The role of device-assisted therapies in the management of non-muscle invasive bladder cancer: A systematic review.

Despite optimal treatment, patients affected by non-muscle invasive bladder cancer (NMIBC) suffer from high risk of recurrence and progression. Intravescical device assisted therapies such as radiofrequency induced thermochemotherapeutic effect (RITE) and electromotive drug administration (EMDA) have shown promising effect in enhancing the effect of intravescical chemotherapies. The aim of the study was to assess clinical outcomes of these two devices in non-muscle invasive bladder cancer.

A systematic literature review was performed in December 2019 using the Medline, Embase, and Web of Science databases. Only articles published in the last 10 years were considered (2009-2019). The articles were selected using the following keywords association: "bladder cancer" AND "EMDA' AND "synergo" AND "hyperchemotherapy" AND "electromotive drug administration", AND "radiofrequency induced thermochemotherapeutic" AND "RITE".

We found 16 studies published in the last ten years regarding the efficacy of RITE (12 studies) and EMDA (4 studies) in the treatment of NMIBC. Both RITE and EMDA showed promising results in the treatment of intermediate and high risk NMIBC as well as in patients affected by recurrent BCa after BCG failure. In high-risk BCG naïve NMIBC patients treated with EMDA recurrence and progression rates were 68% and 95%, respectively. Considering RITE, recurrence and progression range rates were 43%-88% and 62%-97%, respectively. Discordance results were reported regarding its effect on patients with carcinoma in situ. However, only few studies could be compared since differences exist regarding inclusion criteria with high patients' heterogeneity. Considering recurrence after BCG, recurrence and progression range rates were 29%-29.2% and 62%-83% for RITE and 25% and 75% for EMDA, respectively.

Delivery of intravescical hyperthermia seems to enhance the normal effect of intravescical chemotherapy instillation. Although prospective trials supported its effect on both BCG naïve and BCG failure patients, data are urgently required to validate these findings and to understand its effect on patients with carcinoma in situ.


Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie. 2020 Apr 09 [Epub ahead of print]

R Carando, B Pradere, L Afferi, G Marra, A Aziz, F Roghmann, W Krajewski, C Di Bona, M Alvarez-Maestro, V Pagliarulo, E Xylinas, M Moschini

Clinica Luganese Moncucco, Lugano, Switzerland; Clinica S. Anna, Swiss Medical Group, Sorengo, Switzerland; Clinica Santa Chiara, Locarno, Switzerland; Department of Urology, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern, Switzerland. Electronic address: ., Department of Urology, Centre Hospitalier Universitaire Tours, Tours, France; Department of Urology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria., Department of Urology, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern, Switzerland., Division of Urology, Department of Surgical Sciences, University of Studies of Torino, Turin, Italy., Department of Urology, University Medical Center Rostock, Rostock, Germany., Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany., Department of Urology and Oncologic Urology, Wrocław Medical University, Wroclaw, Poland., Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain., Department of Urology, University "Aldo Moro", Bari, Italy., Department of Urology Bichat Hospital, Paris Descartes University, Paris, France.