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Comparing Intra-Arterial Chemotherapy Combined With Intravesical Chemotherapy Versus Intravesical Chemotherapy Alone: A Randomised Prospective Pilot Study for T1G3 Bladder Transitional Cell Carcinoma After Bladder-Preserving Surgery

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Abstract

Purpose

To compare the efficacy of intra-arterial chemotherapy combined with intravesical chemotherapy versus intravesical chemotherapy alone for T1G3 bladder transitional cell carcinoma (BTCC) followed by bladder-preserving surgery.

Materials and Methods

Sixty patients with T1G3 BTCC were randomly divided into two groups. After bladder-preserving surgery, 29 patients (age 30–80 years, 24 male and 5 female) received intra-arterial chemotherapy in combination with intravesical chemotherapy (group A), whereas 31 patients (age 29–83 years, 26 male and 5 female) were treated with intravesical chemotherapy alone (group B). Twenty-nine patients were treated with intra-arterial epirubicin (50 mg/m2) + cisplatin (60 mg/m2) chemotherapy 2–3 weeks after bladder-preserving surgery once every 4–6 weeks. All of the patients received the same intravesical chemotherapy: An immediate prophylactic was administered in the first 6 h. After that, therapy was administered one time per week for 8 weeks and then one time per month for 8 months. The instillation drug was epirubicin (50 mg/m2) and lasted for 30–40 min each time. The end points were tumour recurrence (stage Ta, T1), tumour progression (to T2 or greater), and disease-specific survival. During median follow-up of 22 months, the overall survival rate, tumour-specific death rate, recurrence rate, progression rate, time to first recurrence, and adverse reactions were compared between groups.

Results

The recurrence rates were 10.3 % (3 of 29) in group A and 45.2 % (14 of 31) in group B, and the progression rates were 0 % (0 of 29) in group A and 22.6 % (7 of 31) in group B. There was a significant difference between the two groups regarding recurrence (p = 0.004) and progression rates (p = 0.011). Median times to first recurrence in the two groups were 15 and 6.5 months, respectively. The overall survival rates were 96.6 and 87.1 %, and the tumour-specific death rates were 0 % (0 of 29) and 13.5 % (4 of 31) in groups A and B, respectively. During the intra-arterial chemotherapy cycle, although more than 50 % patients experienced some toxicities, most were minor and reversible [grade 1–2 (46.7 %) vs. grade 1–2 (6.9 %)].

Conclusion

These findings suggest that combining intra-arterial chemotherapy with intravesical chemotherapy could delay tumour recurrence and progression compared with intravesical chemotherapy alone and this type treatment is relatively safe.

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Conflict of interest

The authors declare no conflicts of interest.

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Authors and Affiliations

  1. Department of Urology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China

    Junxing Chen, Zhijun Yao, Shaopeng Qiu & Lingwu Chen

  2. Department of Interventional Oncology, First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China

    Yu Wang, Jianyong Yang & Jiaping Li

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  1. Junxing Chen
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  2. Zhijun Yao
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  3. Shaopeng Qiu
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  4. Lingwu Chen
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  7. Jiaping Li
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Correspondence to Jiaping Li.

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Chen, J., Yao, Z., Qiu, S. et al. Comparing Intra-Arterial Chemotherapy Combined With Intravesical Chemotherapy Versus Intravesical Chemotherapy Alone: A Randomised Prospective Pilot Study for T1G3 Bladder Transitional Cell Carcinoma After Bladder-Preserving Surgery. Cardiovasc Intervent Radiol 36, 1521–1526 (2013). https://doi.org/10.1007/s00270-013-0594-2

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  • DOI: https://doi.org/10.1007/s00270-013-0594-2

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