title: Low-dose chemoradiotherapy followed by partial or radical cystectomy against muscle-invasive bladder cancer: an intent-to-treat survival analysis.
abstract: OBJECTIVE
  To evaluate the clinical outcomes of patients with muscle-invasive bladder cancer treated with a prospective institutional protocol composed of induction low-dose chemoradiotherapy (LCRT) plus partial or radical cystectomy.
  
  
  METHODS
  From March 1997 to March 2006, 102 patients with Stage T2-T4aN0M0 bladder urothelial carcinoma consecutively underwent transurethral resection of the bladder tumor followed by LCRT consisting of radiotherapy to the bladder (radiation dose 40 Gy) concurrent with two cycles of intravenous (20 mg/d for 5 days) or intra-arterial (100 mg) cisplatin. Depending to their post-LCRT tumor status, patients were recommended to undergo partial or radical cystectomy with curative intent.
  
  
  RESULTS
  LCRT-related toxicity of grade 3 or greater was rare (3%). Of 97 eligible patients, 41 (42%) had a complete response, 29 (30%) a partial response, 24 (25%) had stable disease, and 3 (4%) progressive disease. Of the 97 patients, 19, underwent partial cystectomy, and 58 underwent radical cystectomy, 2 underwent transurethral resection of the bladder tumor, and 18 did not undergo surgery. The 5-year overall survival and cancer-specific survival (CSS) rate was 66% and 74%, respectively. The median follow-up was 43 months (range 3-126). On multivariate analysis, the response to LCRT had the strongest effect on CSS, and CSS was clearly stratified by the response to LCRT (P < .0001), with a 5-year CSS rate of 100% for the 41 patients with a complete response.
  
  
  CONCLUSIONS
  The results of our study have shown that LCRT is an effective and less-toxic induction therapy against muscle-invasive bladder cancer. Our therapeutic protocol with LCRT plus partial or radical cystectomy yielded favorable survival outcomes. The response to LCRT was the strongest prognostic factor for CSS.
authors.affiliation: Department of Urology, Tokyo Medical and Dental University, Graduate School, Tokyo, Japan. f-koga.uro@tmd.ac.jp
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Koga
authors.forename: Soichiro
authors.initials: S
authors.lastname: Yoshida
authors.forename: Satoru
authors.initials: S
authors.lastname: Kawakami
authors.forename: Yukio
authors.initials: Y
authors.lastname: Kageyama
authors.forename: Minato
authors.initials: M
authors.lastname: Yokoyama
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Saito
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Fujii
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; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002945:Cisplatin / Q000008:administration & dosage*; D015653:Cystectomy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D018714:Radiotherapy, Adjuvant; D016019:Survival Analysis; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin