Transurethral resection and intra-arterial chemotherapy for muscle-invasive bladder cancer |
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Authors: | J Kondás L Engloner L Váczi Gy Kondér |
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Institution: | (1) Department of Urological Surgery, Municipal Péterfy Sándor Street Hospital, Budapest, Hungary;(2) 2nd Department of Medicine, Semmelweis University Medical School, Budapest, Hungary |
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Abstract: | Thirty-three patients with muscle-infiltrating T2–T3a bladder carcinoma were treated by TUR through the full thickness of
the bladder wall and extended into the perivesical fat. The solitary tumours were not more than 4 cm in diameter. Histology
proved in every case tumour stages of pT2 (17 patients) or pT3a (16 patients), G2 or G3 transitional cell carcinoma and negative
mucosal biopsies. After TUR the patients received 1 or 2 cycles of chemotherapy: 60 mg of doxorubicin, 50 mg of cisplatin,
1 g of 5-fluorouracil administered into the ipsilateral hypogastric artery. There was no perioperative mortality but one patient
died of complications related to chemotherapy. During the first year of follow-up relapses of muscle-invasive cancer were
observed in 3 patients (10%), two were subjected to cystectomy and one to repeated TUR. With a median follow-up of 34 months
27 patients are alive and have functional bladder. The actual 3-year and 5-year survival rates were 17/21 (81%) and 6/9 (67%),
respectively. The results of this study suggest that in strictly selected patients extended TUR and intra-arterial chemotherapy
may be a bladder-preserving treatment modality for muscle-invasive bladder cancer. Regular (three monthly cystoscopy, cytology,
biopsy, CT) investigations and follow-up are necessary to detect recurrences. |
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