[Concomitant radiochemotherapy in invasive bladder tumors].
The treatment of muscle-invasive bladder tumors currently consists of radical cystectomy with lymph node dissection. A combined radio-chemotherapy treatment could allow to preserve a functional bladder without greater risk of relapse. We present a review of 38 available publications found in the international literature concerning this combination treatment. Only 9 publications with appropriate analysis were considered, including 552 evaluable patients, 44% of whom were suitable for radical cystectomy. Cisplatin is the most often used drug. The protocols are variable and generally well tolerated. The median follow-up time is 36 months. The immediate complete response rates vary between 48 and 92% and the overall survival rate is between 42 and 82%. The survival with bladder preservation is between 38 and 75%, while the disease-free survival with bladder preservation is between 33 and 53%. 11% of the initially complete responders had a superficial recurrence and 30% had distant metastases. There is no proven advantage of neoadjuvant polychemotherapy, there is no consensus for the therapeutical protocol, the follow-up protocol remains to be defined, and the function of the preserved bladder has to be studied. Only a prospective randomized trial could precise the role of this experimental technique compared to surgery despite the major evident difficulties (ethical and practical) to conduct such a trial.
Mottet
N
N
Service d'urologie andrologie, CHU Doumergue, Nimes, France.
Di Palma
M
M
Avances
C
C
Costa
P
P
Jardin
A
A
Misset
J L
JL
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D003131:Combined Modality Therapy; D006801:Humans; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D011879:Radiotherapy Dosage; D016019:Survival Analysis; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*
D002945:Cisplatin
Radiochimiothérapie concomitante des tumeurs infiltrantes de vessie.