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Neoadjuvant and adjuvant chemotherapy for locally advanced bladder carcinoma: Development of novel bladder preservation approach, Osaka Medical College regimen
Author(s) -
Azuma Haruhito,
Inamoto Teruo,
Takahara Kiyoshi,
Ibuki Naokazu,
Nomi Hayahito,
Yamamoto Kazuhiro,
Narumi Yoshihumi,
Ubai Takanobu
Publication year - 2012
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 - 10.1111/j.1442-2042.2011.02856.x
Subject(s) - medicine , regimen , bladder cancer , chemotherapy , oncology , urology , neoadjuvant therapy , adjuvant , surgery , cancer , breast cancer
Cisplatin‐based chemotherapy has been widely used in a neoadjuvant as well as adjuvant setting. Furthermore, trimodal approaches including complete transurethral resection of the bladder tumor followed by combined chemotherapy and radiation have generally been performed as bladder preservation therapy. However, none of the protocols have achieved a 5‐year survival rate of more than 70%. Additionally, the toxicity of chemotherapy and/or a decreased quality of life due to urinary diversion cannot be ignored, as most patients with bladder cancer are elderly. We therefore newly developed the novel trimodal approach of “combined therapy using balloon‐occluded arterial infusion of anticancer agent and hemodialysis with concurrent radiation, which delivers an extremely high concentration of anticancer agent to the site of a tumor without systemic adverse effects (“Osaka Medical College regimen” referred to as the OMC regimen). We initially applied the OMC regimen as neoadjuvant chemotherapy for locally advanced bladder cancer. However, since more than 85% of patients with histologically‐proven urothelial cancer achieved complete response with no evidence of recurrence after a mean follow‐up of 170 (range 21–814) weeks, we have been applying the OMC‐regimen as a new approach for bladder sparing therapy. We summarize the advantage and/or disadvantage of chemotherapy in neoadjuvant as well as adjuvant settings, and show the details of our newly developed bladder sparing approach OMC regimen in this review.