Intravesical Thermochemotherapy With Mitomycin-c
Intravesical Thermochemotherapy With Mitomycin-c
To investigate effect of intravesical mitomycin-C(MMC) applied with bladder wall
 thermotherapy system on reccurrence and progression status of intermediate and high risk non
 muscle invasive bladder cancer
Before the application of TCT, complete transurethral bladder tumour resection (TURBT) was
 performed. RE-TURBT was conducted within 4 weeks for patients with initial T1 pathology. The
 first TCT instillation was applied at 1mo following the TURBT or the RE-TURBT.

 Thermochemotherapy application and treatment schedule:

 The bladder wall TCT (BWT) system (Elmedical Ltd, Hod-Hasharon, Israel) was used as a
 conductive heating modality. MMC (40 mg; MMC Kyowa Hakko Kogyo Co., Ltd., Tokyo, Japan) was
 mixed with 50 mL of 0.9% saline solution and applied using a disposable silicone 20Fr 3-way
 TCT catheter (UniThermia catheter; Elmedical Ltd). In each session, the bladder was irrigated
 with MMC solution at 42°C-45°C for 45 min via the BWT system. The treatment schedule
 consisted of an initial 6-week instillation, followed by control cystoscopy and urine
 cytology in the 3rd month and monthly instillations up to 1 yr. Urine cytology and cystoscopy
 were performed every three months. The samples were collected from the suspected areas during
 cystoscopy. At the end of the first year, control cystoscopy with random bladder biopsies was
 conducted. During the second year, routine controls were conducted every three months.
 Subsequently, follow-ups were performed every six months. In case of development of any
 complication in a patient, TCT was discontinued. Before each instillation of TCT, clear urine
 cultures were obtained from all patients. No prophylactic anticholinergic was administered
 prior to intravesical TCT. If TUR BT pathology was Ta or T1 during the follow-up, it was
 accepted as a recurrence. If it was CIS or T2, it was accepted as a progression. All adverse
 events observed during the study were recorded according to the Common Terminology Criteria
 for Adverse Events (CTCAE) Version 4.0 [9. All study protocols were approved by the local
 ethical committee at our institution. An informed consent was obtained from all patients.
Inclusion Criteria:

 -  newly diagnosed or followed as recurrent intermediate-risk non muscle invasive non
 muscle invasive bladder cancer according to the criteria of European Association of
 Urology.

 -  newly diagnosed or followed as recurrent high-risk non muscle invasive non muscle
 invasive bladder cancer according to the criteria of European Association of Urology.

 -  pathology of urothelial carcinoma

 Exclusion Criteria:

 -  Low bladder capacity (<150ml)

 -  increased post voiding residual urine (>150ml)

 -  untreatable or uncontrollable urinary tract infection

 -  history of urethral stricture

 -  presence of bladder diverticula larger than 1 cm

 -  pathology other than urothelial carcinoma

 -  WHO (World Health Organization) performance status > 2

 -  upper urinary tract urothelial carcinoma diagnosis