects in whom the treatment with Bacillus Calmette-Guérin is contraindicated, and those unsuitable for radical cystectomy.
对基于微波诱导热疗（MwHT，CT-MwHT）联合膀胱内化疗（ICT）治疗非肌层浸润性膀胱癌（NMIBC）的作用进行更新综述。
综述过程遵循系统评价和Meta分析的首选报告项目（PRISMA）指南。对Medline、Embase、Cochrane图书馆、CancerLit和ClinicalTrials.gov数据库进行了电子检索。还纳入了相关会议摘要和泌尿外科杂志。主要终点是复发时间。次要终点包括进展时间、膀胱保留率和不良事件（AE）发生率。
共有24项研究符合纳入标准并进行了数据提取。在可行的情况下，使用随机效应Meta分析技术合并数据。与单纯使用丝裂霉素（MMC）相比，CT-MwHT后复发率降低了59%，然而，由于随访时间短，关于对复发时间和进展时间的影响无法得出明确结论。CT-MwHT后的总体膀胱保留率为87.6%。该比率似乎高于单纯使用MMC后的比率，但由于新辅助治疗中缺乏随机试验，无法进行有效的比较研究。CT-MwHT的不良事件发生率高于单纯使用MMC，但这种差异无统计学意义。
已发表的数据表明，在辅助治疗中，与单纯化疗相比，化疗热疗的复发率大幅降低。难治性疾病患者的预后比首次肿瘤接受化疗热疗的患者更差。联合治疗后进展为肌层浸润性疾病的比率明显低于单纯化疗后，膀胱保留率非常高。耐受性良好，临床试验中很少有患者退出。这些结果支持CT-MwHT在未来作为高危复发患者、卡介苗治疗禁忌患者以及不适合根治性膀胱切除术患者的标准治疗方法。
