title: Organ-sparing treatment of advanced bladder cancer: paclitaxel as a radiosensitizer.
abstract: OBJECTIVE
  Transurethral resection of bladder tumor (TUR-BT) and radiochemotherapy with cisplatin achieve high rates of bladder preservation and survival figures identical to radical cystectomy in muscle-invasive bladder cancers. The authors have investigated the potential use of paclitaxel in a radiochemotherapy protocol for patients with inoperable bladder carcinomas and mainly contraindications to cisplatin.
  
  
  METHODS
  Between October 1997 to August 2004, 42 patients (median age 71 years) suffering from muscle-invasive (n=32) or recurrent (n=10) bladder cancers were treated with a paclitaxel-containing radiochemotherapy (paclitaxel 25-35 mg/m(2) twice weekly) after TUR-BT (R0/1/2/x in n=18/4/14/3) or cystectomy with residual tumor (n=3). Five patients received additional cisplatin. Radiation treatment was administered to a total dose of 45-60 Gy.
  
  
  RESULTS
  76.2% completed the planned regimen. Adaptations of treatment were mainly required due to diarrhea. Grade 3/4 toxicities occurred in 15/1 patients. Severe renal toxicities did not occur. 28 patients underwent restaging TUR-BT 6 weeks after radiochemotherapy (complete remission/partial remission/progressive disease: n=24/3/1). Three patients developed a local recurrence and four distant metastases. Seven patients died from tumor, six of other reasons.
  
  
  CONCLUSIONS
  Radiochemotherapy with paclitaxel was feasible and this bladder approach needs further investigation to evaluate whether paclitaxel could become a substitute for cisplatin.
authors.affiliation: Department of Radiation Oncology, University of Halle, Germany. Arndt-Christian.Mueller@med.uni-tuebingen.de
authors.forename: Arndt-Christian
authors.initials: AC
authors.lastname: Müller
authors.forename: Andrea
authors.initials: A
authors.lastname: Diestelhorst
authors.forename: Thomas
authors.initials: T
authors.lastname: Kuhnt
authors.forename: Reinhard
authors.initials: R
authors.lastname: Kühn
authors.forename: Paolo
authors.initials: P
authors.lastname: Fornara
authors.forename: Hans-Jörg
authors.initials: HJ
authors.lastname: Scholz
authors.forename: Jürgen
authors.initials: J
authors.lastname: Dunst
authors.forename: Anthony Laurence
authors.initials: AL
authors.lastname: Zietman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use; D003131:Combined Modality Therapy; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D017239:Paclitaxel / Q000627:therapeutic use*; D011838:Radiation-Sensitizing Agents / Q000627:therapeutic use; D012008:Recurrence; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D011838:Radiation-Sensitizing Agents; D017239:Paclitaxel