RU2848271C1 - Method for stopping macrohaematuria in muscle-invasive bladder cancer - Google Patents

Abstract

FIELD: medicine; oncology.

SUBSTANCE: invention can be used to stop macrohaematuria in muscle-invasive bladder cancer. The method involves performing angiography of the vesical arteries, infusing cisplatin at a dosage of 150 mg/m² diluted in 100 ml of saline solution into the catheterised vesical arteries on both sides, with a repeat course after 21 days.

EFFECT: cessation of haematuria in patients with muscle-invasive bladder cancer by intra-arterial administration of a cisplatin-containing drug that does not reduce the possibility of further exposure to the tumour.

1 cl, 1 ex

Description

The invention relates to the field of medicine, namely to X-ray endovascular surgery, and can be used to stop macrohematuria in muscle-invasive bladder cancer.

Over the past decade, the incidence of bladder cancer has continued to rise globally. In Europe and North America, bladder cancer is the fourth most common cause of cancer in men and the second most common malignant tumor of the genitourinary system. In Russia, bladder cancer ranks seventh among cancers in men and 17th among women. It is important to note that these patients, with an average age of 70 years or older, often have severe underlying medical conditions [1,2].

Various forms of painless hematuria are the most common manifestation of bladder cancer, with macrohematuria associated with a higher stage of the disease compared to microhematuria at initial diagnosis. The intensity of hematuria is independent of tumor size. Conservative hemostatic therapy often fails to produce a significant positive effect, so stopping bleeding is a key issue. Failure to respond to conservative therapy is an indication for surgical treatment, ranging from endoscopic interventions to ligation of the internal iliac artery and radical cystectomy. However, due to the patient's age and the presence of comorbidities, anesthetic risks may not always allow this procedure. Endovascular embolization of the vessels supplying the bladder has no such contraindications and is preferred in these patients [3].

At the same time, R. Loffroy notes that with successful embolization of the bladder arteries, the effectiveness of the hemostatic effect is high, however, there is no clinical response to conservative therapy, but most importantly, the possibility of further chemotherapeutic effects is sharply reduced due to the occlusion of the vessels supplying the bladder [4].

The mainstay of bladder cancer chemotherapy is intravenous platinum therapy. Platinum-based chemotherapy has been shown to improve overall survival in patients with muscle-invasive bladder cancer (MIBC) [5].

Several drugs containing the active ingredient cisplatin are known to be platinum-based antitumor agents. Cisplatin's mechanism of action is similar to that of alkylating agents and involves disrupting the function of DNA strands and forming cross-links between them. Common blood complications associated with its administration include thrombocytopenia, leukopenia, anemia, and myelosuppression (severe bone marrow suppression, including agranulocytosis and/or aplastic anemia, may occur after high-dose cisplatin administration). However, a hypercoagulable effect has not been described [6].

In the literature, cisplatin is used either outside of episodes of macrohematuria or in combination with embolic particles when it is present.

In the work presented by Liang S. and colleagues, intra-arterial chemotherapy was considered as a method of preserving the bladder in patients with muscle-invasive bladder cancer after transurethral resection of the tumor [7]. Forty-six patients underwent 3 courses of intra-arterial administration of cisplatin 50 mg/m2. No complications of this treatment were recorded. When evaluating the results: 32 patients demonstrated a complete response, 3- and 5-year survival rates were 70.65% and 61.23%, respectively. Over the entire observation period, organ-preserving treatment was performed in more than 80% of patients. The authors propose this method as an alternative for patients who refuse or have contraindications for radical cystectomy. However, nothing is mentioned about the effect on macrohematuria.

J. Peng et al. performed intra-arterial chemoembolization in 39 patients with muscle-invasive bladder cancer and macrohematuria who refused open or endoscopic surgery [8]. Before embolization with microspheres (loaded with epirubicin), they administered intra-arterial chemotherapy with cisplatin at a dosage of 40-60 mg/m2. The overall effective rate (complete response + partial response) was 64.1%.

It is important to note that despite all the advantages of using microspheres, there is a significant drawback: they are not absorbed, meaning repeat embolization is impossible.

