Topic Paper

World Journal of Urology

, Volume 27, Issue 3, pp 319-324

Open Access This content is freely available online to anyone, anywhere at any time.

Intravesical hyperthermia and mitomycin-C for carcinoma in situ of the urinary bladder: experience of the European Synergo® working party

  • J. Alfred WitjesAffiliated withDepartment of Urology, Radboud University Nijmegen Medical Centre Email author 
  • , Kees HendricksenAffiliated withDepartment of Urology, Radboud University Nijmegen Medical Centre
  • , O. GofritAffiliated withDepartment of Urology, Hadassah University Hospital
  • , O. RisiAffiliated withDepartment of Urology, Ospedale Consorziale di Treviglio e Caravaggio
  • , O. NativAffiliated withDepartment of Urology, Bnay-Zion Medical Center



To study the results of chemotherapy combined with intravesical hyperthermia in patients with mainly BCG-failing carcinoma in situ (CIS).


Patients with histologically confirmed CIS were included retrospectively. Outpatient thermochemotherapy treatment was done with mitomycin-C (MMC) and the Synergo® system SB-TS 101 (temperature range between 41 and 44°C), weekly for 6–8 weeks, followed by 4–6 sessions every 6–8 weeks.


Fifty-one patients were treated between 1997 and 2005 from 15 European centers. Thirty-four were pre-treated with BCG. Mean age was 69.9 years. Twenty-four patients had concomitant papillary tumors. The mean number of hyperthermia/MMC treatments per patient was 10.0. Of the 49 evaluable patients 45 had a biopsy and cytology proven complete response. In two patients CIS disappeared, but they had persistent papillary tumors. Follow-up of 45 complete responders showed 22 recurrences after a mean of 27 months (median 22): T2 (4), T1 (4), T1/CIS (1), CIS (5), Ta/CIS (2), Ta (5) and Tx (1). Side effects (bladder complaints) were generally mild and transient.


In patients with primary or BCG-failing CIS, treatment with intravesical hyperthermia and MMC appears a safe and effective treatment. The initial complete response rate is 92%, which remains approximately 50% after 2 years.


Bladder cancer CIS Hyperthermia Mitomycin-C Thermochemotherapy