HYPERTHERMIC THERAPY OF THE BLADDER CANCER

III. Clinical Studies

Abstract

In order to develop a new therapy for the management of bladder cancer, hyperthermic therapy of bladder cancer using bladder irrigation with warmed saline, was investigated. Thirty-four patients with multiple transitional cell carcinoma of the bladder were treated with 4 kinds of hyperthermic therapy; hyperthermia alone, combined therapy of hyperthermia and bleomycin, combined therapy of hyperthermia and radiation, and combined therapy of hyperthermia, bleomycin and radiation. Hyperthermic treatment was accomplished as described below: warmed saline was irrigated into the bladder cavity through a 3-way catherter with the temperature in the bladder being maintained at 42°-43°C. A course of treatment consisted of a series of 10 to 12 applications of hyperthermia for 1 hour each. For those patients receiving hyperthermia and bleomycin, bleomycin was added to saline solution to a final concentration of 30mg/l. In those treatments involving radiation, 150 to 200rad/day were administrated to the bladder externally using Linac of ⁶⁰Co. Immediately after irradiation, patients were irrigated with warmed saline (with or without bleomycin) for 1 hour. The total dose of the radiation was limited to 3, 500 to 4, 000rad. Obvious tumor regression was observed in two out of six patients treated with hyperthermic therapy alone. Similar regressions were observed in one out of four, five out of nine and twelve out of fifteen patients who were treated with combined therapy of hyperthermia and bleomycin, combined therapy of hyperthermia and radiation, and combined therapy of hyperthermia, bleomycin, and radiation, respectively.
Among the twenty-four patients who received the combined therapy of hyperthermia and radiation (with or without bleomycin), low staged tumors (T1) responded most effectively to the therapy. Significant results were, however, also obtained with T2-T3 staged tumors. High grade tumor (G2-G3) showed an increased response over low grade tumor (G1).
The most frequent side effects of those therapies were bladder irritation and urethral pain. Bladder irritation was induced most intensively by the combined therapies of hyperthermia, radiation and bleomycin. This side effect was reversed except in one patient. There were no serious complications.
Immunological competency of the patients treated with combined therapy of hyperthermia and radiation (with or without bleomycin) was examined using parameters such as lymphocyte counts and PHA, ConA blastogenesis of peripheral lymphocytes. This therapy induced suppression of blastogenesis of lymphocyte. But this effect was quantitatively the same as that of radiation therapy alone on the bladder cancer.
Those results suggest that hyperthermic therapy is clinically applicable for the treatment of bladder cancer. Those treatments may be particularly useful in the case of multiple superficial tumors, as an adjuvant treatment of preoperative radiation with cystectomy, and in those patients with severe complications of the lung, heart and others.