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Total Cystectomy Versus Bladder Preservation Therapy for Locally Invasive Bladder Cancer: Effect of Combined Therapy Using Balloon-Occluded Arterial Infusion of Anticancer Agent and Hemodialysis With Concurrent Radiation

Azuma, Haruhito MD, PhD*; Yamamoto, Kazuhiro MD, PhD; Inamoto, Teruo MD, PhD*; Ibuki, Naokazu MD*; Kotake, Yatsugu MD, PhD*; Sakamoto, Takeshi MD*; Kiyama, Satoshi MD, PhD*; Ubai, Takanobu MD, PhD*; Takahara, Kiyoshi MD*; Segawa, Naoki MD, PhD*; Narumi, Yoshihumi MD, PhD; Katsuoka, Yoji MD, PhD*

American Journal of Clinical Oncology: December 2009 - Volume 32 - Issue 6 - p 592-606
doi: 10.1097/COC.0b013e318199fb42
Original Article: Genitourinary

Objectives: We tested the usefulness of balloon-occluded arterial infusion (BOAI) of anticancer agent (cisplatin/gemcitabine), concomitant with hemodialysis, which delivers an extremely high concentration of anticancer agent to the site of a tumor without systemic adverse effects, along with concurrent radiation [Osaka-Medical College (OMC)-regimen] in patients with locally advanced bladder cancer. The results were compared with those of cystectomy.

Methods: One hundred twenty-four patients were assigned to receive cystectomy (Gp1, n = 62) or OMC-regimen (Gp2, n = 62). In Gp2, patients besides undergoing complete response subsequently received secondary-BOAI with gemcitabine (1600 mg).

Results: In Gp1, 27 of 62 patients (43.5%) suffered disease recurrence, and more than half died within 1 year; the remainder died thereafter. The overall 5-, 10-, and 15-year survival rates were 53.8%, 46.0%, and 40.0%, respectively. In contrast, in Gp2, >70% of patients (44 of 62), especially >95% of patients with locally invasive tumors achieved complete response with no evidence of recurrent disease or metastasis after a mean follow-up of 163 (range, 32–736) weeks. At 14 years, overall survival was significantly improved at 79.7% (P = 0.015 vs. Gp1). Moreover, salvage therapy for secondary-BOAI with gemcitabine was effective in all 3 patients with T4 tumors or lymph node involvement, who showed stable disease (SD) after primary therapy with CDDP. No patients suffered Grade III or more severe toxicities.

Conclusion: OMC-regimen, a new strategy for patients with locally-invasive bladder cancer, can be curative not only in patients for whom cystectomy is indicated, but also in patients whose condition is not amenable to curative treatment and for whom merely palliative treatment would otherwise seem the only option.

From the Departments of *Urology and †Radiology, Osaka Medical College, Takatsuki, Osaka.

Reprints: Haruhito Azuma, MD, PhD, at the Department of Urology, Osaka Medical College, Takatsuki, Osaka 569-8686, Japan. E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.