Japanese Journal of Clinical Oncology Advance Access published online on April 7, 2009
Japanese Journal of Clinical Oncology, doi:10.1093/jjco/hyp023
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© The Author (2009). Published by Oxford University Press. All rights reserved
Bladder Preservation Therapy Conducted by Intra-arterial Chemotherapy and Radiotherapy for Muscle Invasive Bladder Cancer
1 Department of Urology, National Hospital Organization Shikoku Cancer Center
2 Department of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Japan
For reprints and all correspondence: Katsuyoshi Hashine, Department of Urology, National Hospital Organization Shikoku Cancer Center, 160 Minamiumemoto, Matsuyama 791-0280, Japan. E-mail: khashine{at}shikoku-cc.go.jp
Received January 15, 2009; accepted February 24, 2009
Objective: A previous paper reported favorable results of intra-arterial chemotherapy in combination with radiotherapy for muscle-invasive bladder cancer. The current study will update those results.
Methods: Between January 1992 and December 2006, 94 patients with confirmed muscle invasion were treated with intra-arterial chemotherapy and concurrent radiotherapy after an initial complete transurethral resection. Intra-arterial chemotherapy consisted of cisplatin (Days 1–3) and pirarubicin (Days 8–10), and radiation was administered with the chemotherapy (2 Gy/session) with a total dosage of 44 Gy. The median age was 67.0 years. There were 60 patients in T2, 19 patients in T3 and 15 patients in T4. The median follow-up period was 72.9 months in the survivors.
Results: Among these patients, 84 patients (89.4%) obtained a complete response (CR) and 10 patients did not achieve a CR. Between the CR and non-CR patients, the clinical stage and the existence of hydronephrosis were significantly different. The cause-specific survival rates at 5 and 10 years were 76.2% and 67.5%, respectively. The overall survival rates at 5 and 10 years were 66.6% and 47.4%, respectively. A Cox proportional hazard model showed that only the cause-specific survival rate was associated with a CR after treatment. The bladder preservation rates were 89.7% at 5 years and 87.6% at 10 years. Myelosuppression was the major adverse event but it was manageable. Non-hematological sever adverse events were rare.
Conclusions: Bladder preservation therapy shows good survival and good bladder preservation rates. Clinical stage T2 and the absence of hydronephrosis are favorable factors.
Key Words: bladder preservation therapy • chemotherapy • radiotherapy • invasive bladder cancer