Clinical Outcome Of Chemoradiotherapy For T1G3 Bladder Cancer

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology
Article Date: 15 Jan 2009 - 3:00 PDT

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UroToday.com - For stage T1 grade 3 (T1G3) bladder cancer, the major goal of the treatment should be bladder preservation when possible, but not at the risk of tumor progression. Current treatment choices are early cystectomy or bladder-sparing approach by intravesical immunotherapy or chemotherapy after TUR-Bt. In this study, we demonstrate that the chemoradiotherapy (CRT) protocol can be safely performed for patients with T1G3 bladder cancer. CR was achieved in 90.9% of patients. Tumor progression did not occur in any patients during follow-up periods. Based on good results in this study, CRT is a reasonable treatment option for T1G3 bladder cancer.

Considering the diversity of T1G3 bladder cancer, selection of the patients most suitable for the CRT protocol would be of concern. Not a few patients with T1G3 cancer can be safely treated by TUR-Bt alone or in combination with intravesical BCG therapy. In this study, a majority of the patients were with tumors invading beyond the muscularis mucosae (T1b) that had been considered an ominous sign of subsequent progression. Mhawech-Fauceglia et al. indicated that patients with T1b tumors were more likely to progress sooner than those with T1a tumors1). Thus, the extent of the invasion could be criteria for applying CRT to T1G3 bladder cancer patients.

Chemotherapy was given simultaneously in the 1st and 3rd weeks of radiotherapy. Most of the patients received systemic administration of methotrexate (30 mg/m2) and intra-arterial administration of cisplatin (70 mg/m2). Radiotherapy was initiated 4 to 6 weeks after initial TUR-Bt. A dose of 40 Gy was applied to the pelvis in 4 weeks. Radiation dose was limited 40Gy to avoid postoperative complications of possible radical cystectomy in cases resistant to the CRT. In fact, a similar protocol has been proved to be feasible in muscle invasive bladder cancer without increasing morbidity of radical cystectomy2).

All survivors retained their bladder and no patients required cystectomy due to tumor progression or side-effects. BCG is still a standard treatment for high-risk superficial bladder cancer with excellent cancer control, but associated with local or systemic severe morbidities. In addition, the morbidity and mortality associated with cystectomy are not negligible. Thus, CRT after TUR-Bt is a safe and curative treatment option for patients with T1G3 bladder cancer and a reasonable alternative to intravesical treatment or early cystectomy. Randomized studies investigating whether CRT is as effective as or even superior to intravesical treatment with BCG for T1G3 bladder cancer are awaited.

References
1. Mhawech-Fauceglia P, Fischer G, Alvarez V Jr, et al. Predicting outcome in minimally invasive (T1a and T1b) urothelial bladder carcinoma using a panel of biomarkers: a high throughput tissue microarray analysis. BJU Int. 2007; 100: 1182-7
2. Kageyama Y, Yokoyama M, Sakai Y, et al. Favorable outcome of preoperative low dose chemoradiotherapy against muscle-invasive bladder cancer. Am J Clin Oncol. 2003; 26: 504-7.

Written by Masaharu Inoue, Jun-ichiro Ishioka, Hiroshi Fukuda, Yukio Kageyama, Yoshihiro Saito and Yotsuo Higashi as part of Beyond the Abstract on UroToday.com

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