title: Treatment Results of Radiotherapy Combined with Balloon-occluded Arterial Infusion Chemotherapy for Invasive Bladder Cancer.
abstract: OBJECTIVE
  We present preliminary results from our clinical study evaluating the effectiveness of combination of radiotherapy with balloon-occluded arterial infusion (BOAI) and hemodialysis (HD) for bladder cancer.
  
  
  METHODS
  We investigated 134 patients with a median age of 67 years (range=38-88 years) and a median follow-up time of 31 months. According to the UICC classification, 89 patients were at clinical stage T2, 40 at T3, and 5 at T4. All patients received external-beam radiation therapy (EBRT) of 50 Gy to the whole pelvis with 10 Gy to the bladder as a boost. During EBRT, BOAI of cisplatin (CDDP) (100 mg/body) was administered from bilateral internal iliac arteries with simultaneous HD to prevent back-flow of CDDP into the systemic circulation.
  
  
  RESULTS
  Three-year local control and overall survival (OS) rates were 68% and 80%, respectively, and 3-year bladder preservation rate was 90%. Univariate and multivariate analysis showed that T stage and primary effect were significant prognostic factors for OS. In addition, primary effect was a significant prognostic factor for bladder preservation. None of the patients had grade 2 or more severe hematological toxicity. Late grade ≥3 genitourinary (GU) and gastrointestinal (GI) complications were observed in 6% and 2% of the patients, respectively.
  
  
  CONCLUSIONS
  Combination of radiotherapy with BOAI and HD, associated with reduced hematological toxicity, may be regarded as a curative therapy for patients with bladder cancer. Late GU and GI complications were within acceptable limits. T stage is an important predictive factor for the outcome of this therapy.
authors: Department of Radiation Oncology, Osaka Medical College, Takatsuki, Osaka, Japan rad111@poh.osaka-med.ac.jp.
authors: Hiroto
authors: H
authors: Yoshioka
authors: Department of Radiation Oncology, Osaka Medical College, Takatsuki, Osaka, Japan.
authors: Taiju
authors: T
authors: Shimbo
authors: Department of Radiation Oncology, Osaka Medical College, Takatsuki, Osaka, Japan.
authors: Ken
authors: K
authors: Yoshida
authors: Department of Radiation Oncology, Osaka Medical College, Takatsuki, Osaka, Japan.
authors: Nobuhiko
authors: N
authors: Yoshikawa
authors: Department of Radiation Oncology, Osaka Medical College, Takatsuki, Osaka, Japan.
authors: Yasuo
authors: Y
authors: Uesugi
authors: Department of Radiology, Osaka Medical College, Takatsuki, Osaka, Japan.
authors: Kazuhiro
authors: K
authors: Yamamoto
authors: Department of Urology, Osaka Medical College, Takatsuki, Osaka, Japan.
authors: Haruhito
authors: H
authors: Azuma
authors: Department of Radiology, Osaka Medical College, Takatsuki, Osaka, Japan.
authors: Yoshifumi
authors: Y
authors: Narumi
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D021721:Balloon Occlusion / Q000009:adverse effects / Q000401:mortality; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D002945:Cisplatin / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D007083:Iliac Artery; D007261:Infusions, Intra-Arterial; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin
keywords: Bladder cancer; balloon-occluded arterial infusion; hemodialysis; intra-arterial chemotherapy; radiotherapy