Novel bladder preservation therapy with Osaka medical college regimen

Haruhito Azuma, Teruo Inamoto, Kiyoshi Takahara, Hayahito Nomi, Hajime Hirano, Naokazu Ibuki, Hiroshi Uehara, Kazumasa Komura, Koichiro Minami, Taizo Uchimoto, Kenkichi Saito, Tomoaki Takai, Naoki Tanda, Kazuhiro Yamamoto, Yoshihumi Narumi, Satoshi Kiyama

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish
Pages (from-to)443-450
Number of pages8
JournalJournal of Urology
Volume193
Issue number2
DOIs
Publication statusPublished - 01-02-2015

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Urinary Bladder
gemcitabine
Therapeutics
Cystectomy
Antineoplastic Agents
Cisplatin
Treatment Failure
Palliative Care
Urinary Bladder Neoplasms
Renal Dialysis
Survival Rate
Lymph Nodes
Radiation
Survival
Neoplasms

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Azuma, H., Inamoto, T., Takahara, K., Nomi, H., Hirano, H., Ibuki, N., ... Kiyama, S. (2015). Novel bladder preservation therapy with Osaka medical college regimen. Journal of Urology, 193(2), 443-450. https://doi.org/10.1016/j.juro.2014.08.094
Azuma, Haruhito ; Inamoto, Teruo ; Takahara, Kiyoshi ; Nomi, Hayahito ; Hirano, Hajime ; Ibuki, Naokazu ; Uehara, Hiroshi ; Komura, Kazumasa ; Minami, Koichiro ; Uchimoto, Taizo ; Saito, Kenkichi ; Takai, Tomoaki ; Tanda, Naoki ; Yamamoto, Kazuhiro ; Narumi, Yoshihumi ; Kiyama, Satoshi. / Novel bladder preservation therapy with Osaka medical college regimen. In: Journal of Urology. 2015 ; Vol. 193, No. 2. pp. 443-450.
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abstract = "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.",
author = "Haruhito Azuma and Teruo Inamoto and Kiyoshi Takahara and Hayahito Nomi and Hajime Hirano and Naokazu Ibuki and Hiroshi Uehara and Kazumasa Komura and Koichiro Minami and Taizo Uchimoto and Kenkichi Saito and Tomoaki Takai and Naoki Tanda and Kazuhiro Yamamoto and Yoshihumi Narumi and Satoshi Kiyama",
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Azuma, H, Inamoto, T, Takahara, K, Nomi, H, Hirano, H, Ibuki, N, Uehara, H, Komura, K, Minami, K, Uchimoto, T, Saito, K, Takai, T, Tanda, N, Yamamoto, K, Narumi, Y & Kiyama, S 2015, 'Novel bladder preservation therapy with Osaka medical college regimen', Journal of Urology, vol. 193, no. 2, pp. 443-450. https://doi.org/10.1016/j.juro.2014.08.094

Novel bladder preservation therapy with Osaka medical college regimen. / Azuma, Haruhito; Inamoto, Teruo; Takahara, Kiyoshi; Nomi, Hayahito; Hirano, Hajime; Ibuki, Naokazu; Uehara, Hiroshi; Komura, Kazumasa; Minami, Koichiro; Uchimoto, Taizo; Saito, Kenkichi; Takai, Tomoaki; Tanda, Naoki; Yamamoto, Kazuhiro; Narumi, Yoshihumi; Kiyama, Satoshi.

In: Journal of Urology, Vol. 193, No. 2, 01.02.2015, p. 443-450.

Research output: Contribution to journalArticle

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

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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