Neoadjuvant intra-arterial doxorubicin chemotherapy in combination with low dose radiotherapy for the treatment of locally advanced transitional cell carcinoma of the bladder.

Between 1979 and 1990, 60 patients with locally advanced bladder cancer (stages T2 to 4NXM0) were treated with intra-arterial doxorubicin chemotherapy in combination with low dose radiotherapy and 36 (60%) achieved a complete remission. The tumor size (p < 0.01), tumor grade (p < 0.05) and clinical stage (p < 0.05) correlated significantly with the tumor response to the combined therapy. Of the 36 patients with complete remission and the 24 patients who did not achieve a complete remission 35 and 22, respectively, underwent a conservative bladder operation after treatment. Median followup was 71 months. The overall 5-year disease-free and cause-specific survival rates for the 60 patients were 49% and 72%, respectively. A significantly higher (p < 0.01) 5-year survival rate was observed in patients who achieved a complete remission (94%) than in those who did not (40%). The results suggest that intra-arterial chemotherapy plus radiotherapy is a useful regimen for patients with locally advanced bladder cancer, and bladder function may be preserved in those who achieve a complete remission.