Analysis of treatment for small cell cancer of the bladder and report of three cases.
OBJECTIVE
To present our experience with 3 patients with small cell cancer (SCC) of the bladder who were treated with different modalities and review the literature for patients undergoing primary chemoradiotherapy. SCC of the bladder is a rare tumor, with patients commonly presenting with metastatic disease. Surgery, radiotherapy, and chemotherapy, either alone or as part of combined therapy, have been used. Because of the rarity of this disease, no prospective studies evaluating the most effective treatment have been done.


METHODS
The medical records of 3 patients diagnosed with SCC of the bladder at our institution were reviewed. Additionally, we reviewed published reports to identify all cases of SCC of the bladder treated with primary chemoradiotherapy.


RESULTS
Three patients with SCC of the bladder were identified at our institution. A total of 23 patients with SCC of the bladder who were treated with primary chemoradiotherapy were identified: 22 in published reports and 1 at our institution. Patients presented with muscle-invasive disease (17%), extravesical disease only (26%), and metastatic disease (52%). Multiagent chemotherapy was administered to most patients. The reported median radiation dose was 6000 cGy. A total of 16 patients (70%) were alive at a median follow-up of 34 months. The median survival of patients had not yet been reached in this study at the last follow-up. We did not find any reports of SCC recurrence in the bladder, and the bladder was preserved in most patients (87%).


CONCLUSIONS
SCC of the bladder should be viewed as a systemic disease, because most patients present with metastatic disease. Primary chemoradiotherapy appears to be an effective treatment modality. Prospective studies are needed to evaluate the optimal treatment further.
Karpman
Edward
E
Department of Urology, University of California, Davis, School of Medicine, Sacramento 95817, USA.
Goldberg
Zelanna
Z
Saffarian
Amir
A
Gandour-Edwards
Regina
R
Ellison
Lars M
LM
deVere White
Ralph W
RW
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001500:BCG Vaccine / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000032:analysis; D001859:Bone Neoplasms / Q000556:secondary; D016190:Carboplatin / Q000008:administration & dosage; D018288:Carcinoma, Small Cell / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery; D002295:Carcinoma, Transitional Cell / Q000601:surgery / Q000628:therapy; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D015653:Cystectomy / Q000379:methods; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D018450:Disease Progression; D005047:Etoposide / Q000008:administration & dosage; D006801:Humans; D015993:Life Tables; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D016609:Neoplasms, Second Primary / Q000188:drug therapy / Q000601:surgery; D011468:Prostatectomy; D012189:Retrospective Studies; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D014547:Urinary Diversion; D000093542:Gemcitabine
D001500:BCG Vaccine; D014408:Biomarkers, Tumor; D003841:Deoxycytidine; D005047:Etoposide; D016190:Carboplatin; D002945:Cisplatin; D000093542:Gemcitabine