New preoperative chemotherapy for bladder cancer using combination hemodialysis and direct hemoperfusion: preliminary report.

Preoperative chemotherapy and subsequent cystectomy were performed on 11 patients with locally invasive bladder cancer. Three chemotherapy regimens were tested: 1) 2 to 3 mg. per kg. doxorubicin in 5 patients, 2) 1 mg. per kg. mitomycin C in 3 and 3) 0.6 mg. per kg. mitomycin C with 70 mg. systemic bleomycin in 3. Doxorubicin and mitomycin C were infused once preoperatively into the hypogastric arteries or the aortic bifurcation, with simultaneous hemodialysis and direct hemoperfusion to remove as much extra-regional infusate as possible and, thus, reduce the systemic toxicity of the drug. Objective responses were obtained in 4 of 7 patients with measurable tumor (57 per cent). Downstaging was obtained in 7 of 11 patients (64 per cent). All patients given doxorubicin had leukocytopenia (500 to 1,900 per mm.3) and moderate patchy alopecia, and 1 patient given mitomycin C and bleomycin had thrombocytopenia (44,000 per mm.3). However, these side effects were observed comparatively less in the patients given mitomycin C only.