Transurethral resection and intra-arterial chemotherapy for muscle-invasive bladder cancer.
Thirty-three patients with muscle-infiltrating T2-T3a bladder carcinoma were treated by TUR through the full thickness of the bladder wall and extended into the perivesical fat. The solitary tumours were not more than 4 cm in diameter. Histology proved in every case tumour stages of pT2 (17 patients) or pT3a (16 patients), G2 or G3 transitional cell carcinoma and negative mucosal biopsies. After TUR the patients received 1 or 2 cycles of chemotherapy: 60 mg of doxorubicin, 50 mg of cisplatin, 1 g of 5-fluorouracil administered into the ipsilateral hypogastric artery. There was no perioperative mortality but one patient died of complications related to chemotherapy. During the first year of follow-up relapses of muscle-invasive cancer were observed in 3 patients (10%), two were subjected to cystectomy and one to repeated TUR. With a median follow-up of 34 months 27 patients are alive and have functional bladder. The actual 3-year and 5-year survival rates were 17/21 (81%) and 6/9 (67%), respectively. The results of this study suggest that in strictly selected patients extended TUR and intra-arterial chemotherapy may be a bladder-preserving treatment modality for muscle-invasive bladder cancer. Regular (three monthly cystoscopy, cytology, biopsy, CT) investigations and follow-up are necessary to detect recurrences.
Kondás
J
J
Department of Urological Surgery, Municipal Péterfy Sándor Street Hospital, Budapest, Hungary.
Engloner
L
L
Váczi
L
L
Kondér
G
G
D000368:Aged; D000369:Aged, 80 and over; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000628:therapy*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D015653:Cystectomy / Q000379:methods; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000628:therapy*
D000903:Antibiotics, Antineoplastic; D000964:Antimetabolites, Antineoplastic; D004317:Doxorubicin; D002945:Cisplatin; D005472:Fluorouracil