Colombo R, Da Pozzo L F, Lev A, Salonia A, Rigatti P, Leib Z, Servadio C, Caldarera E, Pavone-Macaluso M
Department of Urology, Scientific Institute H. San Raffaele, Milan, Italy.
J Urol. 1998 Mar;159(3):783-7.
The role of a combined regimen of local hyperthermia and topical chemotherapy in patients with multifocal and recurrent superficial bladder tumors not curable by transurethral resection was evaluated in a neoadjuvant organ sparing clinical study.
A total of 19 patients with multifocal, superficial grades 1 to 3 bladder tumors that recurred after intravesical chemoprophylaxis or immunoprophylaxis underwent local combined administration of microwave induced hyperthermia and intravesical chemotherapy as a debulking approach. Due 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 choice. Endovesical hyperthermia at 42.5 to 46C was delivered using the SB-TS 101 system, based on a microwave transurethral applicator that irradiates the bladder filled with a circulating solution of mitomycin C. Patients underwent 8 weekly 1-hour sessions on an outpatient basis without anesthesia. When possible, after treatment patients underwent transurethral resection of residual tumors and all suspicious areas.
After treatment transurethral resection appeared to be feasible and curative in 16 patients (84%). Histological study revealed complete and partial responses in 9 (47%) and 7 (37%) cases, respectively. Due to extensive residual tumors radical cystectomy was performed in 3 patients (16%). At a median 33-month followup 8 superficial transitional tumor recurrences were documented and easily eradicated by transurethral resection or laser therapy in patients in whom the bladder had been saved.
Microwave induced hyperthermia combined with intravesical mitomycin C seems to be a feasible, safe and elective approach for conservative treatment of multifocal and recurrent superficial bladder tumors when other treatment strategies have failed.
在一项新辅助保器官临床研究中，评估局部热疗与局部化疗联合方案在经尿道切除术无法治愈的多灶性复发性浅表膀胱肿瘤患者中的作用。
共有19例多灶性、1至3级浅表膀胱肿瘤患者，在膀胱内化疗预防或免疫预防后复发，接受了微波诱导热疗与膀胱内化疗的局部联合给药作为减瘤方法。由于膀胱壁广泛的浅表受累，在所有病例中完全经尿道切除所有肿瘤在技术上似乎都不可行，根治性膀胱切除术被认为是首选治疗方法。使用SB-TS 101系统进行42.5至46°C的膀胱内热疗，该系统基于一种经尿道微波施加器，可照射充满丝裂霉素C循环溶液的膀胱。患者在门诊基础上每周接受8次1小时的治疗，无需麻醉。可能的话，治疗后患者接受经尿道切除残余肿瘤和所有可疑区域。
治疗后，经尿道切除术在16例患者（84%）中似乎可行且可治愈。组织学研究分别在9例（47%）和7例（37%）病例中显示完全缓解和部分缓解。由于广泛的残余肿瘤，3例患者（16%）接受了根治性膀胱切除术。在中位33个月的随访中，记录到8例浅表性移行肿瘤复发，在保留膀胱的患者中，经尿道切除术或激光治疗可轻松根除。
当其他治疗策略失败时，微波诱导热疗联合膀胱内丝裂霉素C似乎是多灶性和复发性浅表膀胱肿瘤保守治疗的一种可行、安全且选择性的方法。
