Novel Software-Assisted Hemodynamic Evaluation of Pelvic Flow During Chemoperfusion of Pelvic Arteries for Bladder Cancer: Double- Versus Single-Balloon Technique.

Kiyohito Yamamoto,Yoshifumi Narumi,Haruhito Azuma,Kazuhiro Yamamoto,Go Nakai

doi:10.1007/s00270-016-1296-3

Kiyohito Yamamoto, Yoshifumi Narumi + Show 3 more

Open Access

https://doi.org/10.1007/s00270-016-1296-3

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Abstract

PurposeApproximately 83 % of patients with bladder cancer have achieved a complete response after undergoing a novel bladder preservation therapy involving balloon-occluded intra-arterial infusion chemotherapy (BOAI) using a four-lumen double-balloon catheter, known as the Osaka Medical College regimen. This study aimed to show the quantitative difference in hemodynamics of the bladder arteries using syngo iFlow (Siemens Healthcare, Erlangen, Germany), which provides an automatic tool for quantitative blood flow analysis between double BOAI (D-BOAI) and conventional single BOAI (S-BOAI).Materials and MethodsFifty patients were included. The catheters were introduced into both posterior trunks of the internal iliac arteries via contralateral femoral artery access. A side hole between the distal and proximal balloons was placed at the origin of each bladder artery to allow clear visualization of angiographic flow of the injected agent into the urinary bladder. Digital subtraction angiography was used during analysis with the syngo iFlow to evaluate the hemodynamics of the contrast medium in the pelvic arteries during BOAI. The comparative change in the amount of contrast medium in the bladder arteries between D-BOAI and S-BOAI was assessed using syngo iFlow.ResultsOne-hundred pelvic sides were analyzed. The amount of contrast medium in the bladder arteries using D-BOAI was more than twice that using S-BOAI (right, 3.03-fold; left, 2.81-fold).ConclusionThe amount of contrast medium in the bladder arteries using D-BOAI was higher than that using conventional S-BOAI. This may increase the anticancer drug concentration in the affected bladder, leading to a good clinical response.

Highlights

The gold-standard therapy for locally invasive bladder cancer has long been radical cystectomy with pelvic lymph node dissection
Purpose Approximately 83 % of patients with bladder cancer have achieved a complete response after undergoing a novel bladder preservation therapy involving balloonoccluded intra-arterial infusion chemotherapy (BOAI) using a four-lumen double-balloon catheter, known as the Osaka Medical College regimen
This study aimed to show the quantitative difference in hemodynamics of the bladder arteries using syngo iFlow (Siemens Healthcare, Erlangen, Germany), which provides an automatic tool for quantitative blood flow analysis between double BOAI (D-BOAI) and conventional single BOAI (S-BOAI)

Summary

Introduction

The gold-standard therapy for locally invasive bladder cancer has long been radical cystectomy with pelvic lymph node dissection. Approximately 50 % of all patients with invasive bladder cancer die, and the outcome of this disease is closely related to its pathologic stage [1]. A highly effective but minimally invasive therapy that conserves the bladder is needed. Combined treatment involving radical transurethral resection, chemotherapy, and radiation therapy has been attempted as an alternative approach for patients who require cystectomy. A novel bladder preservation therapy known as the Osaka Medical College (OMC) regimen has resulted in. K. Yamamoto et al.: Novel Software-Assisted Hemodynamic Evaluation of Pelvic Flow During

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