Favorable outcome of preoperative low dose chemoradiotherapy against muscle-invasive bladder cancer.
To investigate the feasibility of preoperative low-dose chemoradiotherapy, 50 patients with localized muscle-invasive bladder cancer (T2-T4) were treated with concurrent cisplatin (100 mg/body x 2 courses) and pelvic irradiation (40 Gy). Among 20 patients (40%) who achieved clinical complete regression, 11 with solitary tumor underwent partial cystectomy because of advanced age, poor condition of the patients, or a reluctance to have radical surgery. Radical cystectomy was carried out in the remaining 39 cases (complete regression 9, partial regression 30). Pathologic T0 response (no residual tumor) was achieved in 18 (36%) of all the cases. Median follow-up was 19 months (range 2-59 months). Estimated 3-year disease-free survival was 75% for all patients and 100% for T0 responders. Local recurrence (2 patients) or distant metastasis (6 patients) developed in 8 of 32 patients with pathologic persistent tumor. All of the 11 patients (9 with T0 response and 2 with a small residual tumor nest) who underwent partial cystectomy were recurrence free for observation periods up to 59 months. Low-dose chemoradiotherapy is as effective as other neoadjuvant protocols and is applicable to high-risk patients. The bladder can be preserved by partial cystectomy in selected cases with clinical complete regression.
Kageyama
Yukio
Y
Department of Urology and Reproductive Medicine, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.
Yokoyama
Minato
M
Sakai
Yasuyuki
Y
Saito
Kazutaka
K
Koga
Fumitaka
F
Yano
Masataka
M
Arai
Gaku
G
Hyochi
Nobuhiko
N
Masuda
Hitoshi
H
Fujii
Yasuhisa
Y
Kawakami
Satoru
S
Kobayashi
Tsuyoshi
T
Kihara
Kazunori
K
D000368:Aged; D000369:Aged, 80 and over; D002945:Cisplatin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D015653:Cystectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D012074:Remission Induction; D016019:Survival Analysis; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000628:therapy*
D002945:Cisplatin