title: Favorable outcome of preoperative low dose chemoradiotherapy against muscle-invasive bladder cancer.
abstract: 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.
authors.affiliation: Department of Urology and Reproductive Medicine, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Kageyama
authors.forename: Minato
authors.initials: M
authors.lastname: Yokoyama
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Sakai
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Saito
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Koga
authors.forename: Masataka
authors.initials: M
authors.lastname: Yano
authors.forename: Gaku
authors.initials: G
authors.lastname: Arai
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Hyochi
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Masuda
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Fujii
authors.forename: Satoru
authors.initials: S
authors.lastname: Kawakami
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Kazunori
authors.initials: K
authors.lastname: Kihara
mesh_terms: 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*
chemical_list: D002945:Cisplatin