title: Pelvic chemoradiotherapy after chemotherapy for metastatic bladder cancer.
abstract: OBJECTIVE
  Consolidative radiotherapy has improved local control in other tumors with high local recurrence rates but has not been well studied in urothelial cancer. We hypothesized that pelvic chemoradiotherapy (PCRT) given after systemic chemotherapy for metastatic bladder cancer (MTCC) might alter the pattern of disease recurrence, and reduce the complications and morbidity of intrapelvic disease relapse. A 74% locoregional relapse rate has been observed in MTCC patients with intrapelvic nodal disease after response to chemotherapy. To explore this hypothesis further, we performed a retrospective analysis and report the efficacy, toxicity and pattern of failure with this approach.
  
  
  METHODS
  Patients treated for MTCC who received consolidative PCRT following at least a partial response to systemic chemotherapy were identified and their charts reviewed for pelvic relapse, disease progression, survival, and toxicity.
  
  
  RESULTS
  Twelve patients were identified and median follow-up was 15.6 months. Nine patients developed progressive disease and died, and median survival was 15.6 months. Three patients had pelvic progression (pelvic failure rate 25%). Median time to pelvic failure was 12.8 months. At last follow-up, three patients were alive and disease-free. No life-threatening toxicities were observed. The most common acute non-hematological toxicities were diarrhea and nausea.
  
  
  CONCLUSIONS
  These data support a hypothesis that consolidative PCRT following chemotherapy in MTCC patients with systemic disease control may be feasible and efficacious for improving pelvic disease control. This intervention should be considered for further study in prospective controlled clinical trials.
authors: Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
authors: Kavitha
authors: K
authors: Passaperuma
authors: Robert
authors: R
authors: Ash
authors: Varugar
authors: V
authors: Venkatesan
authors: George
authors: G
authors: Rodrigues
authors: Eric
authors: E
authors: Winquist