Abstract:
Background: A novel bladder preservation therapy has been developed for patients with muscle-invasive bladder cancer called the Osaka Medical College (OMC) regimen. This regimen comprises balloon-occluded arterial infusion (BOAI) of an anticancer agent and with or without concurrent hemodialysis. Anticancer agents, such as cisplatin, can cause neurotoxicity, leading to peripheral neuropathy. This study aimed to investigate the occurrence of neuropathy after BOAI followed by a second transurethral resection of a bladder tumor (TURBT). We also aimed to investigate the effects of general and spinal anesthesia on neuropathy.
Methods: We performed a retrospective, observational study on 57 patients (49 men, 8 women, median age: 65 years) with bladder cancer who underwent a second TURBT after BOAI. TURBT was initially performed for diagnosis and then patients received the OMC regimen at 4-5 weeks after this first TURBT. Patients had general or spinal anesthesia for TURBT. For BOAI, an intra-arterial catheter with two occlusion balloons was used and inserted into the posterior trunk of the internal iliac artery. Cisplatin was infused through this catheter over 1 hour. Hemodialysis was simultaneously performed in patients (n=16) with a creatinine level >1.5mg/ dl. Radiation therapy was then performed in the pelvis. Patients underwent a second TURBT at 6 weeks.
Results: Seven of 57 patients had neuropathy. Symptoms caused by BOAI in the lower extremities were pain, numbness, and tingling. Although none of the treatments for neuropathy were particularly effective, the combination of tramadol and acetaminophen reduced tingling in one patient. No patients had adverse events of grade 3 or 4. Two patients who had abnormal sensation before the second TURBT underwent general anesthesia to avoid any further deterioration.
Conclusion: This study showed that neuropathy occurs after BOAI of cisplatin for bladder cancer. Although there was no deterioration in sensation of the lower extremities in patients who had a second TURBT under general or spinal anesthesia, further deterioration in sensation is possible. Therefore, spinal anesthesia should be avoided in patients who have neuropathy due to BOAI. Trial Registration: This study was registered in the Japanese Official Clinical Trial Registry (trial registration number: JMAIIA00171) and the registration date was 13 March 2014.
