Pathologic effects of pre-cystectomy therapy with combination intra-arterial doxorubicin hydrochloride and local bladder hyperthermia for bladder cancer.

Nine patients with bulky pelvic bladder cancer underwent combination doxorubicin hydrochloride hypogastric artery infusion and local bladder hyperthermia as a preoperative adjunct to radical cystectomy in a phase I study. Pathologic examination of the cystectomy specimens showed extensive tumor necrosis on the bladder luminal side, with a gradient of tumor destruction to viable tumor on the bladder serosal surface in 8 of the 9 bladders. Normal portions of the bladder showed minor changes in the urothelium, marked submucosal edema and hyperemia, and viable detrusor muscle. One bladder showed no viable tumor and fibrosis of the entire bladder wall. Adjunctive preoperative hypogastric artery infusion of doxorubicin hydrochloride/bladder hyperthermia is safe, well tolerated and merits further study to determine the upper limits of safety of doxorubicin hydrochloride and hyperthermia temperature.