The pilot study. Value of an Immediate Intravesical Instillation of Mitomycin C in Patients with Non-muscle-invasive Bladder Cancer: A Prospective Multicentre Randomised Study in 2243 patients. Society for Immunotherapy of Cancer consensus statement on immunotherapy for the treatment of bladder carcinoma A new approach using local combined microwave hyperthermia and chemotherapy in superficial transitional bladder carcinoma treatment. Multicentric study comparing intravesical chemotherapy alone and with local microwave hyperthermia for prophylaxis of recurrence of superficial transitional cell carcinoma. Combined local bladder hyperthermia and intravesical chemotherapy for the treatment of high-grade superficial bladder cancer.
This pilot aims to better underst and the market for childcare in Saudi Arabia – both the supply and dem and sides – and to design a r and omized controlled experiment to test whether access to affordable day care ( in the form of subsidies , for example ) would incentivize Saudi mothers to search actively for employment and to remain employed once they are hired . In addition , the study seeks to underst and the degree to which employment early on in one ’s life impacts employment in later stages . The pilot will provide information on the groups of women the experiment should target , appropriate levels for the childcare subsidy , and the quality and current geographic locations of daycare sites . Expected Impact Determine the effects of facilitating childcare access on Saudi women ’s employment . PRINCIPAL INVESTIGATORS  Boston University Patricia Cortes  Harvard University Claudia Goldin  Swarthmore College Jennifer BACKGROUND The efficacy of an immediate single chemotherapy instillation after transurethral resection of a bladder tumour ( TURBT ) in patients with non-muscle-invasive bladder cancer ( NMIBC ) remains a topic of debate . Evidence is even more scarce when an immediate instillation is followed by adjuvant instillations . OBJECTIVE To compare the effect of a mitomycin C ( MMC ) instillation within 24h to an instillation 2 wk after TURBT in patients with NMIBC with or without adjuvant instillations . DESIGN , SETTING , AND PARTICIPANTS Between 1998 and 2003 , 2844 NMIBC patients were r and omised for immediate versus delayed MMC instillation after TURBT .  Patients were categorised in low-risk ( LOR ) , intermediate-risk ( IMR ) , and high-risk ( HIR ) groups . Total numbers of instillations in these groups were 1 , 9 , and 15 , respectively . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Primary end point was 3-yr recurrence risk for the IMR and HIR groups and 5-yr risk for the LOR group . Secondary outcomes were time to recurrence and incidence of adverse events . Analyses were performed with the log-rank test , Cox-regression , and χ2 test in SPSS . RESULTS AND LIMITATIONS A total of 2243 patients were eligible on an intention-to-treat basis . Recurrence risks were 43 % and 46 % in the LOR group ( 5-yr follow-up , p=0.11 ) , 20 % and 32 % in the IMR group ( 3-yr follow-up , p=0.037 ) , and 28 % and 35 % in the HIR group ( 3-yr follow-up , p=0.007 ) , for an immediate and a delayed instillation , respectively . For all patients , the recurrence risk was 27 % ( 95 % confidence interval [ CI ] , 24 - 30 ) in the immediate and 36 % ( 95 % CI , 33 - 39 ) in the delayed instillation group ( p<0.001 ) with a 27 % reduction in relative recurrence risk ( hazard ratio : 0.73 , 95 % CI , 0.63 - 0.85 , p<0.001 ) . The incidence of adverse events did not differ significantly between treatment groups ( immediate instillation 25 % , delayed instillation 22 % , p=0.08 ) . The risk groups in our study differ slightly from the current guidelines , which is a limitation of our study . CONCLUSIONS An immediate , single instillation after TURBT reduces the recurrence risk in NMIBC patients , independent of the number of adjuvant installations . PATIENT SUMMARY A single instillation of chemotherapy after the resection of non-muscle-invasive bladder cancer reduces the recurrence risk , even if patients are treated with an adjuvant schedule of instillations The st and ard of care for most patients with non-muscle-invasive bladder cancer ( NMIBC ) is immunotherapy with intravesical Bacillus Calmette-Guérin ( BCG ) , which activates the immune system to recognize and destroy malignant cells and has demonstrated durable clinical benefit . Urologic best- practice guidelines and consensus reports have been developed and strengthened based on data on the timing , dose , and duration of therapy from r and omized clinical trials , as well as by critical evaluation of criteria for progression . However , these reports have not penetrated the community , and many patients do not receive appropriate therapy . Additionally , several immune checkpoint inhibitors have recently been approved for treatment of metastatic disease . The approval of immune checkpoint blockade for patients with platinum-resistant or -ineligible metastatic bladder cancer has led to considerations of exp and ed use for both advanced and , potentially , localized disease . To address these issues and others surrounding the appropriate use of immunotherapy for the treatment of bladder cancer , the Society for Immunotherapy of Cancer ( SITC ) convened a Task Force of experts , including physicians , patient advocates , and nurses , to address issues related to patient selection , toxicity management , clinical endpoints , as well as the combination and sequencing