Top

Published in:

01-08-2018 | Original Article

The effects of intra-arterial chemotherapy on bladder preservation in patients with T1 stage bladder cancer

Authors: Zefu Liu, Yunlin Ye, Xiangdong Li, Shengjie Guo, Lijuan Jiang, Pei Dong, Yonghong Li, Yanxia Shi, Weijun Fan, Yun Cao, Kai Yao, Zike Qin, Hui Han, Fangjian Zhou, Zhuowei Liu

Published in: World Journal of Urology | Issue 8/2018

Abstract

Purpose

To investigate the effects of intra-arterial chemotherapy on T1 stage bladder cancer (Bca) and evaluate patient outcome with bladder-preserving treatment approaches.

Materials and methods

A total of 238 patients with T1 stage Bca were retrospectively analyzed. Among them, 35 patients were categorized into the subgroup of highest-risk T1 stage according to the European Association of Urology guidelines and received immediate radical cystectomy (RC group), whereas 62 were classified as being highest-risk T1 patients but were unwilling to undergo RC and were treated with gemcitabine plus cisplatin intra-arterial chemotherapy (GC group). There were 141 T1 patients who had bladder-preserving surgery with intravesical chemotherapy (IVC group).

Results

For patients with T1 stage Bca, the GC group had a higher estimated recurrence-free survival rate (44.4 vs. 13.9%, P = 0.087), progression-free survival rate (75.4 vs. 32.8%, P = 0.006), and cancer-specific survival (CSS) rate (78.7 vs. 67.5%, P = 0.399) when compared with the IVC group, respectively. Using the multivariable regression model, the GC intra-arterial chemotherapy was significantly related to bladder preservation (P = 0.004), lower recurrence (P = 0.012), and less progression (P = 0.004). For patients with the highest-risk T1 stage, GC group did not have a poorer CSS rate in comparison with the RC group (P = 0.383). Moreover, immediate RC did not confer a survival benefit in terms of CSS when compared with those who underwent deferred RC after failing GC intra-arterial chemotherapy (P = 0.283).

Conclusions

Gemcitabine plus cisplatin intra-arterial chemotherapy may be an effective bladder-preserving alternative adjuvant treatment for patients with T1 stage Bca with oncologic benefits, good compliance, and low toxicity.

Babjuk M, Bohle A, Burger M et al (2017) EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2016. Eur Urol 71:447–461. https://doi.org/10.1016/j.eururo.2016.05.041 CrossRefPubMed

van den Bosch S, Alfred Witjes J (2011) Long-term cancer-specific survival in patients with high-risk, non-muscle-invasive bladder cancer and tumour progression: a systematic review. Eur Urol 60:493–500. https://doi.org/10.1016/j.eururo.2011.05.045 CrossRefPubMed

Martin-Doyle W, Leow JJ, Orsola A et al (2015) Improving selection criteria for early cystectomy in high-grade t1 bladder cancer: a meta-analysis of 15,215 patients. J Clin Oncol 33:643–650. https://doi.org/10.1200/JCO.2014.57.6967 CrossRefPubMed

Sylvester RJ, Brausi MA, Kirkels WJ et al (2010) Long-term efficacy results of EORTC genito-urinary group randomized phase 3 study 30911 comparing intravesical instillations of epirubicin, bacillus Calmette-Guerin, and bacillus Calmette-Guerin plus isoniazid in patients with intermediate- and high-risk stage Ta T1 urothelial carcinoma of the bladder. Eur Urol 57:766–773. https://doi.org/10.1016/j.eururo.2009.12.024 CrossRefPubMed

Brausi M, Oddens J, Sylvester R et al (2014) Side effects of Bacillus Calmette–Guerin (BCG) in the treatment of intermediate- and high-risk Ta, T1 papillary carcinoma of the bladder: results of the EORTC genito-urinary cancers group randomised phase 3 study comparing one-third dose with full dose and 1 year with 3 years of maintenance BCG. Eur Urol 65:69–76. https://doi.org/10.1016/j.eururo.2013.07.021 CrossRefPubMed

Sternberg IA, Keren Paz GE, Chen LY et al (2013) Role of immediate radical cystectomy in the treatment of patients with residual T1 bladder cancer on restaging transurethral resection. BJU Int 112:54–59. https://doi.org/10.1111/j.1464-410X.2012.11391.x CrossRefPubMed

