1986 Volume 77 Issue 3 Pages 474-481
Total cystectomy (TCX) with urinary diversion is adopted in a current therapy for invasive bladder cancer, despite its inevitable disadvantage to patient's performans status. An adjuvant may preserve the bladder function of patients with invasive tumors. In this respect, we reviewed 29 patients with T2-3 bladder cancer treated with either transurethral resection (TUR) or partial cystectomy (PCX): 14 patients (12 in T2 and 2 in T3 tumor) received no preoperative adjuvant (control-group) and the remaining 15 (6 in T2 and 9 in T3) received preoperative arterial chemoembolization with microencapsulated mitomycin C, peplomycin and/or cisplatin (MC-group).
The patients in MC-group well tolerated the microcapule therapy without any severe side effect. Substantial tumor reduction greater than 50% was seen in 11 of 14 measurable patients, facilitating the organ-preserving operations.
Twelve TURs and 2 PCXs were employed as an initial operation in control-group, and 12 TURs and 3 PCXs in MC-group.
Actuarial disease-free survival probabilities at 1 and 3 years after operation were 35.7 and 19.0%, respectively, in control-group, while these were 64.5 and 64.5% in MC-group. For 11 patients with recurrence in control-group, 4 TCXs, 4 TURs and 2 PCXs were indicated. For 5 patients with recurrence in MC-group, 2 TCXs and 3 TURs were done. Six patients in control-group died of cancer, but none in MC-group. Three-year survival probability was estimated as 66.1% in control-group and 100% in MC-group. Statistically significant differencies (p<0.05, Cox-Mantel test) in both tumor recurrence and survival were found between control- and MC-groups.
The results indicate that the microcapsule therapy is an effective adjuvant in extending the indication of organ-preserving operations in the treatment of invasive bladder cancer.
