title: Efficacy and safety of systemic chemotherapy and intra-arterial chemotherapy with/without radiotherapy for bladder preservation or as neo-adjuvant therapy in patients with muscle-invasive bladder cancer: a single-centre study of 163 patients.
abstract: BACKGROUND
  Patients with muscle-invasive bladder cancer (MIBC) often undergo various preoperative treatments to improve survival; however, their efficacy and safety remain unclear.
  
  
  METHODS
  The anti-tumour effects and adverse events were evaluated in 163 MIBC patients who received systemic chemotherapy (SC, n = 34), intra-arterial chemotherapy (IAC, n = 50), or combined IAC and radiotherapy (IAC + R, n = 79).
  
  
  RESULTS
  Pathological complete responses were observed in 17.6%, 22.0%, and 43.0% of patients in the SC, IAC, and IAC + R groups, respectively, with respective 5-year overall survival rates of 42.0%, 46.7%, and 50.3%. Multivariate analysis showed that successful IAC + R protocol administration was a significant predictor for survival (hazard ratio = 0.16, p = 0.028). The incidence of severe adverse events was higher in the IAC + R group (36.7%) than in the SC (9.8%) and IAC groups (16.0%).
  
  
  CONCLUSIONS
  IAC + R was useful for patients with MIBC. Successful completion and optimal patient selection were important for this treatment strategy.
authors.affiliation: Nagasaki University Hospital, Department of Urology, Nagasaki, Japan. Electronic address: int.doc.miya@m3.dion.ne.jp.
authors.forename: Y
authors.initials: Y
authors.lastname: Miyata
authors.affiliation: Nagasaki University Hospital, Department of Urology, Nagasaki, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Nomata
authors.affiliation: Nagasaki University Hospital, Department of Urology, Nagasaki, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Ohba
authors.affiliation: Nagasaki University Hospital, Department of Urology, Nagasaki, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Matsuo
authors.affiliation: Nagasaki University Hospital, Department of Radiology, Nagasaki, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Hayashi
authors.affiliation: Nagasaki University Hospital, Department of Radiology, Nagasaki, Japan.
authors.forename: I
authors.initials: I
authors.lastname: Sakamoto
authors.affiliation: Nagasaki University Hospital, Department of Radiology, Nagasaki, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Uetani
authors.affiliation: Nagasaki University Hospital, Department of Urology, Nagasaki, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Sakai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy; D059186:Chemoradiotherapy, Adjuvant; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D015653:Cystectomy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy / Q000379:methods; D009361:Neoplasm Invasiveness; D059351:Organ Sparing Treatments; D017663:Peplomycin / Q000008:administration & dosage; D011379:Prognosis; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000473:pathology*; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000628:therapy*
chemical_list: D017663:Peplomycin; D016190:Carboplatin; D002945:Cisplatin; D005472:Fluorouracil
keywords: Adverse events; Bladder cancer; Chemotherapy; Preoperative treatment; Prognosis; Radiotherapy