Background: A prospective study was performed to investigate combined treat
ment with intraarterial chemotherapy and radiation therapy for bladder pres
ervation in locally invasive bladder cancer.
Methods: Patients with invasive bladder cancer, stage T2-3N0M0, were includ
ed in the study. Intra-arterial chemotherapy was performed with three injec
tions of methotrexate and cisplatin at 3-week intervals. Simultaneously, th
e patients underwent X-ray irradiation (40 Gy) of the small pelvic space. W
here a post-treatment transurethral resection (TUR) biopsy showed no residu
al tumor, the tumor site was irradiated by a 30 Gy proton beam and the blad
der was preserved. Where tumors remained, radical cystectomy was performed.
Results: Between 1990 and 1996, 42 patients were treated according to this
protocol. Posttreatment TUR biopsy and urine cytology showed no residual tu
mors in 39 of 42 cases (93%). The bladder was preserved in accordance with
the study protocol in 36 cases. A median follow-up of 38 months showed 3-ye
ar non-recurrence in 72% of bladder-preserved patients and the rate of blad
der preservation was 84%. The nine recurrences included eight cases of supe
rficial bladder recurrence. One cancer death occurred among the bladder-pre
sentation patients, giving 3-year sur vival and cause-specific survival rat
es of 84% and 100%, respectively. Although bladder function decreased sligh
tly in compliance, bladder capacity was retained in almost all cases.
Conclusions: This regimen is useful for bladder preservation in T2-3 locall
y invasive bladder cancer. Information from more cases and the results of m
ore long-term observations are needed, as is an evaluation of appropriate s
ubject selection and factors associated with quality of life issues, partic
ularly regarding bladder function.