The negative-balance isolated pelvic perfusion method using ultrahigh-dose cisplatin for invasive bladder cancer with poor risk.
BACKGROUND
Our aim was to evaluate the clinical significance of the negative-balance isolated pelvic perfusion (NIPP) method using ultrahigh-dose cisplatin (CDDP) for ten cases of invasive bladder cancer with poor risk such as high-grade cancer, advanced clinical stage, or appearance of hydronephrosis.


METHODS
A CDDP dosage of 200-300 mg/body was used under the NIPP method. To confirm safety and efficacy, peripheral blood, pelvic arterial blood, pelvic venous blood, and urine were collected for sampling of the platinum (Pt) concentrations. These samples were investigated and compared with those following previous intraarterial chemotherapy sessions.


RESULTS
The Pt concentrations in pelvic blood under intraarterial chemotherapy and NIPP were 5.97 ± 2.06 and 24.15 ± 4.61 μg/ml, respectively. By contrast, the Pt concentration in peripheral blood under NIPP was half the level under conventional intraarterial chemotherapy. No severe adverse events were found in terms of gastrointestinal and hematological toxicity, but renal function was impaired in some cases. Pathological or surgical complete response (CR) was achieved in five of ten cases (50%) in spite of the group being poor risk, and bladder preservation was possible in all the CR cases. Patients with CR experienced survival in all terms of observation.


CONCLUSIONS
The NIPP method was able to deliver high levels of CDDP concentration in pelvis cavity without severe adverse events. The NIPP method makes it possible to achieve CR for the patients with invasive bladder cancer with poor risk who rejected cystectomy.
Kimata
Ryoji
R
Department of Urology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan. s2027@nms.ac.jp
Kondo
Yukihiro
Y
Nemoto
Kaoru
K
Murata
Satoru
S
Kumazaki
Tatsuo
T
D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood / Q000493:pharmacokinetics; D010478:Chemotherapy, Cancer, Regional Perfusion; D002945:Cisplatin / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood / Q000493:pharmacokinetics; D005260:Female; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010388:Pelvis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology
D000970:Antineoplastic Agents; D002945:Cisplatin
J Nippon Med Sch. 2004 Aug;71(4):263-9
15329486
J Clin Oncol. 2006 Dec 10;24(35):5536-44
17158539
J Urol. 2005 Nov;174(5):1944-7
16217363
Int J Urol. 2008 May;15(5):403-6
18384578
J Clin Oncol. 2001 May 15;19(10):2638-46
11352955
Jpn J Clin Oncol. 2007 Nov;37(11):852-7
17965422
Ann Surg Oncol. 2008 Apr;15(4):1107-16
18157578
Gynecol Oncol. 2004 Dec;95(3):576-82
15581966
Cancer Res. 1983 Feb;43(2):917-20
6681533
N Engl J Med. 1959 Nov 19;261:1037-45
13795184
J Cancer Res Clin Oncol. 2007 Oct;133(10):741-7
17503082
Int J Clin Oncol. 2004 Dec;9(6):484-90
15616879
Jpn J Clin Oncol. 2009 Jun;39(6):381-6
19351661
Am J Clin Oncol. 2008 Feb;31(1):11-21
18376222
J Cancer Res Clin Oncol. 2005 Sep;131(9):575-80
15895252
Cancer Chemother Pharmacol. 1996;39(1-2):131-7
8995510
Eur Urol. 2003 Jul;44(1):57-64
12814676