Hautmann RE, Volkmer BG, Gust K (2009) Quantification of the survival benefit of early versus deferred cystectomy in high-risk non-muscle invasive bladder cancer (T1 G3). World J Urol 27:347–351. https://doi.org/10.1007/s00345-009-0402-4 CrossRefPubMed

Kubota Y, Kakizaki H, Numasawa K et al (1989) Preoperative intra-arterial infusion chemotherapy for patients with bladder cancer. Eur Urol 16:189–194CrossRefPubMed

Hoshi S, Mao H, Takahashi T et al (1997) Internal iliac arterial infusion chemotherapy for rabbit invasive bladder cancer. Int J Urol 4:493–499. https://doi.org/10.1111/j.1442-2042.1997.tb00292.x CrossRefPubMed

10.

Eapen L, Stewart D, Collins J et al (2004) Effective bladder sparing therapy with intra-arterial cisplatin and radiotherapy for localized bladder cancer. J Urol 172:1276–1280. https://doi.org/10.1097/01.ju.0000140456.42509.b6 CrossRefPubMed

11.

Sternberg CN, Skoneczna I, Kerst JM et al (2015) Immediate versus deferred chemotherapy after radical cystectomy in patients with pT3–pT4 or N + M0 urothelial carcinoma of the bladder (EORTC 30994): an intergroup, open-label, randomised phase 3 trial. Lancet Oncol 16:76–86. https://doi.org/10.1016/s1470-2045(14)71160-x CrossRefPubMed

12.

Galsky MD, Pal SK, Chowdhury S et al (2015) Comparative effectiveness of gemcitabine plus cisplatin versus methotrexate, vinblastine, doxorubicin, plus cisplatin as neoadjuvant therapy for muscle-invasive bladder cancer. Cancer 121:2586–2593. https://doi.org/10.1002/cncr.29387 CrossRefPubMed

13.

Yang GL, Zhang LH, Liu Q et al (2017) A novel treatment strategy for newly diagnosed high-grade T1 bladder cancer: Gemcitabine and cisplatin adjuvant chemotherapy—a single-institution experience. Urol Oncol 35:38.e9–38.e15. https://doi.org/10.1016/j.urolonc.2016.08.017 CrossRef

14.

Gontero P, Sylvester R, Pisano F et al (2015) Prognostic factors and risk groups in T1G3 non-muscle-invasive bladder cancer patients initially treated with Bacillus Calmette-Guerin: results of a retrospective multicenter study of 2451 patients. Eur Urol 67:74–82. https://doi.org/10.1016/j.eururo.2014.06.040 CrossRefPubMed

15.

Steven K, Poulsen AL (2007) Radical cystectomy and extended pelvic lymphadenectomy: survival of patients with lymph node metastasis above the bifurcation of the common iliac vessels treated with surgery only. J Urol 178:1218–1223. https://doi.org/10.1016/j.juro.2007.05.160 (discussion 23-4) CrossRefPubMed

16.

Stein JP, Lieskovsky G, Cote R et al (2001) Radical cystectomy in the treatment of invasive bladder cancer: Long-term results in 1054 patients. J Clin Oncol 19:666–675CrossRefPubMed

17.

Weiss C, Wolze C, Engehausen DG et al (2006) Radiochemotherapy after transurethral resection for high-risk T1 bladder cancer: an alternative to intravesical therapy or early cystectomy? J Clin Oncol 24:2318–2324. https://doi.org/10.1200/JCO.2006.05.8149 CrossRefPubMed

18.

Meeks JJ, Lerner SP, Svatek RS (2017) Bacillus calmette-guerin manufacturing and SWOG S1602 intergroup clinical trial. J Urol 197:538–540. https://doi.org/10.1016/j.juro.2016.12.024 CrossRefPubMed

19.

Zhang Y, Xie L, Chen T et al (2016) Intravenous chemotherapy combined with intravesical chemotherapy to treat T1G3 bladder urothelial carcinoma after transurethral resection of bladder tumor: results of a retrospective study. Onco Targets Ther 9:605–611. https://doi.org/10.2147/OTT.S99866 PubMedPubMedCentralCrossRef

20.

Hvd Maase, Hansen SW, Roberts JT et al (2000) Gemcitabine and cisplatin versus methotrexate, vinblastine, doxorubicin, and cisplatin in advanced or metastatic bladder cancer: results of a large, randomized, multinational, multicenter, phase iii study. J Clin Oncol 17:3068–3077. https://doi.org/10.1200/JCO.2000.18.17.3068 CrossRef

21.

