Bladder cancer was the ninth most common cancer in the world according to the World Cancer Research Fund International. With more than 430,000 new cases diagnosed each year, bladder cancer is three times more common worldwide in men compared with women.

Level 1b Clinical results like the one below reveal that both Chemotherapy and Radiation treatment are more effective when combined with Hyperthermia.  Hyperthermia warms the tumor to temperatures in the "fever range" which makes the cancer cells more sensitive to treatment. Normal healthy cells recover while cancer cells die.

Clinical Information:

Tumor Entity:

Non Muscle Invasive Superficial Bladder Cancer Tumor Stage Ta & T1, Grade G1 – G3

Treatment Modality:

Chemotherapeutic intravesical instillation of Mitomycin-C (MMC) combined with intravesical hyperthermia applied preoperatively or postoperatively. 8 weekly followed by 4 monthly treatment sessions of 60 minutes each combining MMC instillation dosed as 20 mg MMC solved in 50 ml distilled water with intravesical or external regional deep hyperthermia at 42 °C +/- 2 °C.

Clinical Results as preoperative complete remission for 52 pts (Colombo 1996):

• MMC chemotherapy alone 22 %
• MMC chemotherapy with hyperthermia 66 %

Clinical Results for postoperative 10 y disease-free survival for 83 pts in multicenter randomized clinical trial (Colombo 2003 & 2010):

• MMC chemotherapy alone 15 %
• MMC chemotherapy with hyperthermia 53 %

Endorsement as Level Ib evidence by

• ESHO European Society of Hyperthermic Oncology
• EAU European Association of Urology
• SIU Società Italiana di Urologia

Chemotherapy and Hyperthermia:

When hyperthermia is combined with chemotherapy, general treatment guidelines of the ESHO European Society of Hyperthermic Oncology recommend:

• Target volume for hyperthermia: The target volume for hyperthermia is the gross tumor volume.
• Sequence of treatment modalities: Hyperthermia is given simultaneously with chemotherapy during cytostasis.
• Duration of hyperthermia treatment: Superficial hyperthermia total 60 minutes, deep hyperthermia total 90 minutes (including 30 minutes heating-up time)

References:

• Colombo et al. Neoadjuvant combined microwave induced local hyperthermia and topical chemotherapy versus chemotherapy alone for superficial bladder cancer. J Urol. 1996 Apr;155(4):1227-32.
• Colombo et al. Multicentric study comparing intravesical chemotherapy alone and with local microwave hyperthermia for prophylaxis of recurrence of superficial transitional cell carcinoma. J Clin Oncol. 2003 Dec 1;21(23):4270-6.
• Colombo et al. Long-term outcomes of a randomized controlled trial comparing thermochemotherapy with mitomycin-C alone as adjuvant treatment for non-muscle-invasive bladder cancer (NMIBC). BJU Int. 2011 Mar;107(6):912-8
• Wittlinger M, Rödel CM, Weiss C, Krause SF, Kühn R, Fietkau R, Sauer R, Ott OJ. Quadrimodal treatment of high-risk T1 and T2 bladder cancer: Transurethral tumor resection followed by concurrent radiochemotherapy and regional deep hyperthermia. Radiother Oncol. Nov 2009;93(2):358-63.