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A bladder preservation regimen using intra‐arterial chemotherapy and radiotherapy for invasive bladder cancer: A prospective study
Author(s) -
Miyanaga Naoto,
Akaza Hideyuki,
Okumura Toshiyuki,
Sekido Noritoshi,
Kawai Koji,
Shimazui Toru,
Kikuchi Koji,
Uchida Katsunori,
Takeshima Hitoshi,
Ohara Kiyoshi,
Akine Yasuyuki,
Itai Yuji
Publication year - 2000
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1046/j.1442-2042.2000.00137.x
Subject(s) - medicine , bladder cancer , urology , cystectomy , regimen , radiation therapy , chemotherapy , urinary bladder , surgery , biopsy , prospective cohort study , cisplatin , cancer , radiology
Background: A prospective study was performed to investigate combined treatment with intra‐arterial chemotherapy and radiation therapy for bladder preservation in locally invasive bladder cancer.Methods: Patients with invasive bladder cancer, stage T2–3N0M0, were included in the study. Intra‐arterial chemotherapy was performed with three injections of methotrexate and cisplatin at 3‐week intervals. Simultaneously, the patients underwent X‐ray irradiation (40 Gy) of the small pelvic space. Where a post‐treatment transurethral resection (TUR) biopsy showed no residual tumor, the tumor site was irradiated by a 30 Gy proton beam and the bladder was preserved. Where tumors remained, radical cystectomy was performed.Results: Between 1990 and 1996, 42 patients were treated according to this protocol. Post‐treatment TUR biopsy and urine cytology showed no residual tumors in 39 of 42 cases (93%). The bladder was preserved in accordance with the study protocol in 36 cases. A median follow‐up of 38 months showed 3‐year non‐recurrence in 72% of bladder‐preserved patients and the rate of bladder preservation was 84%. The nine recurrences included eight cases of superficial bladder recurrence. One cancer death occurred among the bladder‐preservation patients, giving 3‐year survival and cause‐specific survival rates of 84% and 100%, respectively. Although bladder function decreased slightly in compliance, bladder capacity was retained in almost all cases.Conclusions: This regimen is useful for bladder preservation in T2–3 locally invasive bladder cancer. Information from more cases and the results of more long‐term observations are needed, as is an evaluation of appropriate subject selection and factors associated with quality of life issues, particularly regarding bladder function.