The second-line conservative device-assisted intravesical treatment in selected patients with recurrent high risk non-muscle invasive bladder cancer

Abstract Introduction In cases of recurrent high-risk non–muscle-invasive bladder cancer, radical cystectomy (RC) is recommended. We compared oncologic and treatment-related outcomes of second-line conservative device-assisted therapy to RC. Patients and Methods In a retrospective cohort study, we analyzed 209 consecutive patients with recurrent bacillus Calmette-Guerin–unresponsive high-risk non–muscle-invasive bladder cancer; 107 subjects refused RC and were offered electromotive drug administration (n = 44) or chemohyperthermia (n = 63) (group A), and 102 patients underwent RC (group B). In group A, patients who did not benefit from device-assisted treatment underwent RC. The endpoints were high-grade disease-free survival, progression-free survival, cancer-specific survival, overall survival, and treatment-related complications. Follow-up was based on international guideline recommendations. Analyses were performed with log-rank and Fisher exact tests. Results The median follow-up was 59 months (SD ± 5.3). When comparing group A to B, overall survival rates were 91.6% and 90.2%, respectively (P > .05); cancer-specific survival was 94.4% and 96.1%, respectively (P > .05); high-grade disease-free survival was 43% and 74.5%, respectively (P  .05). Conclusion Device-assisted treatment may a represent a valid second-line conservative tool in selected patients with recurrent high-risk non–muscle-invasive bladder cancer.