Abstract
Background/Objectives: Non-muscle-invasive bladder cancer (NMIBC) is a common form of bladder cancer with a significant risk of recurrence and progression, especially in intermediate- and high-risk patients. Bacillus Calmette-Guérin (BCG) therapy has been the gold standard, but its limitations have prompted the exploration of alternative therapies. This study aims to compare the long-term effectiveness of two such alternatives-hyperthermia-induced potentiation of mitomycin C (HIVEC) and electromotive drug administration (EMDA)-in preventing recurrence and progression in NMIBC patients. Methods: A prospective observational study was conducted at a Spanish center, including patients with intermediate- and high-risk NMIBC who were treated between August 2018 and December 2024. Participants were allocated to receive either HIVEC or EMDA based on their preferences. Both treatments followed a similar protocol, with an initial induction phase and maintenance sessions. Patient follow-up included regular cystoscopy, cytology, and imaging. Results: At 36 months, the disease-free survival rate was 62.4% for the HIVEC group and 67% for the EMDA group. Statistical analysis showed no significant difference between the two groups in terms of long-term efficacy. The adjusted hazard ratio for the treatment effect was 0.95, indicating comparable outcomes. Conclusions: Both HIVEC and EMDA demonstrate similar long-term efficacy in preventing recurrence and progression in intermediate- and high-risk NMIBC. These findings suggest that both treatments show promise as potential future options for managing NMIBC, providing clinicians with additional considerations based on patient characteristics and preferences. Further studies, particularly randomized controlled trials, are needed to confirm these results and optimize treatment protocols.