Symptomatic relief of patients with advanced bladder carcinoma after regional intra-arterial chemotherapy

Thirty-two patients (30 men, 2 women), median age 68 years (range 47-85) with histologically confirmed advanced bladder carcinoma (Stages T3 and T4 according to the International Union Against Cancer staging system), who were poor surgical candidates, were prospectively treated with 1-6 (median 4) cycles of intra-arterial epirubicin (60 mg/cycle) delivered through two infusion pumps that were surgically implanted to each internal iliac artery, along with intravenous leucovorin 200 mg per day and 5-fluorouracil 750 mg per day for three consecutive days. Regional intra-arterial chemotherapy was well tolerated. There were 12 complete and 10 partial responses for an overall objective response rate of 69%. Eight patients had stable disease and 2 demonstrated progressive disease. All participating patients had gross hematuria prior to therapy. After the end of treatment, 24 out of 32 patients had resolution of their gross hematuria. Eight out of 15 patients with tumor-associated dysuria at the time of initiation of chemotherapy had significant pain relief at the end of the treatment. Regional intra-arterial chemotherapy is a safe and effective technique for patients with advanced, muscle invasive bladder carcinoma and can improve the quality of life of most affected patients by decreasing the degree of hematuria and dysuria associated with this malignancy.