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

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

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)592-606
Number of pages15
JournalAmerican Journal of Clinical Oncology: Cancer Clinical Trials
Volume32
Issue number6
DOIs
Publication statusPublished - 01-12-2009

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Cystectomy
Urinary Bladder Neoplasms
Antineoplastic Agents
Renal Dialysis
Urinary Bladder
Radiation
gemcitabine
Therapeutics
Salvage Therapy
Neoplasms
Palliative Care
Cisplatin
Survival Rate
Lymph Nodes
Neoplasm Metastasis
Recurrence

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Azuma, Haruhito ; Yamamoto, Kazuhiro ; Inamoto, Teruo ; Ibuki, Naokazu ; Kotake, Yatsugu ; Sakamoto, Takeshi ; Kiyama, Satoshi ; Ubai, Takanobu ; Takahara, Kiyoshi ; Segawa, Naoki ; Narumi, Yoshihumi ; Katsuoka, Yoji. / 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. In: American Journal of Clinical Oncology: Cancer Clinical Trials. 2009 ; Vol. 32, No. 6. pp. 592-606.
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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; Yamamoto, Kazuhiro; Inamoto, Teruo; Ibuki, Naokazu; Kotake, Yatsugu; Sakamoto, Takeshi; Kiyama, Satoshi; Ubai, Takanobu; Takahara, Kiyoshi; Segawa, Naoki; Narumi, Yoshihumi; Katsuoka, Yoji.

In: American Journal of Clinical Oncology: Cancer Clinical Trials, Vol. 32, No. 6, 01.12.2009, p. 592-606.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Total cystectomy versus bladder preservation therapy for locally invasive bladder cancer

T2 - Effect of combined therapy using balloon-occluded arterial infusion of anticancer agent and hemodialysis with concurrent radiation

AU - Azuma, Haruhito

AU - Yamamoto, Kazuhiro

AU - Inamoto, Teruo

AU - Ibuki, Naokazu

AU - Kotake, Yatsugu

AU - Sakamoto, Takeshi

AU - Kiyama, Satoshi

AU - Ubai, Takanobu

AU - Takahara, Kiyoshi

AU - Segawa, Naoki

AU - Narumi, Yoshihumi

AU - Katsuoka, Yoji

PY - 2009/12/1

Y1 - 2009/12/1

N2 - 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.

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