Intraarterial Chemotherapy and Concurrent Radiation for Locally Advanced Bladder Cancer

Article Outline

• Purpose/Objective(s)
• Materials/Methods
• Results
• Conclusions
• Copyright

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Purpose/Objective(s) 

Although radical cystectomy is considered to be the standard treatment for muscle-invasive bladder cancer, good results have been recently reported using the combination of radiotherapy and cisplatin-based chemotherapy. Intra-arterial approaches to chemotherapy have been developed to reduce systemic toxicities and improve response rates. This study was designed to determine the effectiveness of intra-arterial chemotherapy with cisplatin and doxorubicin combined with radiotherapy in the treatment of patients with invasive bladder cancer.

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Materials/Methods 

Twenty-seven patients with T2-T4 muscle-invasive bladder cancer were each treated with 2 courses of intra-arterial cisplatin and doxorubicin at 4-week intervals, whereas radiotherapy was administered for 4 weeks (2 Gy given a total of 20 times, at 5 fractions per week) after transurethral resection of the bladder (TURBT). Patients with complete responses were not given additional treatment, and patients with residual tumor after the initial chemoradiotherapy underwent cystectomy or additional chemotherapy.

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Results 

A clinical complete response was observed in 22 patients (81%), 15 of whom (56%) had a continuously tumor free bladder. Incomplete response was observed in 5 (19%). The cumulative survival rate was 81% at 3 years. After a median follow-up interval of 27 months, 22 patients (81%) were alive and 5 (19%) had died due to disease progression. The regimen was well tolerated, with no severe systemic or local toxicities.

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Conclusions 

The high rates of response and survival observed indicate that this combined intra-arterial chemotherapy and radiotherapy regimen would be useful in the management of invasive bladder cancer.