Total cystectomy versus bladder preservation therapy for locally invasive bladder cancer: effect of combined therapy using balloon-occluded arterial infusion of anticancer agent and hemodialysis with concurrent radiation.
OBJECTIVE
We tested the usefulness of balloon-occluded arterial infusion (BOAI) of anticancer agent (cisplatin/gemcitabine), concomitant with hemodialysis, which delivers an extremely high concentration of anticancer agent to the site of a tumor without systemic adverse effects, along with concurrent radiation [Osaka-Medical College (OMC)-regimen] in patients with locally advanced bladder cancer. The results were compared with those of cystectomy.


METHODS
One hundred twenty-four patients were assigned to receive cystectomy (Gp1, n = 62) or OMC-regimen (Gp2, n = 62). In Gp2, patients besides undergoing complete response subsequently received secondary-BOAI with gemcitabine (1600 mg).


RESULTS
In Gp1, 27 of 62 patients (43.5%) suffered disease recurrence, and more than half died within 1 year; the remainder died thereafter. The overall 5-, 10-, and 15-year survival rates were 53.8%, 46.0%, and 40.0%, respectively. In contrast, in Gp2, >70% of patients (44 of 62), especially >95% of patients with locally invasive tumors achieved complete response with no evidence of recurrent disease or metastasis after a mean follow-up of 163 (range, 32-736) weeks. At 14 years, overall survival was significantly improved at 79.7% (P = 0.015 vs. Gp1). Moreover, salvage therapy for secondary-BOAI with gemcitabine was effective in all 3 patients with T4 tumors or lymph node involvement, who showed stable disease (SD) after primary therapy with CDDP. No patients suffered Grade III or more severe toxicities.


CONCLUSIONS
OMC-regimen, a new strategy for patients with locally-invasive bladder cancer, can be curative not only in patients for whom 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
Yamamoto
Kazuhiro
K
Inamoto
Teruo
T
Ibuki
Naokazu
N
Kotake
Yatsugu
Y
Sakamoto
Takeshi
T
Kiyama
Satoshi
S
Ubai
Takanobu
T
Takahara
Kiyoshi
K
Segawa
Naoki
N
Narumi
Yoshihumi
Y
Katsuoka
Yoji
Y
D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D021721:Balloon Occlusion; D002294:Carcinoma, Squamous Cell / Q000556:secondary / Q000628:therapy; D002822:Choriocarcinoma / Q000556:secondary / Q000628:therapy; D002945:Cisplatin / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D015653:Cystectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007261:Infusions, Intra-Arterial; D008875:Middle Aged; D019042:Muscle Neoplasms / Q000556:secondary / Q000628:therapy; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D011879:Radiotherapy Dosage; D006435:Renal Dialysis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000628:therapy*
D000970:Antineoplastic Agents; D002945:Cisplatin