Efficacy Of Intra-arterial Chemotherapy In Bladder Preservation Therapy Of Muscle-invasive Bladder Cancer

OBJECTIVETo explore the therapeutic value of pre-operative intra-arterial chemotherapy and transurethralresection of bladder tumor (TURBT) as bladder preservation therapy in treatment ofmuscle-invasive bladder cancer (MIBC).METHODSBetween August2005and October2012,135patients with clinical stage T2-T4aN0M0MIBC who are unable or unwilling to undergo radical cystectomy were firstly treated withcisplatin-based intra-arterial chemotherapy at one-month intervals. Cystoscopy and CT/MRIwas performed to evaluate the tumor sensitivity of each previous round of intra-arterialchemotherapy. If the chemotherapy was effective，the patients will received the next course ofintra-arterial chemotherapy. After3to5courses of intra-arterial chemotherapy, the tumorswere completely removed by transurethral resection, and all patients received epirubicin forintravesical instillation as a maintenance strategy. At1months after treatment, patientresponse was evaluated by cystoscopy with biopsy, abdomino-pelvic CT/MRI, and urinecytology. Patients showing a complete response (CR) received continuous monitoring, andradical cystectomy was strongly recommended for patients who did not achieve a CR. RESULTSAmong the135patients,8patients’ tumors failed to respond to intra-arterial chemotherapyand underwent a radical cystectomy. A total of127patients completed treatment with abladder preservation therapy, and the median follow-up time for all patients was31.9months(range,5–87months). Among these patients,91(71.7%) achieved a CR, and the5-yearoverall survival and disease-specific survival rates for all patients were50.2%and59.5%,respectively. Among the patients who demonstrated a CR,10experienced a superficialrelapse and15experienced an invasive cancer relapse. The5-year recurrence-free andprogression-free survival rates were62.2%and76.9%, respectively. Patients who showed arecurrence of non-muscle invasive bladder cancer were treated with TURBT combined withepirubicin instillation therapy. Radical cystectomy was strongly recommended for thoseMIBC relapse. An analysis of tumor-related factors suggested that clinical stage waspredictive factor for CR both in univariate analyses and in multivariate analyses. In thecomparison of survival rate, patients with clinical stage T2tumors had significantly betterprognosis than with T3~T4a tumors in overall survival and disease-specific survival（P <0.05）. Meanwhile, the stepwise Cox regression analysis showed that clinical stage wasindependent risk factor for overall survival of patients.CONCLUSIONSPre-operative intra-arterial chemotherapy combined with TURBT is useful for bladderpreservation in certain patients with invasive bladder cancer. Patients with stage T2tumorsare best suited for this type of therapy. BACKGROUND&OBJECTIVEHow to treat with muscle-invasive bladder cancer (MIBC) diagnosed after transurethralresection of bladder tumor (TURBT) has been the quite difficult clinical problem. In principle,these patients are all need to receive radical cystectomy or radical radiotherapy. However,patients are reluctant to accept these kind therapy. Intra-arterial chemotherapy can provideeffect local control in the treatment of MIBC. In this study, we treated MIBC patients whodiagnosed after TURBT with adjuvant intra-arterial chemotherapy, and then, we evaluate theefficacy of this combination as a bladder preservation treatment in patients with MIBC.METHODSFrom June2005to2012November,46patients diagnosed with MIBC (clinical stageT2-T3N0M0) underwent the cisplatin-based intra-arterial chemotherapy as an adjuvanttreatment for bladder preservation after TURBT. All patients also received intravesicalinstillation of chemotherapy as a maintenance strategy. A total of3courses of intra-arterialchemotherapy at1month interval. One month after completion of treatment, cystoscopy withbiopsy, urine cytology and abdomino-pelvic CT/MRI were performed to evaluate treatmentresponse. Kaplan-Meier analysis was used to calculate the overall survival, cancer-specificsurvival, disease-specific survival for bladder-preservation patients and then a survival curvewas drawn. RESULTSAll46patients completed the treatment with minor complications. The median follow-uptime was34.5months (range,8–87months). Thirty-two patients (69.6%) demonstratedcomplete response (CR). The three-year and five-year overall survival was70.65%and61.23%, and the disease-specific survival over the same periods was78.03%and67.62%,respectively. During the entire follow-up period, more than80%preserved their bladder.Among the patients who received a CR, seven patients demonstrated recurring disease duringthe follow-up period (recurrence rate:15.2%). Four patients experienced non-MIBCrecurrence and underwent TURBT, two patients who displayed local MIBC recurrenceunderwent salvage radical cystectomy, and one received systemic chemotherapy because oflung metastasis.CONCLUSIONSAdjuvant intra-arterial chemotherapy treated MIBC diagnosed after TURBT able to getsatisfactory outcomes. Combined with TURBT, it offers an option for bladder preservationtherapy on patients who are unable or unwilling to undergo radical cystectomy.