Intravesical microwave hyperthermia and chemotherapy for non-muscle-invasive bladder cancer

To inform the committee, NICE did a rapid review of the published literature on the efficacy and safety of this procedure. This comprised a comprehensive literature search and detailed review of the evidence from 7 sources, which was discussed by the committee. The evidence included 3 literature reviews, 2 randomised controlled trials (one of which resulted in 2 publications) and 1 case series, and is presented in table 2 of the interventional procedures overview. Other relevant literature is in the appendix of the overview.

The specialist advisers and the committee considered the key efficacy outcomes to be: quality of life, time to disease progression and progression free survival.

The specialist advisers and the committee considered the key safety outcomes to be: thermal bladder damage.

Twelve commentaries from patients who had experience of this procedure were received, which were discussed by the committee.

The committee was advised that non-muscle-invasive bladder cancer is increasingly being diagnosed in patients where alternative, more invasive treatments such as cystectomy may not be considered clinically appropriate.

The mechanism of action of intravesical microwave hyperthermia and chemotherapy is unclear. The committee was informed that the microwave energy itself may have some action on the cancer cells.

The committee noted that the available studies used different treatment protocols, comparators and outcomes. This made interpretation of the evidence difficult.

The committee was informed that the technology may be useful when treatment with Bacillus Calmette-Guérin (BCG) vaccine is contraindicated or unsuitable, has been unsuccessful, or when the vaccine is not available.