[Intra-arterial chemotherapy for bladder preservation in patients with locally advanced bladder cancer].
OBJECTIVE
To evaluate intra-arterial chemotherapy for bladder preservation in patients with locally advanced bladder cancer.


METHODS
A total of 34 patients with locally advanced bladder cancer (T2, n=25; T3, n=9) were treated with intra-arterial chemotherapy. Chemotherapy was consisted of intraarterial administration of cisplatin (100 mg/body), and adriamycin or pirarubicin (50 mg/body) every 4 weeks for two cycles. The response was evaluated by TUR, urine cytology, CT and/or MRI 4 weeks after the treatment. In 4 patients, we combined this treatment with radiotherapy.


RESULTS
Among all 34 patients, 12 (35%) patients presented complete response (CR) and 24 patients (70%) presented in objective response (OR). During mean follow up period of 28.7 months, five patients had locally advanced recurrence and one had distant metastasis. The 5-year survival rate was 69.3%. Bladder was conserved in 19 (56%) of all 34 patients. Hematological and gastrointestinal toxicity (more than grade 3) was occurred in 5 and 3 patients. Risk factors on the outcome of this therapy were tumor size >20 mm, multiple tumors and clinical stage > or = cT3. Patients with no or one risk factor had favorable outcomes; the OR rates of 75-100%, the bladder preservation rates of 71-75% and the 5-year cancer specific survival rates of 83%. Whereas patients with two or three risk factors had unfavorable outcomes; the OR rates of 50-58%, the bladder preservation rates of 25-42% and the 3-year cancer specific survival rates of 0-69%.


CONCLUSIONS
The treatment of locally advanced bladder cancer with intra-arterial chemotherapy seems to be good for patients with less risk factor, but not so good for patients with more risk factors.
Department of Urology, Jichi Saitama Medical Center.
Satoshi
S
Washino
Masaru
M
Hirai
Fumihito
F
Terauchi
Atsushi
A
Matsuzaki
Yutaka
Y
Kobayashi
Katsuhiko
K
Matsuura
D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage / Q000031:analogs & derivatives; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012307:Risk Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology
D004317:Doxorubicin; C027260:pirarubicin; D002945:Cisplatin