Effect of combined therapy using balloon-occluded arterial infusion of cisplatin and hemodialysis with concurrent radiation for locally invasive bladder cancer.
OBJECTIVE
We tested the usefulness of combined therapy using balloon-occluded arterial infusion (BOAI) of cisplatin and hemodialysis, which delivers an extremely high concentration of cisplatin to the site of a tumor without systemic adverse effects, with concurrent radiation in patients with locally advanced bladder cancer.


METHODS
Patients underwent transurethral resection of the bladder tumor followed by BOAI of cisplatin (100, 200, or 300 mg) concurrent with hemodialysis, via both common iliac veins, for 2 hours after initiation of BOAI. A total of 60.4 Gy of radiation was delivered, starting from the day of BOAI.


RESULTS
Forty-one patients (30 males and 11 females, aged 55-98 years) were enrolled and assessable for toxicity and response. None of the patients suffered grade II or more severe toxicities; some experienced grade I blood/bone marrow toxicity, gastrointestinal toxicity, or neuropathy. All patients with histologically confirmed transitional cell carcinoma stage T2 or T3 (29 patients) achieved a complete response and were able to retain their bladder with no evidence of recurrent disease or distant metastasis at a mean follow-up of 132 weeks (range 8-648 weeks) after therapy. Patients with stage T4 tumors, besides transitional cell carcinoma, or lymph node involvement had stable or progressive disease.


CONCLUSIONS
This therapy is a new strategy for patients with locally advanced bladder cancer. It can be a curative treatment not only in patients for whom total cystectomy is indicated, but also in patients whose condition is not amenable to curative treatment and for whom merely palliative treatment would otherwise seem the only option.
Azuma
Haruhito
H
Department of Urology, Osaka Medical College, Takatsuki, Osaka 569-8686, Japan. uro004@poh.osaka-med.ac.jp
Kotake
Yatsugu
Y
Yamamoto
Kazuhiro
K
Sakamoto
Takeshi
T
Kiyama
Satoshi
S
Ubai
Takanobu
T
Inamoto
Teruo
T
Takahara
Kiyoshi
K
Matsuki
Mitsuru
M
Segawa
Naoki
N
Shibahara
Nobuhisa
N
Katsuoka
Yoji
Y
D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D021721:Balloon Occlusion; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000628:therapy; D002822:Choriocarcinoma / Q000473:pathology / Q000628:therapy; D002945:Cisplatin / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D006435:Renal Dialysis / Q000379:methods*; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*
D000970:Antineoplastic Agents; D002945:Cisplatin