The efficacy and safety of Hyperthermia intravesical chemotherapy in the treatment non-muscle invasive bladder cancer:A meta analysis

Background：The current treatment of non-muscle-invasive bladder cancer is suboptimal. However, in recent years, hyperthermia intravesical chemotherapy has emerged as a more effective alternative to conventional bladder perfusion. This novel treatment approach appears to have a similar therapeutic effect as BCG perfusion. Objective: This study aims to evaluate the safety and effectiveness of hyperthermia intravesical chemotherapy compared to conventional bladder perfusion chemotherapy for non-muscle-invasive bladder cancer. Additionally, it aims to evaluate the safety and effectiveness of hyperthermia intravesical chemotherapy in comparison to BCG perfusion therapy for non-muscle-invasive bladder cancer. Methods：We conducted a comprehensive search of PubMed, Embase, Cochrane Library, and Web of Science databases to gather relevant studies on hyperthermia intravesical chemotherapy for non-muscle-invasive bladder cancer. The analysis of the collected data was carried out using RevMan 5.3 software. Results：A total of 8 randomized controlled trials (RCTs) were included in this meta-analysis, involving 1203 patients. Among them, 629 cases received hyperthermia intravesical chemotherapy (HIVEC), 419 cases received conventional bladder perfusion chemotherapy with mitomycin C (MMC), and 155 cases received Bacillus Calmette-Guérin (BCG). The combined analysis revealed that the recurrence rate of bladder hyperthermic perfusion was significantly lower than that of conventional perfusion chemotherapy (RR=0.65, 95%CI 0.52-0.82, P=0.0003). However, there was no significant difference in recurrence rate between hyperthermia intravesical chemotherapy and BCG perfusion (RR=0.78, 95%CI 0.56-1.09, P=0.14). Furthermore, no significant difference was found in the progression rate between the hyperthermia intravesical chemotherapy group and either the conventional bladder chemotherapy group (RR=1.08, 95%CI 0.52-2.26, P=0.83) and the BCG perfusion group (RR=0.48, 95%CI 0.19-1.25, P=0.13). However, Compared with the conventional bladder perfusion chemotherapy group, there was no significant statistical difference in adverse events between the bladder hyperthermia chemotherapy group and the conventional bladder perfusion chemotherapy group (RR1.08, 95% CI 0.80,1.45, p=0.63). No significant difference in the incidence of adverse events was observed between hyperthermia intravesical chemotherapy and BCG perfusion (RR1.03, 95% CI 0.83,1.29, p=0.79).