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Intravesical Chemohyperthermia vs. Bacillus Calmette-Guerin Instillation for Intermediate- and High-Risk Non-muscle Invasive Bladder Cancer: A Systematic Review and Meta-Analysis
H. Zhao, VW. Chan, D. Castellani, EO. Chan, WLK. Ong, Q. Peng, M. Moschini, W. Krajewski, B. Pradere, CF. Ng, D. Enikeev, N. Vasdev, G. Ekin, A. Sousa, J. Leon, F. Guerrero-Ramos, WS. Tan, J. Kelly, SF. Shariat, JA. Witjes, JY. Teoh
Language English Country Switzerland
Document type Systematic Review
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- Publication type
- Systematic Review MeSH
Background: The efficacy of intravesical chemotherapy maintenance for patients with non-muscle invasive bladder cancer (NMIBC) is inferior compared to intravesical bacillus Calmette-Guerin (BCG). How intravesical chemohyperthermia (CHT) compares with BCG is under investigation. Objective: To compare the oncological outcomes and safety profile between intravesical CHT and BCG treatment for intermediate- and high-risk NMIBC. Methods: We performed a systematic review and meta-analysis of clinical studies comparing CHT with BCG for intermediate- and high-risk NMIBC patients. A comprehensive literature search on OVID MEDLINE, EMBASE, and Cochrane Library was conducted. Risk of bias was assessed by the Cochrane RoB tool and ROBINS-I. Certainty of evidence was rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Results: A total of 2,375 articles were identified and five studies were finally included. Among them, four randomised trials comprising 327 patients (CHT group: 156 patients; BCG group: 171 patients) were included in the meta-analysis. There were no significant differences in the 24-36 months recurrence rates (CHT: 29.5%, BCG: 37.4%; RR: 0.83, 95% CI 0.61-1.13; moderate certainty of evidence) and the 24-36 months progression rates (CHT: 4.4%, BCG: 7.6%, RR = 0.62, 95% CI 0.26-1.49; low certainty of evidence). There were also no significant differences in grade 1-2 adverse events (CHT group: 59.9%, BCG group 54.5%; RR = 1.10, 95% CI 0.93-1.30; moderate certainty of evidence) and grade 3 or above adverse events (CHT group: 23.2%, BCG group 22.5%; RR = 0.99, 95% CI 0.69-1.43; low certainty of evidence). Conclusions: Intravesical CHT had equivalent oncological outcomes and similar safety profile when compared to BCG maintenance therapy for patients with intermediate- and high-risk NMIBC. CHT is a possible alternative treatment in the times of BCG shortage.
Department of Urology and Oncologic Urology Wrocław Medical University Wrocław Poland
Department of Urology Charles University Prague Czechia
Department of Urology Comarcal Hospital Monforte Spain
Department of Urology Medical University of Vienna Vienna Austria
Department of Urology Penang General Hospital George Town Malaysia
Department of Urology Radboud University Medical Centre Nijmegen Netherlands
Department of Urology Royal Free Hospital London United Kingdom
Department of Urology University College London Hospital London United Kingdom
Department of Urology University Hospital 12 de Octubre Madrid Spain
Department of Urology University Hospital of Tours Tours France
Department of Urology University of Texas Southwestern Dallas TX United States
Department of Urology Urla State Hospital Izmir Turkey
Department of Urology Weill Cornell Medical College New York NY United States
Division of Surgery and Interventional Sciences University College London London United Kingdom
Institute for Urology and Reproductive Health Sechenov University Moscow Russia
Klinik für Urologie Luzerner Kantonsspital Lucerne Switzerland
School of Medicine Faculty of Medicine and Health University of Leeds Leeds United Kingdom
References provided by Crossref.org
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- $a Intravesical Chemohyperthermia vs. Bacillus Calmette-Guerin Instillation for Intermediate- and High-Risk Non-muscle Invasive Bladder Cancer: A Systematic Review and Meta-Analysis / $c H. Zhao, VW. Chan, D. Castellani, EO. Chan, WLK. Ong, Q. Peng, M. Moschini, W. Krajewski, B. Pradere, CF. Ng, D. Enikeev, N. Vasdev, G. Ekin, A. Sousa, J. Leon, F. Guerrero-Ramos, WS. Tan, J. Kelly, SF. Shariat, JA. Witjes, JY. Teoh
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- $a Background: The efficacy of intravesical chemotherapy maintenance for patients with non-muscle invasive bladder cancer (NMIBC) is inferior compared to intravesical bacillus Calmette-Guerin (BCG). How intravesical chemohyperthermia (CHT) compares with BCG is under investigation. Objective: To compare the oncological outcomes and safety profile between intravesical CHT and BCG treatment for intermediate- and high-risk NMIBC. Methods: We performed a systematic review and meta-analysis of clinical studies comparing CHT with BCG for intermediate- and high-risk NMIBC patients. A comprehensive literature search on OVID MEDLINE, EMBASE, and Cochrane Library was conducted. Risk of bias was assessed by the Cochrane RoB tool and ROBINS-I. Certainty of evidence was rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Results: A total of 2,375 articles were identified and five studies were finally included. Among them, four randomised trials comprising 327 patients (CHT group: 156 patients; BCG group: 171 patients) were included in the meta-analysis. There were no significant differences in the 24-36 months recurrence rates (CHT: 29.5%, BCG: 37.4%; RR: 0.83, 95% CI 0.61-1.13; moderate certainty of evidence) and the 24-36 months progression rates (CHT: 4.4%, BCG: 7.6%, RR = 0.62, 95% CI 0.26-1.49; low certainty of evidence). There were also no significant differences in grade 1-2 adverse events (CHT group: 59.9%, BCG group 54.5%; RR = 1.10, 95% CI 0.93-1.30; moderate certainty of evidence) and grade 3 or above adverse events (CHT group: 23.2%, BCG group 22.5%; RR = 0.99, 95% CI 0.69-1.43; low certainty of evidence). Conclusions: Intravesical CHT had equivalent oncological outcomes and similar safety profile when compared to BCG maintenance therapy for patients with intermediate- and high-risk NMIBC. CHT is a possible alternative treatment in the times of BCG shortage.
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