Comparison of intravesical Bacillus Calmette-Guérin and chemohyperthermia with mitomycin C in with high-risk non–muscle-invasive bladder cancer: a critical assesment focusing on the quality of life and adverse events

This study aimed to compare the effects of intravesical Bacillus Calmette-Guérin (BCG) and chemohyperthermia (CHT) with mitomycin C (MMC) therapy on symptom burden, recurrence, and quality of life in patients with high-risk non–muscle-invasive bladder cancer (NMIBC). A total of 116 male patients with high-risk NMIBC were included, comprising 52 treated with BCG and 64 treated with CHT-MMC. Symptom severity was evaluated using the International Prostate Symptom Score (IPSS) and the Overactive Bladder Questionnaire (OAB-V8) before and after treatment. Post-treatment adverse events such as dysuria, hematuria, and pollakiuria were recorded. Quality of life was assessed using the Short Form-12 (SF-12) Health Survey, including the physical (PCS) and mental component summary (MCS) scores. Recurrence rates were monitored during a 24-month follow-up period. Following treatment, symptom scores (IPSS and OAB-V8) were significantly worsened in the BCG group compared to the CHT-MMC group (p < 0.01). Dysuria occurred in 84.6% of patients in the BCG group and in 46.2% of those in the CHT-MMC group (p = 0.054). Hematuria was observed in 43.8% and 12.5% of patients in the BCG and CHT-MMC groups, respectively (p = 0.095). The mean PCS score was significantly lower in the BCG group than in the CHT-MMC group (43.9 ± 11.0 vs. 54.9 ± 6.3, p = 0.008), whereas there was no statistically significant difference in MCS scores between the two groups (p = 0.145). Disease recurrence was detected in 22 of 52 patients (42.3%) in the BCG group and in 38 of 64 patients (59.4%) in the CHT-MMC group (p = 0.467). Intravesical chemohyperthermia with mitomycin C (CHT-MMC) was associated with a more favorable symptom profile and superior physical quality of life compared to BCG, while no statistically significant difference was observed in recurrence rates. These results indicate that intravesical CHT-MMC may represent a well-tolerated and effective therapeutic alternative for high-risk NMIBC patients who are intolerant to or have contraindications for BCG therapy.