The technical result is the development of an effective, simple method for stopping hematuria in patients with muscle-invasive bladder cancer using intra-arterial administration of a drug containing cisplatin, which does not reduce the possibility of further action on the tumor.

Implementation of the invention. Angiography of the vesical arteries is performed, and cisplatin is infused into the catheterized arteries on both sides at a dosage of 150 mg/m2, diluted in 100 ml of saline, with a repeat course after 21 days.

We examined 8 patients with MIBC and macrohematuria who underwent two courses of intra-arterial administration of a cisplatin-containing drug at a dosage of 150 mg/m2 diluted in 100 ml of saline. Preoperatively, all patients had erythrocytes (>250 cells/μL) detected in a general urine analysis; these completely disappeared (erythrocytes (0 cells/μL)) after two courses of chemoinfusion of the cisplatin-containing drug.

Thus, in patients with MIBC and macrohematuria, intra-arterial administration of two courses of a drug containing cisplatin at a dosage of 150 mg/m2, diluted in 100 ml of saline solution, allows for complete cessation of macrohematuria without loss of the feeding vessel, thereby maintaining the possibility of simultaneous action on the tumor.

Clinical example

Patient D., 70 years old, with a diagnosis of muscle-invasive bladder cancer and macrohematuria, was admitted to the oncourology department of the State Budgetary Institution of the Ryazan Regional Clinical Oncology Center of the city of Ryazan.

The patient has a history of two transurethral bladder resections and a bladder epicystostomy. The patient is receiving systemic chemotherapy.

According to the general urine analysis, erythrocytes >250 cells/μl are detected.

It was decided to perform intra-arterial chemoinfusion with cisplatin 150 mg/m2 diluted in 100 ml of saline solution into the bladder arteries with a repeat course after 21 days.

A postoperative urine test revealed no red blood cells. Magnetic resonance imaging (MRI) showed stabilization of the cancer.

Bibliography:

1. Siegel RL, Miller KD, Jemal A. Cancer statistics 2020. CA Cancer J Clin. 2020. Vol.70, No. 1. R.7-30. doi: 10.3322/caac.21590.

2. Dolgushin B.I. Interventional radiology in oncology. VIDAR; 2022.

3. Karpov V.K., Kapranov S.A., Shaparov B.M., Kamalov A.A. Superselective embolization of bladder arteries in the treatment of recurrent macrohematuria in bladder tumors. Urology. 2020. No. 5. P. 133-138.

4. Loffroy R, Pottecher P, Cherblanc V, Favelier S, Estivalet L, Koutlidis N, Moulin M, Cercueil JP, Cormier L, Krausé D. Current role of transcatheter arterial embolization for bladder and prostate hemorrhage. Diagnosis Interv Imaging. 2014. Vol. 95, No. 11. P.1027-34. doi: 10.1016/j.diii.2014.03.008.

5. Grossman HB, Natale RB, Tangen CM, Speights VO, Vogelzang NJ, Trump DL, deVere White RW, Sarosdy MF, Wood DP Jr, Raghavan D, Crawford ED. Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med. 2003. Vol.349, No.9. P. 859-66. doi: 10.1056/NEJMoa022148.

6. Vidal Handbook 2023. Medicines in Russia. Publisher: Vidal, 2023.

7. Liang S, Zou Q, Han B, Jing Y, Cui D, An X, Gao Y, Hu J, Xia S. Intra-arterial chemotherapy for muscle-invasive bladder cancer following trans-surethral resection. Urol Int. 2015;94(4):406-11. https://doi.org/10.1159/000369301.

8. Peng J, Weng Z, Zhang C, Zhou G, Lin Y, Kołat D, Chipollini J, Wu W. Analysis of prognostic factors in patients diagnosed with bladder cancer complicated by hemorrhage treated by drug-eluting bead embolization. Transl Androl Urol. 2023 Nov 30;12(11):1697-1707. https://doi.org/ 10.21037/tau-23-506.

Claims (1)

A method for stopping macrohematuria in muscle-invasive bladder cancer, including angiography of the bladder arteries, characterized in that cisplatin is infused into the catheterized bladder arteries on both sides at a dosage of 150 mg/ ^m2 , diluted in 100 ml of saline, with a repeat course after 21 days.