TY - JOUR
T1 - Novel bladder preservation therapy with Osaka medical college regimen
AU - Azuma, Haruhito
AU - Inamoto, Teruo
AU - Takahara, Kiyoshi
AU - Nomi, Hayahito
AU - Hirano, Hajime
AU - Ibuki, Naokazu
AU - Uehara, Hiroshi
AU - Komura, Kazumasa
AU - Minami, Koichiro
AU - Uchimoto, Taizo
AU - Saito, Kenkichi
AU - Takai, Tomoaki
AU - Tanda, Naoki
AU - Yamamoto, Kazuhiro
AU - Narumi, Yoshihumi
AU - Kiyama, Satoshi
N1 - Publisher Copyright:
© 2015 American Urological Association Education and Research, Inc.
PY - 2015/2/1
Y1 - 2015/2/1
N2 - Purpose We investigated the effect of balloon occluded arterial infusion of an anticancer agent (cisplatin/gemcitabine), used concomitantly with hemodialysis, which delivers an extremely high concentration of anticancer agent to the tumor site without systemic adverse effects, along with concurrent radiation (referred to as the Osaka Medical College regimen) in patients with advanced bladder cancer. Materials and Methods A total of 329 patients (TisN0 16, T2N0 174, T3N0 77, T4N0 22 and TxN+ 40) were assigned to receive the Osaka Medical College regimen. Patients who did not achieve complete response underwent total cystectomy or secondary balloon occluded arterial infusion with an increased amount of cisplatin and/or gemcitabine. Results The Osaka Medical College regimen allowed 83.6% (276 of 329) of patients in total and 93.6% (250 of 267) of patients with organ confined disease (including T3b) to achieve complete response. Of the patients with a complete response 96% (240 of 250) survived with a functional bladder without evidence of recurrent disease within a mean followup of 159 weeks. Although lymph node involvement, especially N2 stage, was selected as a significant risk factor for treatment failure and survival, it was noteworthy that 61.9% of patients with N1 disease achieved complete response and that the 5-year overall survival rate was 72.2%. No patients had grade III or more severe toxicities. Conclusions The Osaka Medical College regimen, a new bladder preservation strategy, can be curative not only in patients for whom cystectomy is indicated, but also in patients whose condition is not amenable to curative treatment because of disease stage, age or other factors, and for whom merely palliative therapy would otherwise seem the only option.
AB - Purpose We investigated the effect of balloon occluded arterial infusion of an anticancer agent (cisplatin/gemcitabine), used concomitantly with hemodialysis, which delivers an extremely high concentration of anticancer agent to the tumor site without systemic adverse effects, along with concurrent radiation (referred to as the Osaka Medical College regimen) in patients with advanced bladder cancer. Materials and Methods A total of 329 patients (TisN0 16, T2N0 174, T3N0 77, T4N0 22 and TxN+ 40) were assigned to receive the Osaka Medical College regimen. Patients who did not achieve complete response underwent total cystectomy or secondary balloon occluded arterial infusion with an increased amount of cisplatin and/or gemcitabine. Results The Osaka Medical College regimen allowed 83.6% (276 of 329) of patients in total and 93.6% (250 of 267) of patients with organ confined disease (including T3b) to achieve complete response. Of the patients with a complete response 96% (240 of 250) survived with a functional bladder without evidence of recurrent disease within a mean followup of 159 weeks. Although lymph node involvement, especially N2 stage, was selected as a significant risk factor for treatment failure and survival, it was noteworthy that 61.9% of patients with N1 disease achieved complete response and that the 5-year overall survival rate was 72.2%. No patients had grade III or more severe toxicities. Conclusions The Osaka Medical College regimen, a new bladder preservation strategy, can be curative not only in patients for whom cystectomy is indicated, but also in patients whose condition is not amenable to curative treatment because of disease stage, age or other factors, and for whom merely palliative therapy would otherwise seem the only option.
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U2 - 10.1016/j.juro.2014.08.094
DO - 10.1016/j.juro.2014.08.094
M3 - Article
C2 - 25167990
AN - SCOPUS:84920717390
SN - 0022-5347
VL - 193
SP - 443
EP - 450
JO - Journal of Urology
JF - Journal of Urology
IS - 2
ER -