Observation On The Combing Therapy With Retaining Bladder For Muscle-invasive Bladder Cancer Patients

Objective:To explore the safety and effectiveness of transurethral resection of bladder tumor combined with intravesical chemotherapy plus internal iliac arterial infusion chemotherapy for muscle invasive bladder cancer, and to provide reference for the future clinical practice. Methods:In August 2013 to December 2014,20 patients in our hospital who were diagnosed with muscle-invasive bladder cancer(T2N0M0) through cystoscopic biopsy, pelvic CT scan and other related inspection diagnosis, fully introduced the disease and treatment recommendations to the patients and their families, to the patients who refused to accept the radical cystectomy or who were unfit to undergo radical cystectomy, they were conducted by comprehensive (transurethral resection of bladder tumor+intravesical chemotherapy+internal iliac arterial infusion chemotherapy) method of performing a bladder preservation. Results:20 cases were followed up from 3-15 months, the average follow-up time was 9 months. Among these cases,19 cases (95%) survived without relapse or metastasis,1 cases (5%) relapse occurred at the 7th month after bladder-sparing surgery, Cystectomy was performed for local failure, no death and metastasis cases. After a week of internal iliac arterial infusion chemotherapy, All of the patients were underwent transurethral resection of bladder tumor, tumor size reduction was seen in all of the 20 patients, the suface of the tumor of these patients became pale, and the tumor looked like cotton floe, After the internal iliac arterial infusion chemotherapy the blood supply of the tumor was reduced obviously. Inter-arterial chemotherapy was well tolerated, and had no sever local and systemic adverse reaction or toxicities.20 cases of patients with postoperative nausea, vomiting and other mild gastrointestinal reaction,2 cases of patients with postoperative fever, body temperature of 38.5℃,after 2 days of symptomatic treatment, the temperature returned to normal. The second day after the inter-arterial chemotherapy 1 (5%) patients suffered from mild hip pain, without any treatment, the pain disappeared after 1 week. Three days after the surgery, we reviewed the routine blood test, biochemical and laboratory tests,20 patients had no abnormal,7 days later, we reviewed the blood routine and biochemical again,5(25%) patients suffered from mild bone marrow suppression, without any treatment, it was returned to normal in two weeks, platelet and white blood cells were significantly decline in 1(5%) patients after 1 week of the inter-arterial chemotherapy, after given the granulocyte colony-stimulating factor treatment, it returned to normal in two weeks. The side effects of the iliac artery infusion chemotherapy were not affected the surgical treatment. Conclusion: Transurethral resection of bladder tumor and intravesical chemotherapy plus internal iliac arterial infusion chemotherapy (which composed of 5-fluorouracil 1000mg/m2, pirarubicin 40mg/m2 and hydroxycamptothecin 30mg/m2) can significantly improve myometrial invasion for the treatment of patients with bladder cancer efficacy, reduce the amount of bleeding during the operation, effectively reduce the risk of operation and prevention of the recurrence and metastasis after the operation of bladder cancer, it can significantly improve the quality of life of the patients who suffered with muscle invasive bladder cancer, they were relatively easy to accept, the bladder-sparing surgery can be a choice of muscle invasive bladder cancer. It is worthy of further study.