Abstract
Purpose: We evaluated the clinical outcomes following intra-arterial chemotherapy with maximum transurethral resection of bladder tumour (TURBT) for patients with T1 grade 3 (G3) and T2--3N0M0 bladder cancers. Material and methods: Patients were 27 males and 7 females with a median age of 63.6 years. With the cooperation of an interventional radiologist, cisplatin (100 mg/m2), methotrexate (30 mg/m2) and adriamycin (20 mg/ body) were administered via a catheter in 2 cycles every 4 weeks. Results: The 5-year cancer-specific survival rate in T1 G3, T2 and T3 was 100.0%, 57.3% and 50.0%, respectively. In T2--3N0M0 cases, complete response (CR) and non-CR were seen in 13 (46.4%) and 15 cases (53.6%), respectively. Response to treatment proved to be the most significant prognostic predictor of cancerspecific survival by multivariate analysis in T2--3N0M0 cases. T2--3N0M0 cases with ?2 prognostic predictors at staging TURBT (age >70 years, male, size >3 cm and the presence of hydronephrosis) had an unfavourable outcome. There was a statistical association between the number of prognostic predictors at staging TURBT and response to treatment. Conclusion: These results suggest that our protocol prevents disease progression in T1 G3 cases, but that it is not suitable for T2--3N0M0 cases with ?2 prognostic predictors at staging TURBT.
Highlights
Radical cystectomy is the standard therapy for muscle-invasive bladder cancer
It has been suggested that T1 grade 3 (G3) bladder cancer is an indication for early radical cystectomy because of the high likelihood of recurrence and disease progression [1,2]
Survival outcome following radical cystectomy has gradually improved with more modern techniques has decreased by 50% over the past 20 years [36]
Summary
Radical cystectomy is the standard therapy for muscle-invasive bladder cancer. It has been suggested that T1 grade 3 (G3) bladder cancer is an indication for early radical cystectomy because of the high likelihood of recurrence and disease progression [1,2]. Around 15% of patients with muscle-invasive bladder cancer had no residual tumour following radical cystectomy on pathological examination. These data suggest that selected patients with muscle-invasive bladder cancer benefit from bladder preservation therapy. Some patients with muscle-invasive bladder cancer may opt for bladder preservation therapy given the choice. Most multimodality bladder preservation therapies show a similar treatment efficacy when compared to radical cystectomy [7,8]
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