BALLOON-OCCLUDED ARTERIAL INFUSION AS A USEFUL NEOADJUVANT CHEMOTHERAPY FOR BLADDER-CANCER

Objective To evaluate the balloon-occluded arterial infusion (BOAI) of cisplatin and adriamycin as a preoperative adjuvant chemotherapy in p atients with bladder cancer of stage greater than or equal to T2 or in those with stage T1 and multiple large tumours. Patients and methods The study comprised 120 patients with bladder cancer who underwent BOA I from November 1984 to December 1995. BOAI chemotherapy (adriamycin a nd cisplatin) was administered under ischaemia through a 7 F torque-co ntrol balloon catheter, both sides of which were inserted into the con tralateral internal iliac artery. The regression rate of tumours and a ny improvement in tumour stage was assessed. Results The clinical resp onse rate (complete or partial) was 66% and the tumour stage improved in 39% of the patients after BOAI. Of 26 patients with stage T3a diagn osed before BOAI, 12 were diagnosed as T2 or less after treatment. Of 27 patients who underwent total cystectomy because the tumour was diag nosed as T2 after BOAI, the post-operative histopathological examinati on showed that 22 (82%) were stage pT1 or below. The features associat ed with a good response to BOAI in patients with up to pT3a disease we re grade 3, non-papillary tumours with a diameter of <3 cm. Conclusion In patients diagnosed as stage T2 and T3a, or stage T1 with multiple large tumours difficult to be treat by transurethral resection, BOAI s hould be considered as the first choice to decrease the stage or to co nfirm the pathological staging.