Hyperthermia Treatment in Conjunction With Mitomycin C Versus Bacillus Calmette-Guérin Immunotherapy (BCG) for Superficial Bladder Cancer

Inclusion Criteria: * Superficial TCC: Any G3 or any T1 and/or CIS * Multifocal (\>1) Ta lesions * Multiple recurrences (\>2) of Ta lesions in the last 24 months * Complete tumor eradication must be confirmed * WHO performance status 0-2 (Appendix V) * Life expectancy of more than 24 months * Patients willing to sign informed consent Exclusion Criteria: * Bladder tumors other than TCC * Coexistence of another primary malignant tumor other than BCC of the skin * TCC of the bladder involving the urethra or upper urinary tract * Previous history of TCC stage T2 or higher * Clinical presence or previous history of regional spreading or distant metastases * Intravesical MMC treatments during the last 12 months * Previous intravesical BCG therapy (Any intravesical BCG therapy in the last 24 months, or More than 6 BCG intravesical instillations in the last 48 months. * Previous pelvic radiotherapy or systemic chemotherapy * Partial cystectomy * Diverticle of bladder larger than 1cm in diameter * Residual urine \> 100cc measured by uroflowmetry * Bladder volume \< 150cc measured by ultrasound * Urinary incontinence (more than one wet pad a day) * Urethral stricture impeding 20F catheterization * Urethral bleeding or persistent hematuria * Active intractable or uncontrollable UTI * Active tuberculosis or BCG infection * Patients who experienced BCG life threatening sepsis * Known allergy to MMC or BCG * Known impaired immune response, positive HIV serology, patients receiving systemic steroids or immunosuppressive therapy * Hematological disorders; leukocytes \< 3500, platelets \< 100,000 * Kidney or liver function disorders (more than 1.5 times upper normal limit) * Pregnant or lactating women * Patients who cannot be followed up properly or are unable to collaborate