Neoadjuvant chemohyperthermia: Our experience after 10 years. / Quimiohipertermia neoadyuvante: nuestra experiencia después de 10 años.

Neoadjuvant chemohyperthermia (QHT) with MMC has demonstrated its efficacy in NMIBC both in the level of complete response at the time of TURBT and reduction of recurrences after several years of follow up. We present our experience with this treatment. METHODS: We performed a case control study in a group of 104 patients with middle-high risk NMIBC. 43 of them received neoadjuvant recirculated intravesical QHT and 61 passively administered standard adjuvant MMC. Patient follow up was 43 months (3 - 108) evaluating their clinical efficacy and adverse effects in both groups. RESULTS: After neoadjuvant QHT, 27 patients showed CR (63%), 13 PR (30.2%) and 3 NR (6.9%). 5 year recurrence rate after QHT passive MMC were 16.2% and 26.2% respectively. No patient in the QHT group presented tumor progression compared to 5% progressions in the group treated with MMC at room temperature and 1.6% deaths due to metastatic disease. 94% QHT programmed doses were administered in comparison to 97%in the group of standard MMC. In the QHT group there were 60.5% grade 1-2 AEs in comparison with 49% in the standard MMC group (p<0.4). Likewise, 9.3% cases in the QHT group presented Grade 3 AEs versus 6.5% in the standard MMC (p<0,06). CONCLUSIONS: Recirculating neoadjuvant QHT achieves a reduction in tumor recurrence after 4 years with a similar AE rate in comparison with passive instillation of MMC.

Quimiohipertermia neoadyuvante: nuestra experiencia después de 10 años / Neoadjuvant chemohyperthermia: Our experience after 10 years

La quimiohipertermia (QHT) neoadyuvante con MMC ha demostrado su eficacia en el CVNMI tanto a nivel de respuestas completas en el momento de la RTU vesical como en la reducción de recidivas tras varios años de seguimiento. Presentamos nuestra experiencia con este tratamiento. Métodos: Realizamos un estudio de casos y controles de un grupo de 104 pacientes con CVNMI de riesgo medio-alto. De ellos, 43 recibieron QHT intravesical neoadyuvante recirculante y 61 recibieron MMC adyuvante estándar instilada de forma pasiva. Los pacientes fueron seguidos 43 meses (3 - 108) evaluándose su eficacia clínica y efectos adversos en ambos grupos. Resultados: Tras la QHT neoadyuvante, 27 pacientes mostraron RC (63%), 13 mostraron RP (30,2%) y los 3 mostraron NR (6,9%). La recurrencia a 5 años tras QHT fue del 16,2% y del 26,2% tras la MMC pasiva. Ningún paciente del grupo de QHT presentó progresión tumoral frente a un 5% de progresiones en el grupo tratado con MMC a temperatura ambiente y un 1,6% de exitus por enfermedad metastásica. Un 94% de las dosis de QHT pudieron ser administradas frente a un 97 en el grupo de MMC pasiva. En el grupo de QHT aparecieron un 60,5% de EA grado 1-2 frente al 49% en el en el grupo de MMC pasiva (p<0,4). Igualmente, un 9,3% del grupo de QHT presentaron EA grado 3 frente a un 6,5% en la MMC pasiva (p<0,6). Conclusiones: La QHT neoadyuvante recirculante consigue una reducción de las recidivas tumorales tras 4 años de tratamiento con un nivel de EA similar al de la instilación pasiva de MMC

Neoadjuvant chemohyperthermia (QHT) with MMC has demonstrated its efficacy in NMIBC both in the level of complete response at the time of TURBT and reduction of recurrences after several years of follow up. We present our experience with this treatment. METHODS: We performed a case control study in a group of 104 patients with middle-high risk NMIBC. 43 of them received neoadjuvant recirculated intravesical QHT and 61 passively administered standard adjuvant MMC. Patient follow up was 43 months (3 - 108) evaluating their clinical efficacy and adverse effects in both groups. Results: After neoadjuvant QHT, 27 atients showed CR (63%), 13 PR (30.2%) and 3 NR (6.9%). 5 year recurrence rate after QHT passive MMC were 16.2% and 26.2% respectively. No patient in the QHT group presented tumor progression compared to 5% progressions in the group treated with MMC at room temperature and 1.6% deaths due to metastatic disease. 94% QHT programmed doses were administered in comparison to 97% in the group of standard MMC. In the QHT group there were 60.5% grade 1-2 AEs in comparison with 49% in the standard MMC group (p<0.4). Likewise, 9.3% cases in the QHT group presented Grade 3 AEs versus 6.5% in the standard MMC (p<0,06). Conclusions: Recirculating neoadjuvant QHT achieves a reduction in tumor recurrence after 4 years with a similar AE rate in comparison with passive instillation of MMC