Matsubara N, Mukai H, Naito Y et al (2013) Comparison between neoadjuvant and adjuvant gemcitabine plus cisplatin chemotherapy for muscle-invasive bladder cancer. Asia Pac J Clin Oncol 9:310–317. https://doi.org/10.1111/ajco.12017 CrossRefPubMed

22.

Yuh BE, Ruel N, Wilson TG et al (2013) Pooled analysis of clinical outcomes with neoadjuvant cisplatin and gemcitabine chemotherapy for muscle invasive bladder cancer. J Urol 189:1682–1686. https://doi.org/10.1016/j.juro.2012.10.120 CrossRefPubMed

23.

Hautmann RE, de Petriconi RC, Pfeiffer C et al (2012) Radical cystectomy for urothelial carcinoma of the bladder without neoadjuvant or adjuvant therapy: long-term results in 1100 patients. Eur Urol 61:1039–1047. https://doi.org/10.1016/j.eururo.2012.02.028 CrossRefPubMed

24.

Stein BJP, Lieskovsky G, Cote R et al (2001) Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1054 patients. J Clin Oncol 19:666–675CrossRefPubMed

25.

Madersbacher S, Schmidt J, Eberle JM et al (2003) Long-term outcome of ileal conduit diversion. J Urol 169:985–990. https://doi.org/10.1097/01.ju.0000051462.45388.14 CrossRefPubMed

26.

Hautmann RE, de Petriconi RC, Volkmer BG (2011) 25 years of experience with 1,000 neobladders: long-term complications. J Urol 185:2207–2212. https://doi.org/10.1016/j.juro.2011.02.006 CrossRefPubMed

27.

Hautmann RE, de Petriconi RC, Volkmer BG (2010) Lessons learned from 1000 neobladders: the 90-day complication rate. J Urol 184:990–994. https://doi.org/10.1016/j.juro.2010.05.037 CrossRefPubMed

28.

Chen J, Chen L, Li J et al (2013) Comparing intra-arterial chemotherapy combined with intravesical chemotherapy versus intravesical chemotherapy alone a randomised prospective pilot study for T1G3 bladder transitional cell carcinoma after bladder-preserving surgey. Cardiovasc Interv Radiol 36:1521–1526. https://doi.org/10.1007/s00270-013-0594-2 CrossRef

29.

Chen MK, Qin ZK, Zhou FJ et al (2009) Intra-arterial chemotherapy is reliable in preventing high-risk superficial bladder cancer from recurrence and progression. J Chemother 21:681–686. https://doi.org/10.1179/joc.2009.21.6.681 CrossRefPubMed

30.

Randomized prospective investigation of recurrence and progression between intra-artery chemotherapy and intravesical treatment for T1G3 bladder cancer. https://www.chictr.org.cn/. Accessed Feb 2016

Title: The effects of intra-arterial chemotherapy on bladder preservation in patients with T1 stage bladder cancer
Authors: Zefu Liu
Yunlin Ye
Xiangdong Li
Shengjie Guo
Lijuan Jiang
Pei Dong
Yonghong Li
Yanxia Shi
Weijun Fan
Yun Cao
Kai Yao
Zike Qin
Hui Han
Fangjian Zhou
Zhuowei Liu
Publication date: 01-08-2018
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 8/2018
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-018-2199-5

At a glance: The STEP trials

Springer Medicine

The effects of intra-arterial chemotherapy on bladder preservation in patients with T1 stage bladder cancer

Abstract

Purpose

Materials and methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 8/2018

Time between diagnosis and surgical treatment on pathological and clinical outcomes in prostate cancer: does it matter?

Delays in radical prostatectomy for prostate cancer and survival outcomes

The transgluteal approach to shockwave lithotripsy to treat distal ureter stones: a prospective, randomized, and multicenter study

Comparative study of the treatment of 20–30 mm renal stones with miniaturized percutaneous nephrolithotomy and flexible ureterorenoscopy in obese patients

Longer length improvement and more covert incision: a single-center, prospective study of two innovative surgical methods “one stitch” and “four stitch” for pediatric buried penis

Sarcopenia predicts 90-day mortality and postoperative complications after radical cystectomy for bladder cancer