title: Preliminary results of bladder-preserving therapy with definitive radiotherapy and intraarterial infusion of chemotherapy.
abstract: OBJECTIVE
  For management of muscle-invading bladder cancer (clinical stages T2 to T4), combined treatment of definitive radiotherapy (RT) and intraarterial (IA) administration of chemotherapy was carried out for local cure and bladder preservation.
  
  
  METHODS
  Between 1987 and 1990, a pilot study (Protocol-1) was initially conducted in 16 patients to investigate the efficacy of chemoradiotherapy where RT was combined with TURB and continuous IA infusion of cisplatin. We then performed a regimen of possible bladder-preservation treatment (Protocol-2) in which 19 patients were treated with combination of TURB, full-dose RT and one-shot IA infusion of cisplatin and methotrexate. In RT small pelvis irradiation was performed with x-rays followed by proton beam boost irradiation to the original tumor site.
  
  
  RESULTS
  Among patients treated on Protocol-1, a tumor-free bladder was observed in 50% (2/4) after 50-76 Gy but only 8% (1/14) after 30-40 Gy. In this regimen, planned cystectomy was performed in 10 patients and 13 patients (81%) are alive. Among 19 patients treated on Protocol-2, 17 patients (89%) are alive and 13 patients (68%) retained intact bladders without any recurrence. There were 3 cystectomies performed because of persistent tumors. Using a conformal mode of proton beam irradiation, a total dose of 60-80 Gy was safely administered with acceptable morbidities.
  
  
  CONCLUSIONS
  In the light of good complete response and survival rates achieved in the patients treated on Protocol-2, the combined treatment of definitive RT and IA administration of chemotherapy is considered as an effective bladder-preserving strategy.
authors.affiliation: Department of Radiology, University of Tsukuba, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Tsujii
authors.forename: H
authors.initials: H
authors.lastname: Akaza
authors.forename: M
authors.initials: M
authors.lastname: Ohtani
authors.forename: N
authors.initials: N
authors.lastname: Miyanaga
authors.forename: T
authors.initials: T
authors.lastname: Shimazoi
authors.forename: K
authors.initials: K
authors.lastname: Uchida
authors.forename: K
authors.initials: K
authors.lastname: Koiso
authors.forename: H
authors.initials: H
authors.lastname: Tsuji
authors.forename: T
authors.initials: T
authors.lastname: Okumura
authors.forename: K
authors.initials: K
authors.lastname: Ohara
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D015653:Cystectomy; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D011879:Radiotherapy Dosage; D011882:Radiotherapy, High-Energy / Q000379:methods; D012074:Remission Induction; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*
chemical_list: D002945:Cisplatin; D008727:Methotrexate