Presented by: Azik Hoffman MD, MHA
Rambam Medical Center

Introduction

Initial treatment for non-muscle invasive bladder cancer mostly remains the same over many years. Utilizing cryotherapy with CO2 is commonly used to treat superficial papillary lesions of the skin for many years. Recently, we have proven its potential in treating urinary epithelial lesions in an animal model. Therefore, we present our preliminary phase 1  clinical results in treating low grade papillary lesions of the bladder.

Materials

Following local IRB approval, 10 patients with up to 3 papillary lesions and a maximum of 10 mm in size were recruited. No patient had previous high-grade disease nor positive cytology. Following the initial routine cystoscopy, the bladder irrigation medium was replaced with CO2 insufflation, and each lesion was treated with direct visual CO2 spraying for 15 seconds twice and allowing 10 seconds of thawing after every treatment cycle. Follow-up cystoscopy and treatment site biopsy were performed 4-6 weeks later, and routine surveillance was performed every 3 months for 1 year.

Results

,

8 men and 2 women were included (age 57—89 years). Overall, 14 lesions were treated. No complications were noted during treatment nor follow-up (range 2-14 months). Pathological analysis of the treatment site 4-6 weeks later detected residual low grade TCC only in the first patient, attituded to suboptimal lesion freezing due to our initial learning curve.

Conclusion

Initial results of cryotherapy utilizing CO2 spraying for small low grade NMIBC is safe and feasible. Pathological analysis confirms efficacy in tumor eradication. This potential treatment offers a potential paradigm shift in NMIBC treatment.

Funding

none

Co-Authors

Eyal Kochavi, M.sc, MBA
Vessi Medical

Omri Nativ, MD
Rambam Medical Center

Kamil Malshy, MD
Rambam Medical Center

Omer Sadeh, MD
Rambam Medical Center

Michael Mullerad, MD
Rambam Medical Center

Gilad E Amiel, MD
Rambam Medical Center