The role of preoperative intra-arterial doxorubicin chemotherapy in combination with low-dose irradiation for bladder cancer.
Twenty patients with bladder cancer (T1, 3 patients; T2, 6 patients; T3, 8 patients; T4a, 3 patients) were preoperatively treated with intra-arterial doxorubicin chemotherapy in combination with low-dose irradiation. The originally scheduled operations were as follows: total cystectomy in 16 patients (T1 + cis, 1 patients; T2, 5 patients; T3, 7 patients; T4a, 3 patients), segmental cystectomy in 2 patients, and transurethral resection in 2 patients. The total dose of doxorubicin ranged from 120 to 540 mg (251.5 +/- 100.2 mg), and that of irradiation was from 4 to 36 Gy (24.4 +/- 7.3 Gy). Clinical and pathological effects were evaluated in all of the cases. Clinically, complete remission (CR) was observed in 14 cases (70.0%), partial remission (PR) was seen in 3 cases, a minor response (MR) occurred in 2 cases, and no response (NR) was seen in 1 patient; non patient showed progressive disease (PD). The pathological effects (according to the criteria of Shimosato et al.) were as follows: grade IV was seen in 10 cases, grade III in 3 cases, and less than grade II in 7 cases; however, viable tumor cell were not seen in 13 (65.0%) of the 20 cases. The bladder was preserved in 13 (81.3%) of the 16 cases for which total cystectomy had been recommended. All of the patients were followed up for periods ranging from 3 to 54 months (26.3 +/- 16.5 months), during which time 6 patients (30.0%) died (3 with cancer, 1 without cancer, and 2 unknown causes). The actual survival rate according to the stage of disease was 100.0% at 50 months in T1-T2 and 40.9% at 54 months in T3-T4a. In T3-T4a, the actual survival rate in pathologically complete responders was 60% (relative rate 68.8%) at 54 months, and the actual survival rate in incomplete responders was 25.0% (relative rate 27.1%) at 36 months. The results of our study are encouraging, especially in T1-T2 and T3-T4a cases, who showed a complete response. It is concluded that doxorubicin intra-arterial chemotherapy combined with low-dose irradiation could be the first treatment of choice for locally invasive bladder cancer.
Uyama
T
T
Department of Urology, Shikoku Cancer Center Hospital, Matsuyama, Japan.
Moriwaki
S
S
Yokozeki
A
A
Kitada
K
K
Higa
I
I
Shiotsu
T
T
Fujita
J
J
D000368:Aged; D003131:Combined Modality Therapy; D004317:Doxorubicin / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D011292:Premedication; D011379:Prognosis; D011879:Radiotherapy Dosage; D001743:Urinary Bladder / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000628:therapy*
D004317:Doxorubicin