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Organ preservation for muscle-invasive bladder cancer by preoperative intra-arterial chemotherapy and transurethral resection

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Abstract

The aim of this study was to evaluate the clinical outcomes achieved by use of preoperative intra-arterial chemotherapy and transurethral resection of bladder tumors as bladder preservation therapy in treatment of muscle-invasive bladder cancer. Patients with clinical stage T2-T4aN0M0 muscle-invasive bladder cancer were treated with 3 courses of preoperative cisplatin-based intra-arterial chemotherapy at 4-week intervals. Following treatment, the tumors were completely removed by transurethral resection, and all patients received epirubicin for intra-vesical instillation as a maintenance strategy. Patients showing a complete response received continuous monitoring, and radical cystectomy was strongly recommended for patients who did not achieve a complete response. Between August 2005 and October 2012, a total of 127 patients completed treatment with a bladder preservation therapy, and the median follow-up time for all patients was 31.9 months (range 5–87 months). Among these patients, 91 (71.7 %) achieved a complete response, and the 5-year overall survival and disease-specific survival rates for all patients were 50.2 and 59.5 %, respectively. Among the patients who demonstrated a complete response, 10 experienced a superficial relapse and 15 experienced an invasive cancer relapse. The 5-year recurrence-free and progression-free survival rates were 62.2 and 76.9 %, respectively. An analysis of tumor-related factors suggested that clinical stage was significant for predicting both complete response and overall survival. These results suggest that preoperative intra-arterial chemotherapy combined with transurethral resection of the bladder tumor is useful for bladder preservation in certain patients with invasive bladder cancer. Patients with stage T2 tumors are best suited for this type of therapy.

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Authors and Affiliations

  1. Department of Urology, Shanghai First People’s Hospital Affiliated to Shanghai Jiaotong University, No. 100, Haining Road, Shanghai, 200080, China

    Bangmin Han, Shengjie Liang, Yifeng Jing, Di Cui, Qingsong Zou, Haibin Wei & Shujie Xia

  2. Department of Vascular Surgery and Interventional Radiology, Shanghai First People’s Hospital Affiliated to Shanghai Jiaotong University, No. 100, Haining Road, Shanghai, 200080, China

    Xiao An

Authors
  1. Bangmin Han
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  2. Shengjie Liang
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  3. Yifeng Jing
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  4. Di Cui
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  5. Xiao An
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  6. Qingsong Zou
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  7. Haibin Wei
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  8. Shujie Xia
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Correspondence to Shujie Xia.

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Han, B., Liang, S., Jing, Y. et al. Organ preservation for muscle-invasive bladder cancer by preoperative intra-arterial chemotherapy and transurethral resection. Med Oncol 31, 912 (2014). https://doi.org/10.1007/s12032-014-0912-9

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  • DOI: https://doi.org/10.1007/s12032-014-0912-9

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