title: External beam radiation plus concurrent intra-arterial chemotherapy with low dose cisplatin for muscle invasive bladder cancer.
abstract: BACKGROUND
  We aimed to investigate the long-term outcome of trimodality therapy consisting of transurethral resection of bladder tumor, external beam radiation therapy, and concurrent intra-arterial low dose cisplatin for patients with muscle invasive bladder cancer.
  
  
  METHODS
  We retrospectively reviewed the medical records of 37 consecutive patients (28 men and 9 women) who underwent trimodality therapy for T2-3N0M0 bladder cancer at our hospital between 1996 and 2011. A total of 60Gy of external beam radiation therapy was administered. A daily low dose of cisplatin was administered intra-arterially through a subcutaneously placed reservoir on the days of radiation therapy. Complete response was defined as no residual cancer in transurethral resection specimens and negative cytology. When a complete response could not be achieved, patients underwent additional intra-arterial chemotherapy.
  
  
  RESULTS
  Five-year cause specific, disease free, and overall survival rates were 86.4%, 69.7%, and 69.6%, respectively, with a mean follow-up period of 56.5 ± 6.1 months. Five-year cause specific survivals of the complete response group after the trimodality therapy, the complete response group after additional intra-arterial chemotherapy and the non-complete response group were 100% (n = 21), 85.9% (n = 9) and 0% (n = 7), respectively. Five-year overall survivals of the complete response group after the trimodality therapy, the complete response group after additional intra-arterial chemotherapy and the non-complete response group were 82.8%, 85.3% and 0%, respectively.
  
  
  CONCLUSIONS
  This trimodality therapy for muscle invasive bladder cancer could achieve favorable survival rates with bladder preservation and minimal adverse events. This trimodality therapy can be one of the useful treatment options.
authors.affiliation: Department of Urology, Nara Prefectural Nara Hospital, Nara, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Matsumoto
authors.affiliation: Department of Urology, Nara Prefectural Nara Hospital, Nara, Japan.
authors.forename: Shoji
authors.initials: S
authors.lastname: Samma
authors.affiliation: Department of Urology, Nara Prefectural Nara Hospital, Nara, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Fukui
authors.affiliation: Department of Urology, Nara Prefectural Nara Hospital, Nara, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Nakai
authors.affiliation: Department of Urology, Nara Prefectural Nara Hospital, Nara, Japan.
authors.forename: Yoriaki
authors.initials: Y
authors.lastname: Kagebayashi
authors.affiliation: Department of Urology, Nara Medical University, Kashihara, Japan.
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Torimoto
keywords: Bladder preservation; intra-arterial chemotherapy; muscle invasive bladder cancer; radiotherapy