Purpose: To assess the efficacy of intra-arterial chemotherapy as a bladder-preservation treatment in patients with muscle-invasive bladder cancer (MIBC) following transurethral resection of bladder tumors (TURBT). Materials and Methods: From 2005 June to 2012 November, 46 patients diagnosed with MIBC (clinical stage T2-T3N0M0) underwent three courses of cisplatin-based intra-arterial chemotherapy as a remedial approach for bladder preservation after TURBT. All patients also received intravesical instillation of chemotherapy as a maintenance strategy. Results: All 46 patients completed the treatment with minor complications. The median follow-up time was 34.5 months (range, 8-87 months). Thirty-two patients (69.6%) demonstrated complete response. The three-year and five-year overall survival was 70.65 and 61.23%, and the disease-specific survival over the same periods was 78.03 and 67.62%, respectively. During the entire follow-up period, more than 80% preserved their bladder. Conclusions: Intra-arterial chemotherapy can be performed as a remedial treatment for MIBC patient following TURBT. Combined with TURBT, it offers an option for bladder preservation therapy on patients who are unable or unwilling to undergo radical cystectomy.

Keywords:
Muscle-invasive bladder cancer, Intra-arterial chemotherapy, Transurethral resection, Bladder preservation, Radical cystectomy
1.
Ro JY, Staerkel GA, Ayala AG: Cytologic and histologic features of superficial bladder cancer. Urol Clin North Am 1992;19:435-453.
2.
Babjuk M: Transurethral resection of non--muscle-invasive bladder cancer. Eur Urol Suppl 2009;8:542-548.
3.
Süer E, Özcan C, Baltacı S, Gülpınar Ö, Burgu B, Haliloğlu A, Bedük Y: Time between first and second transurethral resection of bladder tumors in patients with high-grade T1 tumors: is it a risk factor for residual tumor detection? Urol Int 2013;91:182-186.
4.
Herr HW, Donat SM: Quality control in transurethral resection of bladder tumours. BJU Int 2008;102:1242-1246.
5.
Berger I, Martini T, Wehrberger C, Comploj E, Ponholzer A, Wolfgang M, Breinl E, Dunzinger M, Hofbauer J, Höltl W, Jeschke K, Krause S, Kugler W, Pauer W, Rauchenwald M, Pycha A, Madersbacher S: Perioperative complications and 90-day mortality of radical cystectomy in the elderly (75+): a retrospective, multicentre study. Urol Int 2014;93:296-302. Doi: 10.1159/000357127.
6.
Hoskin P, Dubash S: Bladder conservation for muscle-invasive bladder cancer. Expert Rev Anticancer Ther 2012;12:1015-1020.
7.
Smith ZL, Christodouleas JP, Keefe SM, Malkowicz SB, Guzzo TJ: Bladder preservation in the treatment of muscle-invasive bladder cancer (MIBC): a review of the literature and a practical approach to therapy. BJU Int 2013;112:13-25.
8.
Witjes JA, Compérat E, Cowan NC, De Santis M, Gakis G, Lebret T, Ribal MJ, Van der Heijden AG, Sherif A: EAU guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2013 guidelines. Eur Urol 2014;65:778-792.
9.
Stewart DJ, Benjamin RS, Zimmerman S, Caprioli RM, Wallace S, Chuang V, Calvo D 3rd, Samuels M, Bonura J, Loo TL: Clinical pharmacology of intraarterial cis-diamminedichloroplatinum(II). Cancer Res 1983;43:917-920.
10.
Mokarim A, Uetani M, Hayashi N, Sakamoto I, Minami K, Ogawa Y, Ochi M, Matsuoka Y, Hayashi K, Nomata K: Combined intraarterial chemotherapy and radiotherapy in the treatment of bladder carcinoma. Cancer 1997;80:1776-1785.
11.
Solsona E, Iborra I, Collado A, Rubio-Briones J, Casanova J, Calatrava A: Feasibility of radical transurethral resection as monotherapy for selected patients with muscle invasive bladder cancer. J Urol 2010;184:475-480.
12.
Leibovici D, Kassouf W, Pisters LL, Pettaway CA, Wu X, Dinney CP, Grossman HB: Organ preservation for muscle-invasive bladder cancer by transurethral resection. Urology 2007;70:473-476.
13.
Herr HW: Transurethral resection of muscle-invasive bladder cancer: 10-year outcome. J Clin Oncol 2001;19:89-93.
14.
Chen RC, Shipley WU, Efstathiou JA, Zietman AL: Trimodality bladder preservation therapy for muscle-invasive bladder cancer. J Natl Compr Canc Netw 2013;11:952-960.
15.
Efstathiou JA, Spiegel DY, Shipley WU, Heney NM, Kaufman DS, Niemierko A, Coen JJ, Skowronski RY, Paly JJ, McGovern FJ, Zietman AL: Long-term outcomes of selective bladder preservation by combined-modality therapy for invasive bladder cancer: the MGH experience. Eur Urol 2012;61:705-711.
16.
Ploussard G, Daneshmand S, Efstathiou JA, Herr HW, James ND, Rödel CM, Shariat SF, Shipley WU, Sternberg CN, Thalmann GN, Kassouf W: Critical analysis of bladder sparing with trimodal therapy in muscle-invasive bladder cancer: a systematic review. Eur Urol 2014;66:120-137. Doi: 10.1016/j.eururo. 2014.02.038.
17.
Eapen L, Stewart D, Collins J, Peterson R: Effective bladder sparing therapy with intra-arterial cisplatin and radiotherapy for localized bladder cancer. J Urol 2004;172:1276-1280.
18.
Han B, Liang S, Jing Y, Cui D, An X, Zou Q, Wei H, Xia S: Organ preservation for muscle-invasive bladder cancer by preoperative intra-arterial chemotherapy and transurethral resection. Med Oncol 2014;31:912.
19.
Zietman AL, Sacco D, Skowronski U, Gomery P, Kaufman DS, Clark JA, Talcott JA, Shipley WU: Organ conservation in invasive bladder cancer by transurethral resection, chemotherapy and radiation: results of a urodynamic and quality of life study on long-term survivors. J Urol 2003;170:1772-1776.
20.
Miyanaga N, Akaza H, Hinotsu S, Joraku A, Oikawa T, Sekido N, Kawai K, Shimazui T: Background variables for the patients with invasive bladder cancer suitable for bladder-preserving therapy. Jpn J Clin Oncol 2007;37:852-857.
21.
Hashine K, Kusuhara Y, Miura N, Shirato A, Sumiyoshi Y, Kataoka M: Bladder preservation therapy conducted by intra-arterial chemotherapy and radiotherapy for muscle invasive bladder cancer. Jpn J Clin Oncol 2009;39:381-386.
© 2015 S. Karger AG, Basel
2015
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.