of therapies . Following the st and ard approach established by the Society for other cancers , a systematic literature review and analysis of data , combined with consensus voting was used to generate guidelines . Here , we provide a consensus statement for the use of immunotherapy in patients with bladder cancer , with plans to up date these recommendations as the field progresses For some time hyperthermia , alone or in combination with radiotherapy or chemotherapy , has proved to be a promising method for treating several kinds of solid tumors . After intensive laboratory investigations a new device , based on a microwave source delivering local bladder hyperthermia together with intravesical mitomycin C chemotherapy has been clinical ly tested as a neoadjuvant approach in 44 patients suffering from superficial cancer of the bladder . The combined approach was administered on an outpatient basis without major complications and with acceptable local toxicity . Endoscopic and histological evaluations proved that combined  local hyperthermia and chemotherapy can induce necrosis of transitional tumors . The overall response rate was 90.8 % , with 70.4 % complete and 20.4 % partial , leaving 4 patients ( 9.2 % ) nonrespondent . Clinical and histological evaluations have confirmed the feasibility and safety of this combined treatment . Further multicentric studies have been initiated PURPOSE To compare the efficacy and local toxicity of the intravesical instillation of a cytostatic drug versus the same cytostatic agent in combination with local hyperthermia as an adjuvant treatment , after complete transurethral resection ( TURB ) of superficial transitional cell carcinoma ( TCC ) of the bladder . PATIENTS AND METHODS The study was design ed as a prospect i ve , multicentric , r and omized trial . Eighty-three patients suffering from primary or recurrent superficial ( Ta-T1 ) TCC of the bladder , after a complete TURB , were r and omly assigned to receive intravesical instillations of mitomycin C ( MMC ) alone , for 41 patients , and MMC in combination with local microwave-induced hyperthermia , for 42 patients . For the combined approach , a new system , Synergo101 - 1 ( Medical Enterprises , Amsterdam , the Netherl and s ) was used . The effectiveness evaluation end points of the study were evaluation of recurrence-free survival and the estimated probability of recurrence . The safety evaluation end points included subjective and objective side effects and clinical complications . For the efficacy end point , Kaplan-Meier analysis was employed , with the log-rank test for significance . Minimum follow-up time was 24 months . RESULTS Of the 83 r and omly assigned patients , 75 completed the study according to the protocol and had valid cystoscopy results . Survival analysis of the 75 assessable patients demonstrated a highly significant difference in the survival curves in favor of thermochemotherapy . Subjective intolerance and clinical complications were significantly higher but transient and moderate in the combined treatment group . CONCLUSION In our series , endovesical thermochemotherapy appears to be more effective than st and ard endovesical chemotherapy as an adjuvant treatment for superficial bladder tumors at 24-month follow-up , despite an increased but acceptable local toxicity OBJECTIVES To evaluate the effectiveness of combined local bladder hyperthermia and intravesical chemotherapy for the treatment of patients with high- grade ( G3 ) superficial bladder cancer . METHODS Patients with G3 bladder tumors ( Stage Ta or T1 ) were treated with combined intravesical chemotherapy with mitomycin-C and local radiofrequency hyperthermia of the bladder wall . The patients were treated with either a prophylactic protocol ( 40 mg mitomycin-C ) after complete transurethral resection of all tumors or with an ablative protocol ( 80 mg mitomycin-C ) when visible tumor was seen on video-cystoscopy or bladder biopsies were positive for carcinoma in situ . RESULTS Combined chemo-thermotherapy was administered to 52 patients with high- grade superficial bladder cancer ( 40 patients with Stage T1 tumor , 11 with Ta , and 3 with concomitant or isolated carcinoma in situ ) . At a median follow-up of 15.2 months ( mean 23 , range 6 to 90 ) , no stage progression to T2 or disease-related mortality had occurred . The bladder preservation rate was 86.5 % . The prophylactic protocol was administered to 24 patients . After a mean follow-up of 35.3 months , 15 patients ( 62.5 % ) were recurrence free . The bladder preservation rate was 95.8 % . The ablative protocol was administered to 28 patients . Complete ablation of the tumor was accomplished in 21 patients ( 75 % ) . After a mean follow-up of 20 months , 80.9 % of these patients were recurrence free . The bladder preservation rate for the ablative group was 78.6 % . CONCLUSIONS Combined local bladder hyperthermia and intravesical chemotherapy has a beneficial prophylactic effect in patients with G3 superficial bladder cancer . Ablation of high- grade bladder tumors is feasible , achieving a complete response in about three quarters of the patients
Background : Non-muscle invasive bladder cancer accounts for nearly 80 % of newly diagnosed bladder cancer cases , which often recur and progress .
This meta- analysis was evaluated by the adverse events and recurrence rate of thermal intravesical chemotherapy vs. normal temperature intravesical chemotherapy in the treatment of non-muscle invasive bladder cancer .