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World J Clin Urol. Jul 24, 2017; 6(2): 34-39
Published online Jul 24, 2017. doi: 10.5410/wjcu.v6.i2.34
Recirculating chemohyperthermia as a treatment for non-muscle invasive bladder cancer: Current and future perspectives
Javier Flores-Carbajal, Alejandro Sousa-Escandón, Daniel Sousa-Gonzalez, Silvia Rodriguez Gomez, Manuel Lopez Saavedra, M Elia Fernandez Martinez
Javier Flores-Carbajal, Alejandro Sousa-Escandón, Daniel Sousa-Gonzalez, Silvia Rodriguez Gomez, Manuel Lopez Saavedra, M Elia Fernandez Martinez, Comarcal Hospital of Monforte, 27400 Monforte-Lugo, Spain
Author contributions: All authors contributed to the treatment with CHT and follow up of patients assisted in our Hospital; Flores-Carbajal J, Sousa-Escandón A and Sousa-Gonzalez D was involved in writing the manuscript.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Alejandro Sousa-Escandón, Chief of Service, Comarcal Hospital of Monforte, Curros Enriquez St. 41, 27400 Monforte-Lugo, Spain. sousa-alejandro@hotmail.com
Telephone: +34-607-856407
Received: August 28, 2016
Peer-review started: September 1, 2016
First decision: December 13, 2016
Revised: December 19, 2016
Accepted: March 13, 2017
Article in press: March 15, 2017
Published online: July 24, 2017
Processing time: 326 Days and 7.1 Hours
Abstract

About 75% of all bladder cancer diagnosed are non-muscle invasive bladder cancer (NMIBC), recurring over 50% of them after transurethral resection of the bladder tumor. In order to prevent recurrences, adjuvant intravesical chemotherapy with mitomycin C and immunotherapy with bacillus Calmette-Guérin (BCG) is traditionally used. Unfortunately, many patients relapse after receiving these treatments and a significant proportion of them require surgery. After a one-to-three years BCG maintenance, the risk for progression at 5 years was 19.3% for T1G3 tumors. Many new treatment approaches are being investigated to increase the effectiveness of adjuvant intravesical therapy. One of the developing treatments for intermediate and high-risk NMIBC is the combination of intravesical chemotherapy and hyperthermia, called chemohyperthermia. This article provides a review of the mechanism of action, current status and indications, results and future perspectives.

Keywords: Bladder cancer; Thermotherapy; Non-muscle invasive; Chemohyperthermia; Recirculating; Intravesical chemotherapy; Treatment; Mechanism of action

Core tip: Chemohyperthermia has demonstrated a selective cytotoxicity on tumoral cells without affecting the remaining healthy cells and it significantly increases the penetration of MMC during intravesical instillations. Moreover, hyperthermia and many chemotherapeutic agents have a synergistic effect, significantly reducing the relative risk of tumoral recurrence in patients non-muscle invasive bladder cancer. Recirculative systems are a novel way to apply endovesical chemohyperthermia, which achieves excellent clinical results with a better side effects profile and a lower price than the one of other chemohyperthermia technologies.