Effective bladder preservation strategy with low-dose radiation therapy and concurrent intraarterial chemotherapy for muscle-invasive bladder cancer

Purpose. The aim of this study was to evaluate retrospectively the toxicity and response, bladder preservation, and survival of patients with muscle-invasive bladder cancer treated with multimodality therapy consisting of low- dose radiation therapy ( RT) and concurrent intraarterial chemotherapy ( IACT). Methods and materials. Between November 1999 and July 2005, a total of 27 consecutive, previously untreated patients with muscle- invasive bladder cancer underwent transurethral bladder tumor resection followed by concurrent low- dose RT and IACT. Patients who achieved a complete response ( CR) were followed up closely without further therapy, and patients who did not achieve a CR underwent further treatment. Results. Complete response was achieved in 22 of 27 patients ( 81%). Of these 22 patients, 7 developed recurrences, and 3 died of their disease. In five patients who did not achieve CR, one died from bone metastases. The 3-year overall survival rate was 81%, with a median follow- up time of 27 months; and 22 of 27 patients ( 81%) with a preserved bladder were tumor- free at the last follow- up. Three patients ( 11%) developed grade 3 acute hematological toxicity. Conclusion. Multimodality therapy consisting of lowdose RT and concurrent IACT for muscle- invasive bladder cancer can achieve survival rates similar to those in patients treated with radical cystectomy, with successful bladder preservation and minimal adverse effects.