ABSTRACT
Background&Aim: High grade non-muscle invasive bladder cancer (NMIBC) is common in urological practice. Most of these cancers are or become refractory to intravesical immunotherapy and chemotherapy. Here we evaluated the efficacy of combined local bladder hyperthermia and intravesical mitomycin-C (MMC) instillation in patients with high-risk recurrent NMIBC. MATERIALS AND METHODS: Between February 2014 and December 2015, 18 patients with high risk NMIBC were enrolled. Patients were treated in an outpatient basis with 6 weekly induction sessions followed by monthly maintenance sessions with intravesical MMC in local hyperthermia with bladder wall thermo-chemotherapy (BWT) system (PelvixTT system, Elmedical Ltd., Hod Hasharon, Israel). The follow-up regimen included cystoscopy after the induction cycle and thereafter with regular intervals. Time to disease recurrence was defined as time from the first intravesical treatment to endoscopic or histological documentation of a new bladder tumour. Adverse events were recorded according to CTC 4.0 (Common Toxicity Criteria) score system. RESULTS: Mean age was 72 (32-87) years. 10 patients had multifocal disease, 9 had CIS, 6 had recurrent disease and 2 had highly recurrent disease (> 3 recurrences in a 24 months period). 6 patients underwent previous intravesical chemotherapy with MMC. The average number of maintenance sessions per patient was 7.6. After a mean follow-up of 433 days, 15 patients (83.3%) were recurrence-free. 3 patients had tumour recurrence after a mean period of 248 days without progression. Side effects were limited to grade 1 in 2 patients and grade 2 in 1 patient. CONCLUSIONS: BWT seems to be feasible and safe in high grade NMIBC. More studies are needed to identify the subgroup of patients who may benefit more from this treatment.
Subject(s)
Antibiotics, Antineoplastic/administration & dosage , Hyperthermia, Induced , Mitomycin/administration & dosage , Neoplasm Recurrence, Local/prevention & control , Urinary Bladder Neoplasms/prevention & control , Administration, Intravesical , Adult , Aged , Aged, 80 and over , Combined Modality Therapy , Disease Progression , Female , Humans , Male , Middle Aged , Neoplasm Invasiveness , Retrospective Studies , Risk , Treatment Outcome , Urinary Bladder Neoplasms/pathology , Urinary Bladder Neoplasms/therapyABSTRACT
OBJECTIVES: Our objective was to investigate the effects of previous open nephrolithotomy on technical features, outcomes, and morbidities of subsequent percutaneous nephrolithotomy (PCNL). METHODS: One hundred and sixty patients underwent PCNL between December 2004 and September 2006. The patients were divided into those who had previous open nephrolithotomy on the same kidney (group 1: 55 patients) and those who had no previous open surgery (group 2: 105 patients). Technical features encountered during operation and outcomes were compared between groups. RESULTS: There were no significant differences between groups with respect to mean age (group 1: 42.6 +/- 10 years vs. group 2: 45.5 +/- 9.6 years), body mass index (24.8 +/- 2.11 vs. 24.6 +/- 2.14), and stone burden (385.6 +/- 140.6 mm(2 )vs. 401.05 +/- 142 mm(2)). In group 1, 28 and 27 stones were located in the right and left kidney, respectively, whereas the location was 51 and 54 for the right and left kidney, respectively, in group 2. When the groups were compared, the mean operative time was significantly longer (155 +/- 30 min vs. 137 +/- 30 min) in group 1. But there was no significant difference with respect to requirement for secondary intervention (11% vs. 10%). Sepsis developed in two patients in group 1 and one patient in group 2. One patient in group 1 died due to septic shock. Ten (18.2%) patients in group 1 and 13 (12.4%) patients in group 2 required blood transfusion. CONCLUSIONS: When PCNL is performed after previous open nephrolithotomy, the operative time lengthens. But there is no difference with respect to success rate and morbidities.
