title: 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.
abstract: 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.
authors: Department of Urology, Osaka Medical College, Takatsuki, Osaka 569-8686, Japan. uro004@poh.osaka-med.ac.jp
authors: Haruhito
authors: H
authors: Azuma
authors: Kazuhiro
authors: K
authors: Yamamoto
authors: Teruo
authors: T
authors: Inamoto
authors: Naokazu
authors: N
authors: Ibuki
authors: Yatsugu
authors: Y
authors: Kotake
authors: Takeshi
authors: T
authors: Sakamoto
authors: Satoshi
authors: S
authors: Kiyama
authors: Takanobu
authors: T
authors: Ubai
authors: Kiyoshi
authors: K
authors: Takahara
authors: Naoki
authors: N
authors: Segawa
authors: Yoshihumi
authors: Y
authors: Narumi
authors: Yoji
authors: Y
authors: Katsuoka
mesh_terms: 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*
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin