Bladder preservation by internal iliac arterial infusion chemotherapy and irradiation in T3 bladder carcinoma patients over the age of 70 years.

Treatment by internal iliac arterial infusion chemotherapy (IA) combined wi th pelvic irradiation has proved to be effective for locally invasive bladd er. Eight male patients, median age of 78 years (range 73-81) were enrolled . Pretreatment ment CT and whole layer core biopsy revealed T3a or T3b. Pel vic CT or fine needle aspiration biopsy following bipedal lymphography reve aled NO in 4 cases, N2 in 2 and N3 in 2, respectively. Three to 7 cycles of cisplatin (CDDP) 30-50 mg/m(2), methotrexate 20 mg/m(2) and tetrahydropymn yl-adriamycin 20 mg/m(2) every 3 week was administered combined with 40-50 Gy. of whole pelvis irradiation. In 4 renal function impaired patients, 100 mg/m(2) of carboplatin was administered instead of CDDP. All patients obta ined complete response and the bladders were preserved. Observation periods were from 9 to 75 months (median 37 months). One N2 patient died with meta static disease and two died without carcinoma. Two patients developed invas ive bladder cancer on the side opposite to the primary tumors. Both were su ccessfully treated by IA and irradiation. Bladders of all except one patien t functioned for a long period. Side effects of IA and irradiation were not significant. IS combined with pelvic irradiation is effective and safe for elderly patients with bladder carcinoma. (C) 2000 Tohoku University Medica l Press.