Bladder preservation therapy conducted by intra-arterial chemotherapy and radiotherapy for muscle invasive bladder cancer.
OBJECTIVE
A previous paper reported favorable results of intra-arterial chemotherapy in combination with radiotherapy for muscle-invasive bladder cancer. The current study will update those results.


METHODS
Between January 1992 and December 2006, 94 patients with confirmed muscle invasion were treated with intra-arterial chemotherapy and concurrent radiotherapy after an initial complete transurethral resection. Intra-arterial chemotherapy consisted of cisplatin (Days 1-3) and pirarubicin (Days 8-10), and radiation was administered with the chemotherapy (2 Gy/session) with a total dosage of 44 Gy. The median age was 67.0 years. There were 60 patients in T2, 19 patients in T3 and 15 patients in T4. The median follow-up period was 72.9 months in the survivors.


RESULTS
Among these patients, 84 patients (89.4%) obtained a complete response (CR) and 10 patients did not achieve a CR. Between the CR and non-CR patients, the clinical stage and the existence of hydronephrosis were significantly different. The cause-specific survival rates at 5 and 10 years were 76.2% and 67.5%, respectively. The overall survival rates at 5 and 10 years were 66.6% and 47.4%, respectively. A Cox proportional hazard model showed that only the cause-specific survival rate was associated with a CR after treatment. The bladder preservation rates were 89.7% at 5 years and 87.6% at 10 years. Myelosuppression was the major adverse event but it was manageable. Non-hematological sever adverse events were rare.


CONCLUSIONS
Bladder preservation therapy shows good survival and good bladder preservation rates. Clinical stage T2 and the absence of hydronephrosis are favorable factors.
Department of Urology, National Hospital Organization Shikoku Cancer Center, 160 Minamiumemoto, Matsuyama 791-0280, Japan. khashine@shikoku-cc.go.jp
Katsuyoshi
K
Hashine
Yoshito
Y
Kusuhara
Noriyoshi
N
Miura
Akitomi
A
Shirato
Yoshiteru
Y
Sumiyoshi
Masaaki
M
Kataoka
D000368:Aged; D003131:Combined Modality Therapy; D006801:Humans; D006869:Hydronephrosis / Q000150:complications*; D007261:Infusions, Intra-Arterial; D008297:Male; D019042:Muscle Neoplasms / Q000556:secondary*; D009361:Neoplasm Invasiveness / Q000473:pathology; D009926:Organ Preservation; D055034:Osteochondrosis; D012074:Remission Induction; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000209:etiology / Q000473:pathology* / Q000601:surgery / Q000628:therapy*