NEOADJUVANT INTRAARTERIAL DOXORUBICIN CHEMOTHERAPY IN COMBINATION WITH LOW-DOSE RADIOTHERAPY FOR THE TREATMENT OF LOCALLY ADVANCED TRANSITIONAL-CELL CARCINOMA OF THE BLADDER

Between 1979 and 1990, 60 patients with locally advanced bladder cance r (stages T2 to 4NXM0) were treated with intra-arterial doxorubicin ch emotherapy in combination with low dose radiotherapy and 36 (60%) achi eved a complete remission. The tumor size (p <0.01), tumor grade (p <0 .05) and clinical stage (p <0.05) correlated significantly with the tu mor response to the combined therapy. Of the 36 patients with complete remission and the 24 patients who did not achieve a complete remissio n 35 and 22, respectively, underwent a conservative bladder operation after treatment. Median followup was 71 months. The overall 5-year dis ease-free and cause-specific survival rates for the 60 patients were 4 9% and 72%, respectively. A significantly higher (p <0.01) 5-year surv ival rate was observed in patients who achieved a complete remission ( 94%) than in those who did not (40%). The results suggest that intra-a rterial chemotherapy plus radiotherapy is a useful regimen for patient s with locally advanced bladder cancer, and bladder function may be pr eserved in those who achieve a complete remission.