Low Energy Shock Wave Therapy and Non-Muscle Invasive Bladder Cancer

Last updated: December 17, 2020
Sponsor: Mansoura University
Overall Status: Active - Recruiting

Phase

N/A

Condition

Urothelial Cancer

Bladder Cancer

Treatment

N/A

Clinical Study ID

NCT04644835
LESW-NMIBC
  • Ages 18-90
  • All Genders

Study Summary

The investigators hypothesize that low energy shock wave therapy (LESW) might induce damage to the tumor tissues of non-muscle invasive bladder cancer (NMIBC), so they could be ablated and detached from the surface.

The patients who are suffering from NMIBC will be randomly allocated into two groups: The first group (control group): 25 patients will be exposed to sham treatment before transurethral resection of bladder tumor (TURBT) without using LESW therapy. The second group (LESW group): 25 patients will be exposed to LESW therapy before TURBT.

The apoptotic effect of LESW will be studied via histopathological examination and molecular studies of the resected bladder tissues.

The patients will receive intravesical chemotherapy or BCG immunotherapy and they will be followed up at outpatient clinic for two years by MRI, outpatient cystoscopy and cytology to identify the recurrence and progression rate of NMIBC.

Eligibility Criteria

Inclusion

Inclusion Criteria:

  • Patients with ≤ T1, de novo, single and small (<3cm) papillary lesions will beincluded in the study.

Exclusion

Exclusion Criteria:

  • Patients with ≥ T2 bladder cancer, evidence of nodal metastasis, associated uppertract urothelial carcinoma, morbidly obese patients, patients with absolutecontraindication for shock wave therapy or those who refuse will be excluded from thestudy.

Study Design

Total Participants: 50
Study Start date:
November 28, 2020
Estimated Completion Date:
November 28, 2023

Study Description

The investigators hypothesize that low energy shock wave therapy (LESW) might induce damage to the tumor tissues of non-muscle invasive bladder cancer (NMIBC), so they could be ablated and detached from the surface.

The patients who are suffering from NMIBC will be randomly allocated into two groups: The first group (control group): 25 patients will be exposed to sham treatment before transurethral resection of bladder tumor (TURBT) without using LESW therapy. The second group (LESW group): 25 patients will be exposed to LESW therapy before TURBT. The shock wave applicator (Dornier AR2, shock wave device, Dornier MedTech 2010, Wessling, Germany) will be gently placed directly on the ultrasound transmission gel over the skin surface of the suprapubic region above the urinary bladder at the site of the papillary lesion (US guided) and at other five points. Points 1 and 2 will be at the level of transverse crease 2 cm above the pubic bone and 5 cm from each, points 3 and 4 will 2 cm above points 1 and 2, and point 5 will be centered of points 1-4. A total of 2000 pulses at 0.25 mJ/mm2 will be delivered with a frequency of 3 pulses per second. The position of the shock wave applicator will be changed after every 400 pulses.

The apoptotic effect of LESW will be studied via histopathological examination for the type of bladder tumor, pathological stage, grade, association of carcinoma in situ and morphological features of apoptosis in terms of compaction of the nuclear chromatin (pyknosis), loss of cellular volume and chromatin condensation on the nuclear envelope (nuclear crescents), Immunohistochemical analysis of anti-caspase-3 antibody and molecular studies of Bax (an apoptotic promotor), BCL-2 and Survivin (apoptotic inhibitors) Relative Gene Expression in the resected bladder tissues.

The patients will receive intravesical chemotherapy or BCG immunotherapy and they will be followed up at outpatient clinic for two years by MRI, outpatient cystoscopy and cytology to identify the recurrence and progression rate of NMIBC.

Connect with a study center

  • Urology and Nephrology Center, Mansoura University

    Mansoura,
    Egypt

    Active - Recruiting

Not the study for you?

Let us help you find the best match. Sign up as a volunteer and receive email notifications when clinical trials are posted in the medical category of interest to you.