| Abstract |
Locally advanced bladder cancer is a therapeutic challenge for the physician, since 5-years survival does not exceed 45% in such patients. One of the latest developments for the treatment of locally advanced blad-der cancer is intra-arterial infusion of chemotherapeutics. Its has the follow-ing advances: 1) it has not systemic adverse effects, 2) it can be applied to elderly people, 3) it delivers high concentrations of the applied drug into the tumor tissue, 4) it preserves the urinary bladder and 5) it is favored by the anatomical position of the urinary bladder and by its arterial blood supply, that comprises form only one major root, the interior iliac artery. This study was performed to evaluate the therapeutic efficacy and the adverse reactions of the intra-arterial chemotherapy in patients with lo-cally advanced bladder cancer. The study groups were two: Treatment group (32 patients, 30 males and 2 females, mean age of 65.6 years, dis-ease stage T3 or T4) and control group (22 patients which underwent sys-temic chemotherapy with the M-VEC regimen). The remission of local symptomatology (tumor size, local pain, hematuria, renal insufficiency) and the possibility of post-treatment surgical resection of the tumor were the objectives of the treatment. Intra-arterial chemotherapy was performed after insertion of an in-fuse-a-port catheter in the anterior branch of the interior iliac artery. The catheter was inserted under general anesthesia with a bilateral incision and was tolerated well. No patient suffered from any complication of the surgical procedure. Infusion of epirubicin 10 mg in each catheter was performed at days 1, 2 and 3 and at concurrently intravenous infusion of leucovorin 200 mg and 5-fluorouracil 750 mg was given. Therapy was repeated every 21 days for a total number of four cycles. Results were estimated by clinical examination, cystoscopy and laboratory evaluation. There was a 68.7% total response rate (complete response: 37.5% and partial response: 31.2%). No major side effects were attributed to the intra-arterial chemotherapy. Pelvic pain and hematuria remitted in most patients. In contrast control patients had a 13.6% total response rate (one complete response and two partial responses) and they experienced major adverse effects of the systemic chemotherapy. The difference between the two methods was statistical significant in respect to hematuria remission (p<0.02) and overall response (p<0.03) and intra-arterial chemotherapy leaded to a higher percentage of remission in respect to pain and renal insufficiency (though not statistical significant). In conclusion, intra-arterial chemotherapy for patients with locally advanced bladder cancer 1) is well tolerated, 2) improves quality of life and 3) leads to higher remission rates. In the future the optimization of the method, the precise characterization of inclusion criteria and the selection of the chemotherapeutic drugs that will be applied will lead to further im-provement and possibly to better treatment for patients with locally ad-vanced bladder cancer.
|
Η περιοχική ενδαρτηριακή χημειοθεραπεία του προχωρημένου καρκίνου της ουροδόχου κύστης
