Resumen
Intravesical instillation using bacillus Calmette-Guérin (BCG) is the standard therapy for patients with high-risk, non-muscle-invasive bladder cancer. If BCG therapy fails, however, radical cystectomy with urinary diversion is recommended. Still, some patients are unfit or just refuse major surgery. We showed in this study that for these patients at highest risk for recurrence and progression, device-assisted hyperthermic intravesical chemotherapy using conductive heating and epirubicin in an optimized setting might be a bladder-sparing alternative with excellent recurrence-free survival rates within the bladder and without severe side effects. Still, a major concern is the extravesical manifestation of urothelial cancer in these patients with poor prognosis due to the associated risk of metastasis. Urologists should be aware that the window of opportunity for cure by undergoing radical cystectomy is tight and should not be missed.