In chapter 7 of the EAU Guidelines released on NMIBC we can find a sub-section (22.214.171.124.2) dedicated to a possible adjuvant treatment modality for chemotherapy administration. In particular, microwave-induced hyperthermia for mitomycin-c (MMC) administration in intermediate/high-risk NMIBC have been included on the evidence from the data presented by Ardens TJ et al in 2014 and 2016 [ref].
In this RCT, 1-year of BCG vs. 1-year MMC/microwave-induced hyperthermia in patients with intermediate- and high-risk NMIBC, were found to improve RFS at 24 months in the MMC group. This relatively novel yet expensive methodology for intravesical chemotherapy administration may play a role especially in the era of BCG shortage. It could become a promising alternative to offer for high-risk recurrent NMIBC failing BCG in future trials designed to assess the sequential administration of BCG and intravesical chemotherapy.