Bladder-sparing, Combined Modality Approach For Muscle-Invasive Bladder Cancer

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology;  Clinical Trials / Drug Trials
Article Date: 16 Dec 2007 - 0:00 PDT

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UroToday.com- This article published in the journal Cancer, details the complete response rate, disease-specific, and overall survival of patients with cT2-cT4 transitional cell carcinoma to combined transurethral tumor resection, chemotherapy, and radiation therapy. The authors evaluated 121 patients with T2, T3, or T4 bladder cancer (mean age, 63 years; ratio of men to women, 3:1), underwent induction by transurethral resection (TUR) of the tumor, and received 2 cycles of neoadjuvant chemotherapy followed by radiotherapy (RT) (n = 43 patients) or radiochemotherapy (RCT) (n = 78 patients). The response rate was determined by a repeat transurethral resection 6 weeks after the end of radiation therapy. Treatment at that point was observation with repeated cystoscopy if there was no tumor in the specimen or other treatments (radical or partial cystectomy, repeat transurethral resection) if persistent tumor was present.

Local response evaluation by restaging TUR was possible in 119 patients and 102 of those patients (85.7%) achieved a complete response. After a median follow-up of 66 months (range, 6-182 months) no local or distant disease recurrences were observed in 67 of 102 complete responders (65.7%); 17 of 102 complete responders (16.7%) experienced superficial local disease recurrence, and 18 of 102 complete responders (17.6%) had a muscle-invasive relapse. The 5-year tumor-specific, overall, and bladder-intact survival rates were 73.5%, 67.7%, and 51.2%, respectively. The factors that influenced survival included stage after the induction transurethral resection and treatment if persistent disease was found after radiation therapy.

These results show that a combination of local tumor resection, systemic chemotherapy, and radiation therapy can provide long-term disease and overall survival to select patients with cT2-cT4 bladder cancer. Unfortunately, our ability to predict who will or won't be a long-term responder to such therapy is poor thus limiting the effectiveness of this therapy to the general bladder cancer population.

Perdonà S, Autorino R, Damiano R, Sio MD, Morrica B, Gallo L, Silvestro G, Farella A, De Placido S, Di Lorenzo G

Cancer. ePub: November 15, 2007

Doi: 10.1002/cncr.23137

Reported by UroToday.com Contributing Editor David P. Wood, M.D

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