Mr Will Maynard
Urology consultant at Frimley Health
For patients with high-risk non-muscle invasive bladder cancer (NMIBC), the clinical journey is often difficult.
When first-line treatment with BCG therapy fails, the traditional answer has been radical cystectomy, completely removing the bladder surgically. Over recent years, due to advancements in treatment, that picture has begun to change.
Bladder-preserving alternative treatment
At Heatherwood Hospital, part of Frimley Health NHS Foundation Trust, we have been using the Synergo system for five years, and the outcomes in our cohort have been very encouraging.
The majority of patients who complete treatment have gone on to avoid bladder cancer progression to date, and very few have ultimately required radical surgery. For patients who come to us facing the prospect of major surgery, being able to offer a viable bladder-preserving alternative offers a real advancement in care.
Treatment with MMC using Synergo is associated with fewer cystectomies and an increase in life years gained and QALYs
Durable cancer control approach that protects quality of life
What sets this approach apart technically is its simultaneous delivery of radiofrequency energy alongside recirculating chemotherapy locally into the bladder. Research over the past decade has established that the radiofrequency component produces both thermal and non-thermal anti-cancer effects, with selectivity for malignant cells.1 Delivered as a course of one-hour outpatient sessions, patients tolerate it well and resume normal activities the same day.
The evidence base behind Synergo is sufficient to allow European guidelines to formally recommend this approach for patients with intermediate or high-risk NMIBC who have failed previous treatments and cannot have, or do not want, bladder removal.2
As urologists, our goal is always to achieve durable cancer control while protecting quality of life wherever possible. For more bladder cancer patients, this is now a realistic ambition.
All models resulted in fewer radical cystectomies and an increase in total life years and quality-adjusted life years (QALYs). In the model comparing treatment with MMC using Synergo with MMC alone, the incremental reduction in cystectomies was 0.22 per person and the increases in total life years and QALYs per person were 2.15 and 2.35, respectively. In the model that compared MMC using Synergo with second-line BCG, these changes were smaller: a 0.02 per person reduction in cystectomies, and a 0.8 and 0.79 increase in the total life years and QALYs per person, respectively.
