Feasibility and Characteristics of Pressurized Aerosol Chemotherapy (PAC) in the Bladder as a Therapeutical Option in Early-stage Urinary Bladder Cancer

Abstract

Background: Pressurized aerosol chemotherapy (PAC) is a novel approach to the treatment of surface malignancies. This study aimed to investigate whether PAC is a feasible treatment of early-stage bladder cancer.

Materials and methods: PAC via inserted microcatheter was performed on a fresh urinary bladder in a post-mortem swine model (n=3), creating a pressurized doxorubicin chemoaerosol. Drug penetration of aerosolized doxorubicin at different concentrations (3 mg/50 ml, 9 mg/50 ml and 15 mg/50 ml) and different locations on the mucosa was measured via fluorescence microscopy.

Results: Mean endoluminal penetration rates for the urothelium following PAC reached 149±61 μm (using 15 mg/50 ml). Doxorubicin penetration was significantly increased with higher drug concentration (15 vs. 3 mg/50 ml: p<0.01). This study demonstrated the feasibility of PAC for intravesical use.

Conclusion: PAC is a feasible minimally-invasive approach to the treatment of early-stage bladder cancer.

Keywords: PAC; PIPAC; Pressurized aerosol chemotherapy; early-stage cancer; intravesical chemotherapy; penetration; urinary bladder carcinoma.