title: Evidence supporting preoperative chemotherapy for small cell carcinoma of the bladder: a retrospective review of the M. D. Anderson cancer experience.
abstract: OBJECTIVE
  Neuroendocrine tumors of the bladder comprise a small subset of all bladder tumors. To improve our understanding of this tumor and define outcomes with current management, we performed a retrospective review of these cases.
  
  
  METHODS
  We reviewed the records of 88 patients with small cell bladder carcinoma evaluated at our institution between 1985 and 2002. Of these patients 46 underwent cystectomy, including 25 who were treated with initial cystectomy and 21 who received preoperative chemotherapy.
  
  
  RESULTS
  For patients treated with initial cystectomy median cancer specific survival (CSS) was 23 months, with 36% disease-free at 5 years. For patients receiving preoperative chemotherapy median CSS has not been reached (p = 0.026), although CSS at 5-years was 78% with no cancer related deaths observed beyond 2 years. Notably 7 of 25 patients treated with initial cystectomy received chemotherapy after surgery but their survival was no better than those treated with cystectomy alone. As others have observed, the pathological stage was higher than clinically appreciated for 56% of patients treated with initial cystectomy. Moreover, there were no cancer related deaths among patients with disease down staged to pT2 or less.
  
  
  CONCLUSIONS
  Like other neuroendocrine tumors, small cell carcinoma of the bladder grows rapidly but is chemo-sensitive. Clinical under staging is the rule. Optimal results are achieved via integration of local and systemic treatment. Our results suggest that preoperative chemotherapy is the optimal strategy, even in the setting of clinically localized cancer. On the basis of these observations, we have initiated a trial in which 4 cycles of aggressive multiagent preoperative chemotherapy are followed by radical cystectomy.
authors.affiliation: Center for Genitourinary Oncology, and Department of Genitourinary Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, 77030-4009, USA. asiefker@mdanderson.org
authors.forename: Arlene O
authors.initials: AO
authors.lastname: Siefker-Radtke
authors.forename: Colin P
authors.initials: CP
authors.lastname: Dinney
authors.forename: Neil A
authors.initials: NA
authors.lastname: Abrahams
authors.forename: Cesar
authors.initials: C
authors.lastname: Moran
authors.forename: Yu
authors.initials: Y
authors.lastname: Shen
authors.forename: Louis L
authors.initials: LL
authors.lastname: Pisters
authors.forename: H Barton
authors.initials: HB
authors.lastname: Grossman
authors.forename: David A
authors.initials: DA
authors.lastname: Swanson
authors.forename: Randall E
authors.initials: RE
authors.lastname: Millikan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018288:Carcinoma, Small Cell / Q000188:drug therapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D015653:Cystectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery