Pre-cystectomy intra-arterial cis-diamminedichloroplatinum II with local bladder hyperthermia for bladder cancer

A total of 6 patients with bulky pelvic bladder cancer underwent combination cis-diamminedichloroplatinum II (cisplatin) hypogastric artery infusion and local bladder hyperthermia as a preoperative adjunct to radical cystectomy. Pathological examination showed extensive tumor necrosis on the luminal side, with a gradient of tumor destruction to viable tumor on the serosal surface in 4 of the 6 bladders, while 2 specimens showed no tumor. Uninvolved portions of the bladders showed minor changes in the urothelium, submucosal edema and no effect on detrusor muscle or perivesical fat. Analysis of tissue for platinum revealed uptake by the tumors and normal tissues. Systemic effects of spillover cisplatin were not seen. Adjunctive preoperative hypogastric artery infusion of cisplatin is safe and well tolerated. Further study is required to determine the upper limits of safety of the regimen.