[Doxorubicin intra-arterial chemotherapy combined with low-dose irradiation in bladder cancer].
Fifteen patients with non-disseminated bladder cancer (T1:2, T2:2, T3:8, T4:3) were preoperatively treated with intra-arterial doxorubicin chemotherapy in combination with low-dose irradiation. The originally scheduled operations had been as follows; total cystectomy in 11, segmental cystectomy in 2, and TUR- or SVR-Bt in 2. The total dose of doxorubicin ranged from 120 to 540 mg/body, with an average of 312.7 mg/body and that of irradiation was from 4 to 34 Gy with an average of 24.0 Gy. Clinically, in the early phase of the study, complete remission (CR) was revealed in 10 (66.7%), and partial remission (PR) in 2 (13.3%). The bladder was preserved in 9 of 11 (81.8%) cases in which total cystectomy had been recommended. Pathological effects according to the criteria presented by Shimosato, Oboshi and Baba, were as follows; grade IV in 6 cases (40.0%), grade III in 2 (13.3%), grade II in 4 (26.7%) and grade I or 0 in 3 (20.0%). Therefore, viable tumor cells were not seen in 8 of 15 (53.3%) cases. Vesical non-recurrent rate in the cases with bladder preservation was 56.2% at 48 months by simple mode and 44.6% by accumulated mode. Survival in 13 cases (T2-T4) by pathological effects was 75.0% at 48 months in the grade IV and III group (n = 8), and 40.0% at 42 months in the grade II or less group (n = 5). The results obtained from this study seem encouraging, especially in the group where the pathological effects were grade IV or III, and leads to the conclusion that doxorubicin intra-arterial chemotherapy, combined with low-dose irradiation, could be a first-choice treatment for locally invasive bladder cancer.